Summary
This week House Speaker Kevin McCarthy will be working to pass The Limit, Save Grow Act, the House Republicans’ plan that raises the debt limit through May of 2024 while also cutting discretionary federal spending by approximately 22% down to FY 2022 levels (text/summary/section by section), rescinding unspent COVID-19 funds, and imposing controversial policies such as requiring Medicaid recipients to work 80 hours a month. Speaker McCarthy has presented a united party front on the package, but no more than 4 Republicans can vote against the bill for it to pass. President Biden called the bill the “MAGA Economic Agenda” and Senate Democrats have called it a nonstarter. The House Appropriations Committee is expected to use the proposed $1.5 trillion figure as their spending cap for FY 2024 appropriations bills, which are likely to be marked up starting next month. House Democrats released a memo breaking down the deep spending cuts included in the Republican plan.
Hearings
House Labor-HHS Appropriations: On Wednesday HRSA Administrator Carole Johnson will be testifying in an Oversight hearing titled “Provider Relief Fund and Healthcare Workforce Shortages.”
House Ways & Means: On Wednesday, the House Ways and Means Committee will hold a hearing next on Tax-Exempt Hospitals and the Community Benefit Standards.
House Energy & Commerce Committee: On Wednesday, CMS Administrator Chiquita Brooks-LaSure will testify before the House Energy and Commerce Subcommittee on Health in a legislative hearing on “solutions to increase transparency and competition in health care.” The subcommittee will discuss legislative proposals on Medicare payment reforms, Medicaid disproportionate share hospital (DSH) payments, prescription drug pricing, and price and transparency ownership. A second panel of [TBD on witnesses] will also participate in the hearing. The bills under discussion are below:
Medicare
- H.R.___, To require the Secretary of Health and Human Services to consider, within the annual rulemaking process, the effect of regulatory changes to certain Medicare payment systems on provider and payer consolidation, and for other purposes
- H.R.___, To amend title XVIII of the Social Security Act to provide for parity in Medicare payments for hospital outpatient department services furnished off-campus
- H.R.___, To amend title XVIII of the Social Security Act to require payment for all hospital-owned physician offices located off-campus be paid in accordance with the applicable payment system for the items and services furnished
- H.R.___, To amend XVIII of the Social Security Act to provide for site neutral payments under the Medicare program for certain services furnished in ambulatory settings
- H.R.___, To amend titles XI and XVIII of the Social Security Act to require each outpatient department of a provider to include a unique identification number on claims for services, and to require hospitals with an outpatient department of a provider to submit to the Centers for Medicare & Medicaid Services an attestation with respect to each outpatient department
- H.R.___, To phase out certain services designated as inpatient-only services under the Medicare program.
- H.R. 977, the Patient Access to Higher Quality Health Care Act of 2023 to remove the ACA ban on the creation and expansion of physician-owned hospitals (POHs) and allow these hospitals to participate in Medicare and Medicaid.
Medicaid
- H.R. 1613, the Drug Price Transparency in Medicaid Act of 2023, which bans spread pricing in Medicaid;
- H.R. 2666, the Medicaid VBPs for Patients (MVP) Act, which supports the use of value-based purchasing of prescription drugs in the Medicaid program.
- H.R. 2665, the Supporting Safety Net Hospitals Act to delay pending cuts to Medicaid Disproportionate Share Hospital (DSH) payments to 2026.
Commercial Insurance
- H.R.___, which would establish patient protections with respect to highly rebated drugs by limiting the cost sharing for such drugs.
Price Transparency
- H.R.___, which would increase transparency and oversight of the 340B drug discount program.
- H.R. 2679, the PBM Accountability Act, which increases PBM transparency by requiring them to submit annual reports to plan sponsors on information related to PBM practices.
- H.R. 2691, the Transparent PRICE Act which will require hospitals to publish a list of standard charges of items and services.
- H.R.___, To amend title XVIII of the Social Security Act to increase price transparency of diagnostic laboratory tests
Ownership Transparency
- H.R.___, To amend title XI of the Social Security Act to increase transparency of certain health-related ownership information.
- H.R.___, To amend title XVIII of the Social Security Act to require Medicare Advantage plans to report to HHS, among other things, the number of claims per year by a specified provider; the average per-enrollee number of qualifying diagnoses; the average risk score for enrolled individuals; the number of prior authorization requests for an item or service submitted per year; and the average premium for the plan as well as the amount expended and the average medical loss ratio.
House Energy & Commerce Committee: On Thursday, the House Energy and Commerce Subcommittee on Innovation, Data, and Commerce will hold a hearing to discuss a national data privacy standard. In the hearing announcement, Chair of the full committee Cathy McMorris Rodgers(R-WA) and Chair of the subcommittee Gus Bilirakis (R-FL) noted that a patchwork of different laws govern how information ca be collected and used across a variety of sectors, including health care. This hearing will likely build off of work the committee did last year when it passed the American Data Privacy and Protection Act, which has not been reintroduced yet this Congress.
Regulatory Update
The Centers for Medicare and Medicaid Services (CMS) is expected to release a proposed rule that would make Deferred Action for Childhood Arrivals (DACA) recipients eligible for Medicaid and ACA Marketplace coverage. The proposed rule, to be introduced shortly, would amend the definition of “lawful presence”, for purposes of Medicaid and ACA Marketplace coverage to include DACA recipients. If finalized, for the first time the proposed rule would allow DACA recipients to apply for coverage through the Marketplace, where they may qualify for financial assistance based on income, and through their state Medicaid agency. The Office of Management and Budget (OMB) completed the review of the proposed rule last Wednesday.
OMB has started to review calendar year 2024 Medicare payment policies. Specifically, OMB is review proposed updates to the CY 2024 Physician Fee Schedule and the CY 2024 End-Stage Renal Disease Prospective Payment System and Quality Incentive Program.