Summary
After a very busy March, Congress is now out on a two week spring recess. Over the last two weeks, HHS Secretary Becerra testified before five separate Congressional Committees selling the President’s fiscal year (FY) 2024 budget proposal. He highlighted priorities including: increases to enhance Medicare benefits, Medicaid and CHIP investments to support equity and sustainability, investments in pandemic preparedness, and expanding mental and behavioral health services. Though the Secretary faced some less than friendly Republican talking points, there was bipartisan support for several initiatives including expanding the telehealth flexibilities of the Public Health Emergency (PHE), strengthening the health care workforce, and investments at the National Institutes of Health.
In addition to the budget hearing, the House Energy & Commerce Committee Health Subcommittee held a hearing last week on ways to promote transparency and competition in health care. Members presented a largely bipartisan front, focusing on asking witnesses ways to improve the Hospital Price Transparency Final Rule and the Transparency in Coverage Final Rule and how to address provider consolidation.
The Senate Finance Committee also held a hearing to examine pharmacy benefit manager (PBM) practices and their impact on patients and taxpayers. Witnesses spoke to how PBMs have contributed to the rise in prescription drug prices, through rebates, direct and indirect remuneration (DIR) fees, and formulary placement, and how these practices have had a negative impact on beneficiary out-of-pocket (OOP) costs.
COVID-19 Response
President Biden is expected to sign H.J.Res.7 – a joint resolution to terminate the COVID-19 national emergency order issued by President Trump in March 2020. The COVID-19 national emergency will end on the date that the President signs the resolution, and the COVID-19 PHE will end May 11, 2023. The joint resolution does not affect the planned May 11 expiration of the federal public health emergency (PHE) for COVID-19 or any related unwinding plans. “Even if the COVID-19 National Emergency were to end, any existing waivers currently in effect and authorized under the 1135 waiver authorization for the pandemic, would remain in place until the end of the federal PHE for COVID-19,” explains the Centers for Medicare and Medicaid Services (CMS).
Medicaid continuous coverage requirements end on March 31, meaning all states have started the redetermination process for all Medicaid enrollees. The eight states that initiate renewals in February can begin disenrollments for procedural reasons, such as non-response to a renewal, in April (Arizona, Arkansas, Idaho, Iowa, New Hampshire, Ohio, South Dakota, and Wyoming). The enhanced FMAP has been phased down from 6.2 percentage points to 5 percentage points and will continue to base phased-down (2.5 percentage points for July-September, 1.5 percentage points from October through December). See state timelines for initiating unwinding-related renewals.
Litigation Update
Last week, Judge Reed O’Connor of the US District Court for the Northern District of Texas blocked the Affordable Care Act (ACA) requirement for commercial health plans to cover preventive services recommended by the U.S. Preventive Services Task Force. Judge O’Connor’s decisions applies to preventive services recommended by USPSTF after 2010, inlcuding HIV pre-exposure prophylaxis (PrEP). The ruling is not expected to impact coverage, because health plan contracts are in place for the calendar year, explains the Kaiser Family Foundation. The Department of Justice and Department of Health and Human Services are reviewing the decision, said White House Press Secretary Karine Jean-Pierre. The Biden Administration is expected to appeal the decision, and the case will likely reach the U.S. Supreme Court.
Regulatory Update
As soon as today, the Biden Administration may release a slate of annual regulatory updates to Medicare payments, final policy and technical changes to Medicare Advantage (MA) and Part D, and a proposed rule on health IT and interoperability. The Office of Management and Budget (OMB) completed their review at the end of last week.
- Medicare Payments – We anticipate CMS will soon release proposed fiscal year (FY) 2024 regulatory updates for inpatient rehabilitation facilities, skilled nursing facilities, and inpatient psychiatric facilities. The proposed rule on Medicare payment updates for inpatient hospitals and long-term care hospitals is pending review at OMB.
- MA and Part D – CMS is also expected to soon issue final revisions to regulations governing MA, the Medicare Prescription Drug Benefit for calendar year (CY) 2024. The proposed rule included proposes intended to enhance beneficiary protections, advance health equity, and improve access to behavioral health and prescription drugs in MA and Part D plans (WHG summary).
- Health IT and Interoperability – The Office of National Coordinator for Health Information Technology (ONC) will release a proposed rule implementing certain provisions of the 21st Century Cures Act, including:
- Electronic Health Record Reporting Program condition and maintenance of certification requirements under the ONC Health IT Certification Program;
- Process for health information networks that voluntarily adopt the Trusted Exchange Framework and Common Agreement (TEFCA) to attest to such adoption of the framework and agreement;
- Enhancements to support information sharing under the information blocking regulations.
The rule will also proposals for new standards and certification criteria under the Certification Program related to the United States Core Data for Interoperability, real-time benefit tools, electronic prior authorization, and potentially other revisions to the Certification Program