Summary
Welcome back! We hope everyone enjoyed a restful and happy Thanksgiving! Congress is scheduled to return this week with a long list of “to-dos” in a frantic three-week session. As we have been discussing there are several issues that Congress must deal with over the next few weeks before recessing for the holidays and the end of the year.
- First and foremost, Congress must decide if they will finalize the fiscal year 2025 budget before the current Continuing Resolution (CR) expires on December 20. With no top-line funding agreement in sight, the general expectation is that Congress will pass another CR into next year, but the length of the CR is still being worked out. Some Republican members are pushing for an extension into March, where others are favoring late January/early February. Regardless of where the Republican party lands, House Speaker Mike Johnson (R-LA) will need to get agreement from Senate Democrats and the White House. It will also take time for the Appropriations Committees to put together a package and for the package to get through both the House and Senate. So, time is of the essence.
- In addition to the CR, Congress must also deal with a disaster aid package submitted by the White House prior to Thanksgiving. While the nearly $100 billion request is not likely to be rubber stamped, there is bipartisan agreement that substantial funding is critical and needs to be provided before the end of the year.
- The National Defense Authorization Act is another key legislative priority that will need to be addressed this month. The House and Senate Armed Services Committees have been negotiating a deal that should be made public by the end of the week, though there are still some outlying details that need to be hammered out.
- Expiring health care authorizations are also going to need to be addressed. Legislative provisions that need to be extended include popular expiring telehealth provisions; funding for community health centers and the public health service; delaying scheduled cuts to disproportionate share hospitals (DSH) that serve communities most vulnerable members; and preventing a scheduled cut to physician payment fees (otherwise known as a “doc fix”). Congress was expected to include a legislative fix for these issues in an end of the year health care package, but the chances of such a package materializing are growing dimmer by the day, particularly if the FY 2025 budget is punted into next year. More likely, is that a temporary extension will accompany a CR, though the details and the length of the extension is yet to be determined.
Still Waiting on Final Election Results: Nearly a month after the election, the very last House race is getting close to being called. At this point the Republicans control the House with 220 members, while the Democrats have 214 seats. If the last California race is called for the Democrat, as currently expected, the Republicans will have a 3-seat majority. So far, the incoming Trump Administration has also poached three sitting House members to join the Administration (pending Senate confirmation), leaving the margins between the two parties extraordinarily tight.
Hearings This Week:
- Senate HELP Committee: On Thursday, the Senate Health, Education, Labor and Pensions Committee will hold a hearing titled “What Is the FDA Doing to Reduce the Diabetes and Obesity Epidemics in America and Take on the Greed of the Food and Beverage Industry?”
- House Oversight Select Subcommittee on the Coronavirus Pandemic: On Wednesday the Select Subcommittee on the Coronavirus Pandemic will hold a meeting to consider their new report entitled “After Action Review of the Covid-19 Pandemic: The Lessons Learned and a Path Forward”
Regulatory Update
The Office of Management and Budget (OMB) released the contract year (CY) 2026 Medicare Advantage and Part D Policy and Technical Changes proposed rule and a final rule would establish a new mandatory Medicare payment model, the Increasing Organ Transplant Access Model (IOTA Model). Impact Health is working on summaries and will send them out shortly.
OMB is also reviewing the following:
- MA and Part D Advance Notice – This notice establishes the proposed capitation rates for Part C (MA) and Part D plans, as well as payment policies, including draft CY 2026 Part D redesign program instructions.
- Notice of Benefit and Payment Parameters for 2026 – The final rule sets forth payment parameters and provisions related to the risk adjustment programs; cost-sharing parameters; and user fees for issuers offering plans on Federally-facilitated Exchanges and State-based Exchanges using the Federal platform.
- Health Data, Technology, and Interoperability – The final rule builds on the HTI-1 rule and seeks to advance interoperability, improve transparency, and support the access, exchange, and use of electronic health information through new and revised standards and certification criteria in the ONC Health IT Certification Program.
- Healthcare System Resiliency and Modernization – The proposed rule would revise and update national emergency preparedness requirements for Medicare- and Medicaid-participating providers and suppliers (was set for December 2023).
- Retail Pharmacy Standards – The final rule would require pharmacies and vendors to modify the currently adopted National Council for Prescription Drug Programs (NCPDP) standards to the Telecommunications Standard Implementation Guide Version F6 (F6); Batch Standard Implementation Guide version 15; and Batch Standard Subrogation Implementation Guide version 10 (was set for February 2024).
- Cybersecurity – The proposed rule would make modifications to the Security Standards for the Protection of Electronic Protected Health Information (the Security Rule) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act). These modifications will improve cybersecurity in the health care sector by strengthening requirements for HIPAA regulated entities to safeguard electronic protected health information to prevent, detect, contain, mitigate, and recover from cybersecurity threats.