Summary
Congress is in session this week as the mad dash towards the end of the year continues. Last week a lame duck health care package emerged as the Republicans presented an opening proposal to begin negotiations. The Democrats countered, and a package is taking shape that will likely include 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”). The sticking point continues to be the length of the extensions and how to pay for them. The Republican offer was a three-year extension for telehealth provisions and two years for other expiring authorizations to be paid for with PMB and transparency reforms and a repeal of the Biden nursing home staffing rule. Democrats agree to most of the PBM and transparency reforms but are opposed to a repeal, or even a delay, of the nursing home staffing rule. Negotiations are expected to continue over the next few days, but agreement will need to be reached soon in order for the text to be written in time to circulate to members. If an agreement is reached, we may expect some non-controversial bills such as the Accelerating Kids Access to Care Act and the Improving Seniors’ Timely Access to Care Act to be included as well. This is a very fluid and fast-moving negotiation; Impact Health Policy Partners will send analysis of the agreed upon text when it becomes available.
Negotiations also continue on a new Continuing Resolution (CR) to keep the government in operation past December 20 when the current CR expires. The expectation is that the new CR will extend into March, though further details have not emerged. A disaster aid package is also expected to be attached, though the amount is still unknown. And, finally, the National Defense Authorization Act is expected to go to the Rules Committee this evening after the text was released over the weekend.
119th Congress: This week the Republican and Democratic Steering Committees will be meeting to start to finalize the Committee leadership positions for the next Congress. While leadership of the key health Committees are expected to remain largely unchanged, we will see a new Chair of the House Energy & Commerce Committee as Rep. Cathy McMorris Rodgers (R-WA) is retiring. Representatives Bob Lotta (R-OH) and Brett Guthrie (R-KY) are in the running to be the new Chair. We will also see a new Democratic leader of the Energy & Commerce Committee’s Health Subcommittee to replace retiring Rep. Anna Eshoo (D-CA) and a new Republican Chair of the House Education and the Workforce Committee to replace current Chair Virginia Foxx (R-NC) who is term limited in the position.
Presidential Transitions: On the presidential transition front, the incoming Trump Administration continues to send their nominees for key cabinet posts to the Hill for courtesy meetings. The nominee for HHS Secretary, Robert F. Kennedy, Jr., has not yet had his day on the Hill, but we expect those meetings will occur soon. We also expect that transition “landing teams” will begin to show up at agencies to start working with agency personnel on transition plans in the coming weeks. The Trump Administration is about a month behind schedule as they did not sign a transition agreement until November 26, and just started submitting names of people who will serve on the transition teams last week. Both of which are necessary before the “landing teams” can begin work in the agencies.
Regulatory Update
The Office of Management and Budget (OMB) completed review:
- 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).
OMB is also reviewing the following:
Other Topics
- 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).
- 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.