Summary
Senate Votes
A third continuing resolution (CR) appears to be the charm for fiscal year (FY) 2022 appropriations. On the heels of an agreed-to “bipartisan appropriations framework,” the Senate is expected to pass the House-approved (272-162) stopgap funding extension before the current CR expires on February 18. Lawmakers will then have until March 11 to negotiate and finalize all 12 appropriations bills.
The FY 2022 omnibus appropriations bill could serve as a legislative vehicle for health policy priorities – possibly mental health provisions with strong bipartisan support that lawmakers are prepared to pass (as opposed to advancing them in the forthcoming bipartisan Senate mental health bills). Whether COVID-19 supplemental funding will be attached to the FY 2022 omnibus appropriations bill remains an open question. The White House appears to not yet have made a formal request for additional funding.
The Senate is also expected to vote on the confirmation of Dr. Robert Califf, President Biden’s pick to lead the Food and Drug Administration (FDA). Dr. Califf previously served as FDA Commissioner from 2016-2017, for which he was confirmed by the Senate with broad bipartisan support (89-4). We anticipate that the Senate will confirm Dr. Califf, though likely by a narrower margin. A simple majority is needed to confirm executive branch nominations.
COVID-19 Public Health Emergency
Early in the Biden Administration, the Department of Health and Human Services (HHS) vowed to give states a 60-day notice prior to the end of the COVID-19 public health emergency (PHE) – i.e., terminating the PHE or allowing the PHE to expire. February 15 marks 60 days until the end of the PHE on April 16. If HHS does not give such notice tomorrow, we can expect HHS Secretary Xavier Becerra to extend the PHE another 90 days to July 15. If the PHE is renewed, the next 60-day mark would be May 16.
The end of the PHE will initiate the winding down of key health policy measures:
- Medicaid: States will resume Medicaid eligibility redeterminations at the end of the PHE. As a condition of receiving enhanced federal funding for Medicaid – 6.2 percentage point bump to the state’s Federal Medical Assistance Percentage (FMAP) – states must keep individuals enrolled in Medicaid throughout the PHE. States will have up to 12 months after the month in which the PHE ends to complete verifications, redeterminations, and renewals. However, the enhanced FMAP for the continuous enrollment requirement, as well as other maintenance of eligibility requirements, would expire at the end of the quarter in which the PHE ends (i.e., before the 12 months are up).
- Telehealth: The COVID-19 telehealth flexibilities under Medicare will cease at the end of the PHE absent congressional action (through the Administration may allow any flexibilities to persist for up to an additional 60 days following the end of the PHE). While there is bipartisan interest to act on telehealth reform, Congress still appears to be divided on the extent to which it will extend these flexibilities. The timing of reform is also uncertain and may depend on the Administration’s timing for ending the PHE. Additional details are available in WHG’s latest roundup of telehealth policy.
Under the scenario that the PHE expires on April 16, key dates below:
- February 15, 2022: 60-day mark until the end of the current PHE
- April 16, 2022: End of current PHE
- June 15, 2022: End of certain telehealth flexibilities, assuming the Administration uses the additional 60-day period
- June 30, 2022: Expiration of 6.2 percent FMAP bump for Medicaid for continuous enrollment
- April 16, 2023: Deadline for state Medicaid programs to complete verifications, redeterminations, and renewals
Mental Health
Lawmakers will continue to ramp up their legislative efforts on mental health with two additional hearings this week.
Tomorrow, the Senate Finance Committee’s (SFC) second hearing on youth mental health will feature a panel of providers and policy experts. “The goal is to produce a bipartisan bill this summer that brings all that work together,” said Chairman Ron Wyden (D-OR) at the first hearing (WHG summary). So far, areas of most consensus appear to be strengthening workforce, expanding telehealth, and improving access to mental health care for children through school-based programs.
Opening remarks from Ranking Member Mike Crapo (R-ID) at the first hearing signal where we could see disagreements arise between Democrats and Republicans over the mental health bill. Ranking Member Crapo’s call for “fiscal integrity, fully paying for any and all provisions we look to enact,” and warning that “unrestrained government spending risks pushing inflation even higher” will likely complicate consensus building between the two parties. These sticking points could ultimately limit the size and scope of the mental health bill.
On Thursday, the House Energy and Commerce Subcommittee on Oversight and Investigations will hold a hearing focused on “mental health challenges facing Americans, particularly those affecting children and young people, people of color, and LGBTQI+ individuals.”
Regulatory Update
The fiscal year (FY) 2023 Medicare payment update proposed rules have begun to arrive at the Office of Management and Budget (OMB) for review. Specifically, OMB is reviewing the FY 2023 Inpatient Prospective Payment System proposed rule as well as the 2023 Hospice Wage Index proposed rule. These, as well as the other FY 2023 Medicare payment update proposed rules, are expected for release later this April.