Summary
Happy August Recess! Both the House and Senate are in recess until after Labor Day. Prior to adjournment, both bodies managed to make progress on several key pieces of legislation summarized below. The HELP Committee was scheduled to markup healthcare workforce legislation introduced by Senator Sanders, but it was ultimately cancelled in order for the Committee to work towards a bipartisan bill. Additionally, prior to recessing both the House and Senate managed to pass H.R. 2544, Securing the U.S. Organ Procurement and Transplantation Network Act (summary), legislation that will remove statutory barriers and give the Health Resources and Services Administration (HRSA) the authority to expand competition for the OPTN contract. .
The House Ways and Means Committee held a markup of two bills related to transparency and competition (summary). The legislation mirrors bills that have been discussed in other committees. Both bills were favorably forwarded to the full committee along party lines. Even though most of the provisions of the bills discussed in the markup have bipartisan support, the overall tenor of the meeting was tense, and all votes broke along party lines. Democrats criticized Republicans for rushing these bills through the legislative process and ignoring bipartisan work in this committee and in the Energy and Commerce (E&C) Committee, especially on transparency for Medicare Advantage (MA) and private equity. There is enough bipartisan agreement on transparency and site neutrality to expect a package in the House and Senate, but tension between the parties will be a significant barrier to passage.
The Senate Finance Committee convened a markup of the Modernizing and Ensuring PBM Accountability (MEPA) Act (markup summary, section-by-section, CBO score, description of the Chairman’s Mark). The bill was advanced out of Committee by a vote 26-1. The SFC is the sixth committee of jurisdiction to take up and advance PBM-related legislation out of committee. Impact Health Policy provides a chart here of all PBM legislation considered in the 118th Congress.
The Senate Appropriations Committee finished marking up all 12 of their FY 2024 appropriations bills, including the Labor-HHS bill. The House has yet to markup their version of the Labor-HHS or Commerce-Justice-Science bills in Committee, and they pulled the Agriculture Appropriations bill from the House floor late last week due to factions within the Republican party. Appropriations will be a top priority for Congress when they return in September, as the government will run out of funding at midnight on September 30.
Regulatory Update
The Office of Management and Budget (OMB) completed the review of final fiscal year 2024 Medicare policy and payment updates for skilled nursing facilities and acute care hospitals/long-term care hospitals last week. We could see final rules this week. OMB is also reviewing the following:
- Minimum staffing standards for long-term care facilities – Proposed rule would address staffing requirements at long-term care facilities, including nursing homes. Industry pushback has delayed the release of the rule, initially intended for June. Stakeholders are meeting with OMB in early September, meaning we are unlikely to see the proposal until the fall.
- Medicaid and CHIP Enrollment and Eligibility – Final rules intended to simplify the processes for eligible individuals to enroll and retain eligibility in Medicaid, CHIP and the Basic Health Program. The first final rule expected in September 2023 will remove barriers and facilitate enrollment of new applicants, particularly those dually eligible for Medicare and Medicaid. The second final rule expected in February 2024 will implement changes to align enrollment and renewal requirements for most individuals in Medicaid and promote maintenance of coverage.
- Mandatory Medicaid and CHIP Cor Set Reporting – Final rule would establish requirements for mandatory reporting of the Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP, the behavioral health measures on Adult Health Care Quality Measures for Medicaid, and the Core Set of Health Care Quality Measures for Medicaid Health Home Programs. The final rule is expected in August 2023.
Medicaid Unwinding Data
The Centers for Medicare and Medicaid Services (CMS) released unwinding data for March and April 2023 that show how states are resuming regular eligibility operations following the end of the Medicaid continuous enrollment condition.
- Key Takeaways: In April 2023, more than 2 million people with Medicaid and CHIP coverage went through a full renewal process for the first time since early 2020. Within that group, nearly half were successfully reenrolled in Medicaid and CHIP. About one-third of the group lost their Medicaid and/or CHIP coverage. Of those that lost their Medicaid/CHIP coverage, 79% were for procedural reasons. Nearly 21% lost their Medicaid or CHIP coverage because the state determined they were ineligible, based on the information they submitted.
- Monthly Data Reports: CMS expects to release data on a monthly basis, with monthly releases expected to continue until all data is reported for months through June 2024. Full data on individuals who are transitioning from Medicaid and CHIP to Marketplace coverage is expected to be available beginning in fall 2023. Information to help interpret the reported data is available here.
- March and April 2023 Medicaid and CHIP CAA Reporting Metrics– released July 2023 (Excel): State-reported data on Medicaid and CHIP eligibility renewals conducted during the reporting period and call center operations.
- National Summary of Renewal Outcomes (March 2023; April 2023) (PDF) – released July 2023: Summary-level information on the outcomes of Medicaid and CHIP eligibility renewals in states that had completed a full cohort of unwinding-related renewals during the reporting month.
- April 2023 Medicaid and CHIP Unwinding Operations Snapshot (PDF) – released July 2023: Data on state operations as reported in the Performance Indicator data set that examine application counts, the eligibility determination process, call center operations and total enrollment.
- April 2023 Marketplace Medicaid Unwinding Report (gov, SBM) – released July 2023 (Excel): Metrics from individual Marketplaces during the current reporting period. The report includes data for the states using HealthCare.gov and State-based Marketplaces (SBMs) that use their own eligibility and enrollment platforms.