Summary
Negotiations over infrastructure legislation continue, with a bipartisan group of 10 senators leading the discussions with the White House. Like the Biden Administration’s talks with Sen. Shelley Moore Capito (R-WV), the main sticking point is how to pay for infrastructure investments. Whether the new bipartisan proposal, even if supported by the White House, can garner the 60 votes needed to block a filibuster remains to be seen. Meanwhile, Democrats will push forward with the budget reconciliation process as an alternative pathway for advancing President Biden’s American Jobs Plan and American Families in July.
Today, House Budget Chair John Yarmuth (D-KY) is slated to introduce a “deeming resolution,” which will provide spending allocations to House appropriators for fiscal year (FY) 2022. The deeming resolution is expected to set discretionary spending at $1.5 trillion, which aligns with President Biden’s FY 2022 budget request. The House Appropriations Committee plans to begin marking up FY 2022 spending bills on June 24.
| White House | Bipartisan Group of 10 Senators | Senate Republicans (No Deal) | ||||
| March 31 | May 21 | June 2 | June 10 | April 23 | May 27 | |
| Size | $2.25 trillion | $1.7 trillion | $1.2 trillion over 8 years ($974 billion over 5 years) | $568 billion | $928 billion | |
| Pay-For | Increase corporate tax rate to 28 percent (up from 21 percent), other tax reforms | No corporate tax increase; increase the global minimum tax rate to 15 percent (up from 10.5 percent) and increase tax enforcement; other tax reforms | No tax increase; other details not specified | Implement user fees (e.g., electric vehicles), repurpose appropriated federal funds (e.g., coronavirus relief) | ||
| Scope | Traditional infrastructure and nontraditional infrastructure (including home health, housing, schools, research and development, manufacturing) in American Jobs Plan | Traditional infrastructure only | Traditional infrastructure only | |||
HHS Policies, Surprise Medical Billing
Health and Human Services (HHS) Secretary Xavier Becerra will be back on Capitol Hill on Wednesday to answer questions about the Department’s policies and priorities, this time before the House Education and Labor Committee. Questions are likely to focus on the FY 2022 budget for HHS as well as the newly released spring 2021 unified agenda, which sets the Biden Administration’s regulatory playbook for the coming months.
The unified agenda includes the highly anticipated implementation of surprise billing legislation enacted in December 2020. The first interim final rule with comment, with a target date of July 2021, is expected to include components statutorily required to be issued by July 1, 2021. They are:
- Methodology for determining the “qualifying payment amount,” which is generally the median contracted rate. The qualifying payment amount is one of the factors that an arbiter will consider when making a payment determination. Insurers will also use the qualifying payment amount to calculate the cost-sharing requirement for items and services that fall within the scope of protections (e.g., emergency services furnished by out-of-network hospitals); and
- Guidance on notice and consent requirements for out-of-network providers and facilities. A provider or facility may balance bill a patient for allowable services (e.g., non-emergency services) if they obtain consent within 72 hours before the delivery of care.
The second interim final rule with comment, scheduled for August 2021, is expected to establish the independent dispute resolution process, including how arbiters must weigh the multiple factors when considering the payment determination. Policymakers and stakeholders alike will be highly attuned to whether the qualifying payment amount carries more weight than other factors, such as patient acuity or complexity of the item or service. In late April, Sens. Maggie Hassan (D-NH) and Bill Cassidy (R-LA) emphasized to the Administration that the intent of the law is to “give each arbitration factor [including the qualifying payment amount] equal weight and consideration.”
Mental and Behavioral Health
Tomorrow, the Senate Finance Committee (SFC) will hold a hearing to discuss policy solutions to increase mental health care access, a pressing need amid the COVID-19 pandemic. Based on the findings of a Government Accountability Office (GAO) report requested by SFC Chairman Ron Wyden (D-OR), the policy solutions discussed may focus on increasing the behavioral health workforce; increasing oversight of claims payments, particularly in Medicaid; and intensifying enforcement of mental health parity requirements.
The GAO report found a shortage of qualified behavioral health professionals, particularly in rural areas in its review of federal data. GAO interviewed stakeholders, including the National Council for Behavioral Health and hospital associations and insurance regulators in four states (OR, PA, TX, and VA). Stakeholders cited “concerns about denials or delays in payment for behavioral health services” but “identified limited data to assess the extent of issues with the payment of claims for behavioral health services.”
Vaccine-Focused Legislation
Tomorrow, the House Energy and Commerce Subcommittee on Health will convene a hearing to discuss a slew of bills aimed at bolstering the nation’s immunization infrastructure and public health system. The Health Subcommittee will address bills centered on the COVID-19 pandemic – e.g., requiring weekly reports to COVID-19 on COVID-19 vaccine distribution, including disaggregated data on COVID-19 vaccine distribution (H.R. 979); and requiring HHS to publish the formula used to determine the allocation of COVID-19 vaccines to states, localities, etc. (H.R. 1452). Other bills are broader in scope and seek to strengthen immunization infrastructure (H.R. 550). The slate also includes bills that would revise vaccine coverage requirements for adults under traditional Medicaid (H.R. 2170) and modify eligibility for the Vaccines for Children Program (H.R. 2347). See the briefing memo for additional details.