Summary
Happy Anniversary to the Affordable Care Act which was signed into law 14 years ago this week! The House and Senate are both in session this week as we once again countdown towards the expiration of the Continuing Resolution (CR) that is currently funding the last six fiscal year (FY) 2024 appropriations bills, including the bill that funds the Department of Health and Human Services. Five of the six bills appear ready to go but have been delayed over negotiations over immigration provisions in the Homeland Security Appropriations bill. The clock is ticking as House leadership has promised 72 hours for members to review legislation before a vote is scheduled and there will be some Senate Republicans that will want to offer amendments and have time to debate the large spending package. While a shutdown remains unlikely, even if text was released today, it leaves very little time to pass the final FY 2024 bills through both the House and Senate before the CR expires at midnight on Friday. This package covers funding for two-thirds of the federal government. The other six bills were passed and signed into law March 8.
Over the last week there has been a lot of discussion about possibly attaching additional health related bills to the omnibus budget package. Last Thursday Senate Finance Committee Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) held a press conference with pharmacy leaders and pharmacists putting pressure on leadership to attach bipartisan pharmacy benefit manager (PBM) reforms to the budget bill. House Republican leadership is reluctant to add to the size of the package and so far have resisted adding any additional riders.
Though the hope is to finally wrap up FY 2024 at the end of the week, last week we moved on to FY 2025 when the President submitted his 7.3 trillion budget proposal to Congress (IHPP summary). The proposal focuses on lowering costs for American families, a cornerstone of President Biden’s re-election campaign, including lowering the cost of prescription drugs, ensuring access to affordable health care, protecting and strengthen Social Security and Medicare, and fully funding federal nutrition assistance for women, infants, and children. Representatives from the Administration will continue to present and defend the budget proposal to Congress in hearings this week.
Hearings
- House Appropriations Committee: On Tuesday the House Labor, Health and Human Services, Education Appropriations Subcommittee will hold a hearing to examine the President’s FY 2025 budget request for the Department of Health and Human Services (HHS) with the HHS Secretary Xavier Becerra.
- House Ways and Means Committee: On Tuesday the House Ways and Means Committee will hold a hearing on the President’s FY 2025 budget request for HHS with HHS Secretary Xavier Becerra.
- House Appropriations Committee: On Thursday the House Agriculture Appropriations Subcommittee will hold a hearing to examine the President’s proposed budget request for FY 2025 for the Department of Agriculture (USDA) with the USDA Secretary Thomas Vilsack.
- House Oversight and Accountability Committee: On Thursday the House Oversight and Accountability Cybersecurity, Information Technology, and Government Innovation Subcommittee will hold a hearing titled “White House Overreach on Artificial Intelligence (AI).”
- House Oversight Select Committee on Coronavirus: On Thursday the House Oversight and Accountability Select Subcommittee on the Coronavirus Pandemic will hold a hearing titled “Assessing America’s Vaccine Safety Systems, Part 2.”
- House Energy & Commerce Committee: On Thursday the House Energy and Commerce Health Subcommittee will hold a hearing to discuss the Food and Drug Administration’s (FDA) proposed rule to regulate lab developed tests and alternative approaches to diagnostic regulation.
Regulatory Update
The Office of Management and Budget (OMB) is reviewing the following rules:
Medicare
- Alternative Payment Models – The proposed rule would implement a new Medicare payment model titled, Increasing Organ Transplant Access (IOTA) Model (was set for December 2023).
- Payment Update – The proposed rules would make policy payment updates for acute care hospitals inpatient and long-term care hospitals, hospice, inpatient psychiatric facilities, skilled nursing facilities, and inpatient rehabilitation facilities (April 2024).
- Nursing Homes – The final rule would establish minimum staffing standards for long-term care facilities and establish Medicaid institutional payment transparency reporting requirements (September 2026).
Medicaid
- Disproportionate Share Hospital Program – The final rule would implement requirements under section 203 of the Consolidated Appropriations Act, 2021 (CAA), which relate to Medicaid shortfall and third-party payments (February 2024).
- Eligibility and Enrollment – The final rule would implement changes to align enrollment and renewal requirements for most individuals in Medicaid and promote maintenance of coverage (February 2024).
- Access to Care – A pair of final rule intended to access to care and quality outcomes for Medicaid and CHIP beneficiaries enrolled in managed care delivery systems and fee-for-service Medicaid (April 2024).
Commercial Insurance
- ACA Marketplace – The final rule would make changes to regulations governing Affordable Care Act (ACA) Marketplace plans, insurance standards, and the risk adjustment program for plan year 2025 (not specified but likely April 2024).
- Short-Term Plans – The final rule would modify definitions to ensure short-term, limited duration insurance and fixed indemnity benefits coverage do not undermine consumer protections and requirements under the Affordable Care Act (April 2024).
Other Topics
- 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).
- Reproductive Health Care Privacy – The final rule would modify the HIPAA Privacy Rule to support reproductive health care privacy (March 20240.
- Health IT – The proposed rule would advance interoperability through proposals for: standards adoption; public health IT certification; expanded uses of certified application programming interfaces (APIs), such as for electronic prior authorization, patient engagement, care management, and care coordination; and information sharing under the information blocking regulations (was set for November 2023).
- Disability – The final rule would revise regulations under section 504 of the Rehabilitation Act of 1973 to address discrimination on the basis of disability in HHS-funded programs and activities (April 2024).