WHG - Weekly, March 4, 2024

Summary

This week promises to be a busy one in Washington! Almost halfway into the fiscal year (FY), this week the House and Senate are poised to finally pass six of the 12 FY 2024 appropriations bills as well as a long-awaited healthcare package. Text was released on the Agriculture, Energy and Water, MilCon-VA, Transportation-HUD, Commerce-Justice-Science, and Interior spending bills at levels consistent with the bipartisan budget agreement (Senate and House press releases). The House is expected to vote on the package on Wednesday followed by the Senate prior to the expiration of the first continuing resolution (CR) on Friday, March 8. The remaining six bills, including the largest two bills that fund HHS and the Department of Defense, are on a Continuing Resolution until March 22. The Committee, however, has indicated that text for the second package should be released “soon” and votes should occur well before the 22^nd. Bipartisan support will be needed for both packages to pass.

Also included in this week’s budget bill is a healthcare package that, while smaller than many hoped for, includes funding increases and authorization extensions for several key healthcare programs as well as funding to restore recent cuts to Medicare payments for physicians (details).  Lawmakers agreed to a 10% increase in funding for the Community Health Centers program, a 17% increase for the National Health Service Corps, a 56% increase for the Teaching Health Center Graduate Medical Education Program and increases for the Special Diabetes Program and the Special Diabetes Program for Indians. All of these programs will be extended until December 31, 2024. The agreement further restores 1.68% of the 3.4% cut to the Medicare physician fee reimbursement that went into effect on January 1 and includes a 1.88% increase to Advanced Payment Model (APM) bonuses. Finally, the package eliminates scheduled cuts to disproportionate share hospitals (DSH) through the end of the year, secures permanent Medicaid coverage for medication-assisted treatment for those struggling with substance use disorders, and provides Medicaid protections for incarcerated individuals. The package does not include any of the site neutral or price transparency requirements for hospitals, insurers, and pharmacy benefit managers that were included in the House passed Lower Costs, More Transparency (LCMT) Act (H.R. 5378),

 State of the Union: On Thursday, President Biden will speak to a joint session of Congress at the annual State of the Union speech. Among the health care issues expected to be highlighted include the Administration’s efforts on lowering the cost of prescription drugs, the ACA, cancer research, and others. Alabama Senator Katie Britt is going to give the Republican response following the President’s address.

2024 Election: On Tuesday, 16 states will vote in their primary elections allocating approximately one-third of all delegates to the presidential nominating conventions. President Joe Biden and former President Donald Trump are expected to easily win all 16 contests. This could be the end of the road for former South Carolina Governor Nikki Haley’s bid for the Republican nomination.

Hearings and Markups

• Senate Homeland Security Committee: On Wednesday the Senate Homeland Security and Governmental Affairs will hold a markup to consider several cybersecurity bills, including a bill to improve the President’s Cup Cybersecurity Competitions, and one to prohibit contracting with certain biotechnology providers connected to foreign adversaries.
• Senate Budget Committee: On Wednesday the Senate Budget Committee will hold a hearing “Primary Care’s Role in Health Care Efficiency “ to examine how primary care improves health care efficiency.
• Select Committee on the Coronavirus Pandemic: Also on Wednesday, the House Oversight and Accountability Select Subcommittee on the Coronavirus Pandemic will hold a hearing titled “Examining the White House’s Role in Pandemic Preparedness and Response.” Maj. Gen. Paul Friedrichs, Director of the Office of Pandemic Preparedness and Response Policy at the White House will be testifying.

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 (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).