Summary
With a short 5 days to go before the government runs out of funding, this week Congress will be working to pass a Continuing Resolution (CR) to avoid a shutdown. True to form for this Congress, however, it won’t be easy. On Saturday House Republicans released their proposed text for a second CR, which is a laddered concept, meaning the Military Construction-VA, Agriculture, Energy-Water and Transportation-HUD bills are extended to Jan. 19, and all other agencies would be extended to Feb. 2. The draft CR further includes an extension until January 19, for key health programs that would otherwise expire at the end of this CR, including community health centers, the National Health Service Corps, teaching health centers and graduate medical education programs. The stopgap measure also includes a delay of the Medicaid disproportionate share hospital (DSH) pay cuts until January 19, a temporary extension of the Special Diabetes Program for Type I Diabetes and Special Diabetes Program for Indians, and, unlike the previous CR, an extension for the Pandemic and All-Hazards Preparedness Act. The bill further includes an extension for programs covered under the Farm Bill until September 20, 2025.
The House Rules Committee is expected to meet Monday afternoon to begin to structure a rule for the bill, with a floor vote scheduled for Tuesday. Whether Speaker Johnson has the votes to pass the CR is very much up in the air. House Freedom Caucus members are disappointed that steep spending cuts were not included in the draft CR, and several members have stated that they will not vote for the CR. Democrats, meanwhile, do not support the laddered approach and are upset the bill does not include any emergency assistance for Israel, Ukraine, Indo-Pacific partners, humanitarian aid, or disaster victims. However, since the CR does not contain any funding cuts or “poison pill” policy riders, some Democrats may vote for it to avoid a shutdown.
The Senate is expected to invoke cloture on Monday afternoon on a legislative vehicle for their own CR. The details of what will be included in their CR are not finalized, nor is it certain if a supplemental package will be attached.
Even if the House and Senate do avert a government shutdown at the end of the week, they are no closer to coming to resolution on a budget package for the year. The House Republican leadership was unable to pass the Transportation-HUD and Financial Services bill last week, indicating House Republicans are far from unified on the remaining highly divisive spending bills. The Labor-HHS and Commerce-Justice-Science bills are scheduled to be brought up this week, in addition to the Transportation-HUD bill, but as the most controversial bills of all, passage is somewhat unlikely. Finding agreement on a final spending package that the House, Senate, and White House all support seems to be an increasingly daunting task.
Hearings
Senate Finance Committee: On Tuesday the Senate Finance Subcommittee on Health will hold a hearing titled “Ensuring Medicare Beneficiary Access: A Path to Telehealth Permanency.”
GAO Report
The Government Accountability Office (GAO) released a report on awards made by the Centers for Disease Control and Prevention (CDC) to state and local public health departments to build and maintain infrastructure for public health threats and the challenges some groups identified to building and maintaining their public health infrastructure. In total, jurisdictions receive about $845 million annually on average between 2019 through 2022 and an additional $7.1 billion in response to COVID-19 for public health infrastructure.
Officials that GAO interviewed and stakeholder organizations identified several challenges to building and maintaining a public health infrastructure that is prepared for future public health threats. These challenges include:
- “Boom and bust” pattern of public health emergency funding: Officials expressed concern about the pattern of an increase in federal funding to respond to a public health emergency followed by a decrease once that emergency terminates and associated funding runs out, which makes it harder for jurisdictions to invest in long-term sustainable efforts;
- CDC award amounts from annual appropriations have supported less as costs have increased so jurisdictions combine funding sources to cover gaps;
- Disease-specific awards are of limited use for preparedness and initial response to public health threats because they limit flexibility;
- Varying levels of jurisdictional funding for infrastructure which means that jurisdictions vary in the extent to which they rely on CDC awards; and
- Challenges building a public health workforce due to the temporary nature of awards.
GAO does not make any recommendations and CDC did not provide any substantive comments.
Regulatory Update
The Office of Management and Budget (OMB) is reviewing an array of rules.
Medicare, Medicaid, or Both:
- CMS Enforcement of State Compliance with Medicaid Reporting and Renewal Requirements –The interim final rule would establish rules regarding CMS enforcement of states’ compliance with reporting requirements and renewal requirements during the period that begins on July 1, 2023 and ends on June 30, 2024. The interim final rule may codify existing guidance and provide more details on how CMS may enforce the requirements. The interim final rule was not included in the Spring 2023 Unified Agenda.
- Healthcare System Resiliency and Modernization – Proposed rule to establish culturally competent and person-centered requirements for all provider and supplier types that participate in Medicare and Medicaid programs.
- Skilled Nursing Facilities – Final rule to require the disclosure of certain ownership, managerial, and other information regarding Medicare skilled nursing facilities (SNFs) and Medicaid nursing facilities.
Commercial Insurance:
- Annual Rulemaking for Commercial Insurers – Proposed rules for the CY 2025 Notice of Benefit and Payment Parameters
Other Topics:
- Conscience Rights in Health Care – Final rule to safeguard the rights of federal conscience and religious nondiscrimination while protecting access to care, including abortion.
- Health Data Interoperability – Final rule to implement certain provisions of the 21st Century Cures Act and make several enhancements to the ONC Health IT Certification Program to advance interoperability, improve transparency, and support the access, exchange, and use of electronic health information.