Summary
Today, President Biden will sign the Infrastructure Investments and Jobs Act (H.R. 3684) into law. The bipartisan infrastructure deal provides $65 billion for broadband infrastructure to expand access to reliable high-speed internet, which is widely recognized as a social determinant of health (see our recent Issue Brief on Medicare telehealth coverage and health equity for a discussion on the intersection of broadband access and health equity).The bill will also create new grant programs to promote digital equity and help households with lower incomes access internet. In addition, the bill requires internet providers to display a “Broadband Nutrition Label” to help families comparison shop and promote competition in areas with inadequate service.
The House may vote on the Build Back Better Act (BBBA, H.R. 5376) as soon as this week. House Democrats are waiting on the Congressional Budget Office (CBO) to deliver cost estimates on the health-related provisions (e.g., prescription drug pricing, ACA Marketplace coverage, Medicare hearing benefits), among others included in the Ways and Means, Energy and Commerce, and Education and Labor titles. The CBO score may not be released until Thursday, which could push the vote to the weekend or even early next week. Once in the Senate, BBBA is likely to undergo changes to comply with the Byrd Rule and ensure the Democratic caucus is voting in lockstep. “Timing of consideration of the BBBA in the Senate will largely depend on when the House sends us the bill and when CBO finalizes their scores for all of the committees, which are needed to complete the “Byrd Bath” process, said Senate Majority Leader Chuck Schumer (D-NY) in a Dear Colleague letter sent yesterday.
Schumer also acknowledged that Congress is unlikely to finalize a fiscal year (FY) 2022 appropriations spending bill before December 3, the expiration of the current continuing resolution (CR). The new funding deadline remains to be seen, as Democrats push for a late December 2021 timeframe while Republicans prefer February or March 2022. Lawmakers will also need to address the debt ceiling. The date by which Congress must take action is unclear (and referred to as “X date” in Schumer’s letter) since enactment of the bipartisan infrastructure bill is expected to move the date.
Medicare Premiums, Deductibles, and Co-insurance Amounts for 2022
Late last Friday, the Centers for Medicare and Medicaid Services (CMS) announced the premiums, deductibles and coinsurance amounts for Medicare Parts A and B, along with the Part D income-related monthly adjustment amounts, for Calendar Year (CY) 2022 (Part A notice; Part B notice; fact sheet; press release).
For 2022, the standard Part B monthly premium is set to jump from $148.50 in 2021 to $170.10 in 2022 – one of the largest increases in the program’s history. CMS cites its need to “maintain a contingency reserve for unanticipated increases in health care spending, particularly certain drug costs” – specifically citing the new Alzheimer’s drug (Aduhelm), which accounts for roughly half of the premium increase – as reason for the unprecedented hike in premiums. CMS’ proposed National Coverage Decision (NCD) on Aduhelm and other drugs in this category is pending review, with a proposed decision expected in January, followed by a final decision in April (details). Other factors contributing to the Part B premium increase include spending increases driven, in large part, by the ongoing COVID-19 pandemic.
For Part A, nearly all (99 percent) of Medicare beneficiaries do not have a Part A premium. The Part A inpatient hospital deductible, however, is set to increase from $1,484 in 2021 to $1,556 in 2022.
Additional Regulatory Updates
Last week, the Office of Management and Budget (OMB) cleared a CMS final rule on proposed delays to the effective date for when drug manufacturers would be allowed to report multiple best prices connected to a value-based arrangement for a drug. CMS also proposed to delay the effective date for including U.S. territories in the definition of “States” for the Medicaid Drug Rebate Program. Such effective dates were initially finalized under the Trump Administration, though CMS proposed these delays in May 2021 to allow stakeholders more time to make the complex changes needed to implement such changes, especially amidst the ongoing pandemic.
In addition, two key health insurance rules arrived at OMB for review last week. This includes the proposed rule for the Notice of Benefit and Payment Parameters for 2023. OMB also received an additional final rule for its Contract Year (CY) 2022 Policy and Technical Changes to the Medicare Advantage (MA) Program, Medicare Prescription Drug Benefit Program, Medicaid Program, Medicare Cost Plan Program, and PACE. In its previous final rule for the CY 2022 Policy and Technical Changes, CMS noted it left a number of provisions unfinalized which it stated could be addressed in subsequent rulemaking, including:
- Maximum out-of-pocket limits for Medicare Parts A and B services; and
- Service category cost sharing limits for Medicare Parts A and B services and per member per month actuarial equivalence cost sharing.