Summary
With two weeks left before the end of the current Continuing Resolution (CR), the House will continue to bring up individual fiscal year (FY) 2024 appropriations bills. This week the plan is to bring up the Transportation-HUD bill, as well as the Financial Services bill. Last week the Transportation-HUD bill was delayed due to disagreement over funding for Amtrack, and it is unclear if the issue has been resolved. Amendments are also due today for the Labor, HHS, and Education and Commerce-Justice-Science bills, both of which were unable to pass at the Committee level, leaving floor passage very much up in the air. Speaker Johnson (R-FL) is going to have to start to focus on an additional CR, with the current one ending on November 17. The Speaker is on record of being in favor of a CR that runs through mid-January, though last week he floated the concept of a “laddered CR” where different bills and agencies would have different lengths of CR, rather than keeping the entire government on the same timeline. There were few details offered and it was met with resistance.
The Senate will start the week with votes on nominations, including the nomination of Dr. Monica Bertagnolli to be Director of the National Institutes of Health. The Senate will also be starting to focusing on their foreign aid package. Last week the House approved a $14.3 billion Israeli aid package, with the help of approximately 12 Democrats. The House bill not only does not include funding for Ukraine, but it cuts funding from the IRS as an offset. The Senate will ignore the House package and formulate their own. Both Democratic Leader Schumer and Republican Leader McConnell are committed to a package that includes funding for both Israel and the Ukraine, as well as some form of border security. The details, however, are far from worked out.
There are also several elections this week across the country, including gubernatorial races in Kentucky and Mississippi and state legislature elections in Virginia.
Hearings and Markups
Senate Finance Committee: On Wednesday the Senate Finance will hold a markup on the Committee’s legislative package aimed at expanding mental health care under Medicaid and Medicare and reducing prescription drug costs for seniors at the pharmacy counter. The package also includes extensions for CMS provisions that will expire this year, including delaying the disproportionate share hospital payment reductions, and changes to Medicare provider payments. (Impact Summary of legislative package.)
Senate HELP Committee: Also on Wednesday, the Senate HELP Subcommittee on Primary Health and Retirement Security will hold a hearing to examine policy considerations for AI in health care.
Regulatory Update
Last week, the Centers for Medicare and Medicaid Services (CMS) released a slew of CY 2024 Medicare payment final rules, including updates to the physician fee schedule, hospital outpatient and ambulatory surgical centers, and home health. We expect CMS will soon release the proposed CY 2025 Policy and Technical Changes to Medicare Advantage and Part D, which cleared OMB review on October 27. OMB is also reviewing:
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.