Summary
This week, President Biden will sign the Infrastructure Investments and Jobs Act (H.R. 3684) into law. Meanwhile, House Democrats are waiting for the Congressional Budget Office (CBO) to score the Build Back Better Act (BBBA, H.R. 5376). Five moderate Democrats vowed to vote for the BBBA “in its current form” if the CBO score aligns with the estimates presented by the White House. House Speaker Nancy Pelosi (D-CA) plans to hold a vote on BBBA next week, though it is unclear if the CBO score and White House estimates will align or if the CBO score will even be ready.
Last week’s updated legislative text for the BBBA also featured the Democrats’ agreed upon approach for addressing drug prices (WHG summary), including the following provisions:
- Authorize the Department of Health and Human Services (HHS) Secretary to negotiate the cost of single-source Part B and Par D drugs without competition directly with drug manufacturers;
- Impose penalties on drug manufacturers if they increase prices faster than the rate of inflation;
- Redesign the Medicare Part D benefit to lower out-of-pocket costs for beneficiaries and offset greater financial liability onto insurers and manufacturers; and
- Repeal the Trump Administration’s “rebate rule.”
Vaccine Mandate
A three-judge panel from the U.S. Court of Appeals for the Fifth Circuit in Louisiana issued a stay on last week’s large employer mandate on COVID-19 vaccines by the Occupational Safety and Health Administration (OSHA) (full summary here). Opponents of the mandate argue it is unconstitutional and an overstep of regulatory authority, stating Congress did not grant OSHA the authority to “end pandemics.”
The injunction is temporary pending further action by the court. OSHA and the petitioners of the mandate will file two respective briefs, after which the court will review them and determine whether a permanent injunction is warranted or whether to lift the temporary injunction. If the court rules in favor of a permanent injunction, OSHA may take the case to the Supreme Court.
MedPAC
The Medicare Payment Advisory Commission (MedPAC) convenes today and tomorrow to discuss various payment policies:
- Instituting site-neutral payments for certain services delivered in ambulatory settings – which include physician offices, ambulatory surgical centers (ASCs), and hospital outpatient departments – to lower Medicare spending and beneficiary cost sharing;
- Supporting safety-net providers, who rely primarily on Medicare and Medicaid revenues, with additional resources for labor, technology, and other needs; and
- Balancing benchmark incentives for accountable care organizations (ACOs).
Additionally, commissioners will examine Part D coverage for nursing home residents. While they account for three percent of Part D enrollees, prescriptions for nursing home residents make up five percent of spending before rebates and postsale discounts, according to MedPAC. Commissioners will also discuss new information on telehealth use and clinicians’ and patients’ experiences with telehealth during the public health emergency. In the March 2021 Report to Congress, MedPAC recommended a time-limited period in which Medicare coverage of telehealth remains broadly available for beneficiaries, allowing policymakers additional time to examine the impact of telehealth on access, quality, and cost. Along these lines, MedPAC specifically suggests that Medicare should temporarily:
- Pay for specified telehealth services provided to all beneficiaries regardless of their location;
- Cover selected telehealth services in addition to services covered before the PHE if there is potential for clinical benefit; and
- Cover certain telehealth services when they are provided through an audio-only interaction if there is potential for clinical benefit.