Summary
Over the weekend, President Biden signed a 30-day extension to funding for surface transportation programs (H.R. 5434) – effectively buying Democrats more time to reach a consensus on the topline number and policies of the Build Back Better Act (budget reconciliation package). October 31st is the new deadline for the House to pass the Senate-approved bipartisan Infrastructure Investment and Jobs Act (H.R. 3684). This is a hard deadline, because failing to pass the bipartisan infrastructure package – which includes long-term funding authorization for highways and transit programs – by this date would force the Department of Transportation to furlough thousands of workers (again).
Given that (1) House Speaker Nancy Pelosi (D-CA) can only afford to lose three votes and (2) the “majority” of the 96-member Congressional Progressive Caucus holding firm on its position to “only vote for the small infrastructure bill after the Build Back Better Act passes,” October 31st is also the deadline for the House to pass the budget reconciliation package. With Sen. Joe Manchin’s (D-WV) topline of $1.5 trillion for budget reconciliation, Democrats in the House and Senate are negotiating a trimmed down package – with a possible price tag between $1.5 trillion and the original $3.5 trillion. There is less certainty on how exactly the health care priorities – expanding Medicare benefits, address the Medicaid expansion coverage gap, extending premium subsidies, and lowering prescription drug prices – may be scaled back.
MedPAC
Later this week, the Medicare Payment Advisory Committee (MedPAC) will convene to discuss a wide array of policy issues on payment and delivery reform:
- Approaches for Medicare to address (1) high prices for new “first-in-class” drugs, and (2) high and growing prices for drugs or new products with therapeutic alternatives;
- Proposed projects using new data on Medicare’s net prices for prescription drugs. The Consolidated Appropriations Act, 2021 (P.L. 116-260) made the direct and indirect remuneration (DIR) data reported by Part D plan sponsors to the Centers for Medicare and Medicaid Services (CMS) and pricing information for provider-administered drugs under Part B available to MedPAC;
- An update on MedPAC’s forthcoming report on beneficiaries’ access to care in rural areas. The House Committee on Ways and Means submitted a bipartisan request for the report. The interim report was in the June 2021 report to Congress, and the final report will be in the June 2022 report;
- Policy approaches to implement a “small, more harmonized portfolio” of Medicare’s alternative payment models, particularly greater harmonization among spending benchmarks, risk adjustment, allocation of financial risk, and provide participation;
- Ways to improve Medicare Advantage (MA) risk adjustment by limiting the influence of outlier beneficiaries; and
- Alternative Medicare hospital wage index policies.
Regulatory Update
The regulatory front appears relatively quiet this week after last week’s promulgation of the Surprise Billing Part II interim final rule (details). Of note, a proposed rule to authorize the sale of hearing aids over the counter (OTC) has cleared review by the Office of Management and Budget (OMB). Doing so will allow patients to bypass the need for costly specialist evaluations that the Administration says drives the cost of hearing aids currently to an average cost of $5,000 per pair. As a reminder, the proposed rule is pursuant to President Biden’s executive order on promoting competition in the U.S. economy released earlier this summer (WHG summary here). The forthcoming release of this proposed rule will thus mark one of the first major implementation milestones of the EO (another recent developing being the recently released comprehensive plan for drug pricing reform).