Summary
The House and Senate are both back in session this week, continuing to march toward the end of the fiscal year on September 30, and a possible government shutdown. September 30 also marks the expiration of many important legislative authorizations including the Pandemic and All Hazards Preparedness Act, the SUPPORT Act, Community Health Center Fund, the National Health Service Corps, FDA User Fee programs, the Farm Bill, the FAA, and more. Additionally, on October 1, drastic cuts are scheduled to hit Medicaid Disproportionate Share Hospitals (also known as DSH cuts).
On the House side, last night a draft Continuing Resolution (CR) was released by Republicans that would keep the government in operation for 30 days at current spending levels for the Departments of Defense, Homeland Security, FEMA, and the VA, but would cut spending for all other federal programs by 8% for the time of the CR. It further includes new border security and immigration restrictions. This proposal, which stands no chance of passing the Senate, was put together by representatives from both the House Freedom Caucus and the Main Street Republicans, but it is unclear if the full Republican caucus will vote in favor of the measure. With a very slim majority, House Speaker Kevin McCarthy needs to garner the support of his entire caucus. Speaker McCarthy is in a perilous position trying to strike a balance between the demands of the conservative House Freedom Caucus members that continue to oppose continuing resolutions and insist on drastic spending cuts along with “culture war” riders, and the more moderate members who are not in favor of a shut down or the more extreme funding bills. The Majority Whip’s office has signaled that the FY 2024 DOD bill will be brought to the floor on Wednesday, and the CR on Thursday. This could change if the bills don’t have the votes to pass.
A recently introduced bipartisan health package, the Lower Costs, More Transparency Act (Impact Health summary), is scheduled to be brought to the floor under suspension on Monday evening. The bill largely includes previously marked up and advanced legislation from the Energy & Commerce, Ways and Means, and Education and Workforce Committees. While Energy & Commerce Committee Ranking Member Frank Pallone has endorsed the bill, the Ranking Members of the other two Committees have not.
The Senate is scheduled to continue debate on their first appropriations “minibus” package early this week which will include the Committee passed Agriculture, Military Construction-VA, and Transportation bills. The package ran into some Republican opposition late last week, though the majority of both parties in the Senate are united with the White House in their hope to pass a clean continuing resolution along with emergency funding for disaster relief and aid to the Ukraine.
Senate HELP Committee- Senate HELP Committee Chairman Bernie Sanders (I-VT) and Senator Roger Marshall (R-KS), Ranking Member of the Subcommittee on Primary Health and Retirement Security, released bipartisan health care workforce legislation (Impact Summary/bill text/section by section) that invests in programs to address the major shortages of nurses, primary care doctors, and other important health care jobs across the country, and to increase funding for community health centers, the National Health Service Corps, and Teaching Health Centers (Impact Summary). HELP Ranking Member Senator Bill Cassidy put out a statement criticizing the bill, and it is unclear how much support the bill has beyond the two sponsors. The bill is currently scheduled to be marked up on Thursday along with S. 1573, PREEMIE Reauthorization Act of 2023, S. 2415, Preventing Maternal Deaths Reauthorization Act of 2023, and S. 1624, Gabriella Miller Kids First Research Act 2.0.
House Energy & Commerce: On Tuesday, the Health Subcommittee will hold a legislative hearing titled “Examining Policies to Improve Seniors’ Access to Innovative Drugs, Medical Devices, and Technology.” The hearing will discuss 25 bills focused on giving seniors better access to the best treatments, medical devices and technology available. Witnesses will include Dr. Dora Hughes, Acting Director, Center for Clinical Standards and Quality; Acting Chief Medical Officer, CMS; and, Mr. John Dicken, Director, Health Care, Public Health and Private Markets, U.S. Government Accountability Office.
On Wednesday, the Subcommittee on Oversight and Investigations will have a hearing titled “At What Cost: Oversight of How the IRA’s Price Setting Scheme Means Fewer Cures for Patients.” Witnesses have not yet been announced.
House Ways and Means: On Tuesday, the House Committee on Ways and Means Committee will hold a hearing to examine the impact of the failure to fully implement the key patient protections from surprise medical bills contained in the No Surprises Act.
Senate Finance Committee: On Wednesday, the Senate Finance Subcommittee on Health Care will hold a hearing titled “Aging in Place: The Vital Role of Home Health in Access to Care.”
Regulatory Update
The Office of Management and Budget (OMB) completed reviewing the first of two final rules intended to simplify the processes for eligible individuals to enroll and retain eligibility in Medicaid, CHIP and the Basic Health Program. The first final rule expected in September 2023 will remove barriers and facilitate enrollment of new applicants, particularly those dually eligible for Medicare and Medicaid. The second final rule expected in February 2024 will implement changes to align enrollment and renewal requirements for most individuals in Medicaid and promote maintenance of coverage.
OMB is also reviewing the following rules:
- 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.
- Food and Drug Administration (FDA) Regulation of Laboratory-Developed Tests (LDTs) – Proposed rule would make explicit that LDTs are devices under the Federal Food, Drug, and Cosmetic Act and subject to FDA regulation.
- Annual Rulemaking for Commercial Insurers – Proposed rules for the CY 2025 Policy and Technical Changes to Medicare Advantage and Part D (expected in October 2023) and CY 2025 Notice of Benefit and Payment Parameters (expected in November 2023)
- Surprise Billing Regulations – A proposed rule to amend requirements for the independent dispute resolution (IDR) process, as well as a proposed rule to set fees for IDR. Due to legal challenges, the IDR process is temporarily suspended for all disputes.
- Over-the-Counter Contraception – A request for information regarding coverage of over-the-counter preventive products arrived at OMB for review last week. The RFI was not included in the Unified Agenda. It stems from President Biden’s Executive Order on Strengthening Access to Affordable, High-Quality Contraception and Family Planning Services, which requires HHS, Labor, and Treasury to pursue actions increasing access to affordable OTC contraception. The first and only FDA-approved OTC oral contraceptive will be available in early Q1 2024.
- Conscience Rights in Health Care – Final rule to safeguard the rights of federal conscience and religious nondiscrimination while protecting access to care, including abortion.