Summary
The House and Senate have both recessed until after the November elections. Prior to adjourning, both bodies of Congress passed a Continuing Resolution (CR) until Friday, December 20, 2024. While this avoids a government shut down before the election, it leaves a lot of big decisions to be made in final weeks of the year. Besides the fiscal fight, Congress will need to pass several key health care extensions, including: extending the COVID-19 Telehealth flexibilities; Medicare policy extensions to avoid a 2.8 percent provider payment cut for CY 2025 as well as an array of other Medicare policies affecting reimbursement; a delay of Medicaid DSH Cuts; and expiring authorization for health programs such as community health centers, the National Health Service Corps, the Teaching Health Center Graduate Medical Education Program, Special Diabetes Program, and National Health Security Extensions (see our full analysis of public health extenders here.)
The CR, while relatively clean, did include some health extenders on public health, Medicaid, and Medicare.
Public Health
- Autism-Related Programs – The CR reauthorized developmental disabilities surveillance and research program at the Centers for Disease Control and Prevention; federal programs on autism education, early detection, and interventions; and the Interagency Autism Coordinating Committee through December 20, 2024. On September 18, the House passed a bipartisan bill by a 402-13 vote to reauthorize these programs through September 30, 2029.
- Drugs for Rare Pediatric Diseases – The CR reauthorized the Rare Pediatric Disease Designation and Priority Review Voucher Program at the Food and Drug Administration through December 20, 2024. On September 23, the House pass a bipartisan bill by voice vote to reauthorize the voucher program through September 30, 2029.
- No Surprises Act Implementation – The CR extended the spending authority for the No Surprises Act implementation fund through September 30, 2025. The one-time appropriation of $500 million was originally available for FY 2021 through 2024. The CR did not replenish funding. At the beginning of FY 2024, the No Surprises Act implementation fund had an unobligated balance of $186 million. Congress will need to provide additional funding in the future to support continued implementation and enforcement.
Medicaid
- Funding for Northern Mariana Islands – The CR provides an additional $27.1 million in Medicaid funding for the Northern Mariana Islands.
Medicare
- Clinical Laboratory Tests – The CR extends the phase-in for reductions to the Clinical Laboratory Fee Schedule from 2027 to 2028. It also limits cuts to 0 percent through 2025 and limits cuts to 15 percent for 2026 through 2028. Related to the reporting of private sector clinical lab rates, the CR extends the period for which no reporting is required by a year to December 31, 2025.
- Medicare Improvement Fund – The CR appropriates nearly $3.2 billion to the Medicare Improvement Fund for services furnished during and after FY 2026.
Regulatory Update
The Office of Management and Budget (OMB) completed reviewing the following rules:
- Medicare Appeals – The final rule would establish new appeals processes for Medicare beneficiaries who have an inpatient hospital admission changed to outpatient by a hospital, and meet other conditions.
- Hospital Payment – The interim final rule would make changes to the Medicare hospital inpatient and long-term care hospital prospective payment system for fiscal year (FY) 2025.
OMB is also reviewing the following:
Medicare
- Physician Payment – The final rule would make changes to the Medicare physician fee schedule for calendar year 2025 (November 2024).
- Outpatient Payment – The final rule would make changes to the Medicare hospital outpatient prospective payment system for calendar year 2025 (November 2024).
- Medicare Advantage – The proposed rule would make policy and technical changes to the Medicare Advantage, Medicare Prescription Drug Benefit, and Medicare Cost Plan Programs, and PACE for contract year 2026 (September 2024).
Private Insurance
- ACA Marketplace – The proposed rule would set payment parameters and provisions related to the risk adjustment programs; cost-sharing parameters; and user fees for issuers offering plans on Federally-facilitated Exchanges and State-based Exchanges using the Federal platform. It would also provide additional standards for several other ACA programs (September 2024).
- Preventive Services – The proposed rule is titled, “Enhancing Coverage of Preventive Services under the Affordable Care Act.” It was not included in the latest Unified Agenda.
Other Topics
- Healthcare System Resiliency and Modernization – The proposed rule would revise and update national emergency preparedness requirements for Medicare- and Medicaid-participating providers and suppliers (was set for December 2023).
- Retail Pharmacy Standards – The final rule would require pharmacies and vendors to modify the currently adopted National Council for Prescription Drug Programs (NCPDP) standards to the Telecommunications Standard Implementation Guide Version F6 (F6); Batch Standard Implementation Guide version 15; and Batch Standard Subrogation Implementation Guide version 10 (was set for February 2024).
- Organ Transplants – The final rule would establish a new mandatory Medicare payment model, the Increasing Organ Transplant Access Model (IOTA Model), that would test whether performance-based incentive payments paid to or owed by participating kidney transplant hospitals increase access to kidney transplants for patients with end-stage renal disease (ESRD) while preserving or enhancing the quality of care and reducing Medicare expenditures.