Health Care Checkup: October 13, 2023

Health Care Checkup

October 13, 2023

THE BIG PICTURE: KEY CONGRESSIONAL & EXECUTIVE BRANCH DEVELOPMENTS

In addition to the Speaker race, attention in Washington is heavily focused on the war in Israel.

What to Expect Next Week: The House GOP Conference is expected to meet today (10/13) to discuss the next steps of nominating a Speaker-designate. Austin Scott (R-GA) announced today that he has filed to run against House Judiciary Committee Chair Jim Jordan (R-OH) for the Republican nomination for Speaker. It is possible Jim Jordan (R-OH) will want to move quickly to hold an internal party vote. Until a new Speaker has been elected, the House will not consider legislation on the floor.

The Senate will be in session next week. The HELP Committee will hold a confirmation hearing for Monica Bertagnolli, the Biden Administration’s pick to lead the NIH, and the Senate Finance Committee will hold a hearing on Medicare Advantage Enrollment.

DEEP DIVE

Congressional:

Scalise Drops Out of Speaker Race After Winning Internal GOP Caucus Vote

On Wednesday morning, House Republicans selected Majority Leader Steve Scalise (R-LA) as the party’s nominee for Speaker, defeating House Judiciary Chairman Jim Jordan (R-OH) in a 113-99 majority vote. On Thursday, after it became clear Scalise would not be able to secure the 217 GOP votes needed to win the position on the floor, Scalise announced he was dropping out of the race but would remain in his position as Majority Leader. The impasse has left some Republicans in the House wondering whether they should officially empower the acting Speaker Pro Tempore, Rep. Patrick McHenry (R-NC), who assumed the position on a temporary, but mostly ceremonial basis, after Kevin McCarthy’s removal on October 3. In addition, today, Austin Scott (R-GA) announced he has filed to run against House Judiciary Committee Chair Jim Jordan for the Republican nomination for Speaker.

In addition to the Speaker race, attention in Washington is heavily focused on the war in Israel.

House Energy and Commerce Committee Announces Health Legislative Hearing on Strengthening Patient Access to Care in Medicare

On Thursday, House Energy and Commerce Committee Chair Cathy McMorris Rodgers (R-WA) and Subcommittee on Health Chair Brett Guthrie (R-KY) announced a legislative subcommittee hearing titled “What’s the Prognosis?: Examining Medicare Proposals to Improve Patient Access to Care & Minimize Red Tape for Doctors.” The hearing will be on Thursday, October 19, at 10:00 AM and will discuss the following legislation:

H.R.___, To amend title XVIII of the Social Security Act with respect to the work geographic index for physician payments under the Medicare program
H.R.___, To amend title XVIII of the Social Security Act with respect to the work geographic index for physician payments under the Medicare program and to improve the accuracy of geographic adjustment factors under such program
H.R. 2377, the Saving Access to Laboratory Services Act (Reps. Hudson and Kuster)
H.R.___, To amend title XVIII of the Social Security Act to revise the phase-in of clinical laboratory test payment changes under the Medicare program
H.R.___, To amend title XVIII of the Social Security Act to extend incentive payments for participation in eligible alternative payment models (Rep. Dunn)
H.R.___, the Improving Seniors Timely Access to Care Act of 2023 (Reps. Kelly, DelBene, Bucshon, and Bera)
H.R. 1352, the Increasing Access to Biosimilars Act of 2023 (Rep. Hudson)
H.R.___, the Provider Reimbursement Stability Act of 2023
H.R. 5526, the Seniors’ Access to Critical Medications Act of 2023 (Reps. Harshbarger, Wasserman Schultz, and Davis)
H.R. 1406, the Sustainable Cardiopulmonary Rehabilitation Services in the Home Act (Reps. Joyce and Peters)
H.R. 2583, the Increasing Access to Quality Cardiac Rehabilitation Care Act of 2023 (Rep. Blunt Rochester)
H.R. ___, To amend title XVIII of the Social Security Act to exempt certain practitioners from MIPS payment adjustments under the Medicare program based on participation in certain payment arrangements under Medicare Advantage (Reps. Miller-Meeks and Burgess)
H.R. 4402, To amend title XI of the Social Security Act to clarify manufacturer transparency reporting requirements for certain transfers used for educational purposes (Rep. Burgess)
H.R. 3674, the Providing Relief and Stability for Medicare Patients Act of 2023 (Reps. Bilirakis and Cardenas)
H.R.___, To amend title XVIII of the Social Security Act to revise certain physician self-referral exemptions relating to physician-owned hospitals (Rep. Burgess)
H.R.___, the Fewer Burdens for Better Care Act of 2023 (Reps. Moore and Bilirakis)
H.R. 5395, the SURS Extension Act (Reps. Stansbury and Burgess)
H.R.___, To amend title XVIII of the Social Security Act to promote provider choice using real time benefit information (Rep. Arrington)
H.R. 5555, the DMEPOS Relief Act of 2023 (Reps. Miller-Meeks and Tonko)
H.R. 4104, the Preserving Patient Access to Home Infusion Act (Reps. Buchanan and Dingell)
H.R. 4878, the EMPOWER Act (Reps. Lesko and Kuster)
H.R.___, the Telehealth Privacy Act of 2023 (Reps. Balderson, Dunn, and Schweikert)
H.R.___, To amend title XVIII of the Social Security Act to allow for the use of alternative measures of performance under the Merit-based Incentive Payment System under the Medicare program (Rep. Bucshon)

Read the hearing announcement here.

Wyden Announces Hearing on Medicare Advantage Marketing and Enrollment

On Tuesday, Senate Finance Committee Chairman Ron Wyden (D-OR), announced there will be a committee hearing on Wednesday, October 18, at 10:00 AM to hear testimony on “Medicare Advantage Annual Enrollment: Cracking Down on Deceptive Practices and Improving Senior Experiences.” The following witnesses are scheduled to testify:

Christina Reeg, Ohio Senior Health Insurance Information Program Director, Ohio Department of Insurance, Columbus, OH
Cobi Blumenfeld-Gantz, Co-Founder & Chief Executive Officer, Chapter, New York, NY
Krista Hoglund, ASA, MAAA, Chief Executive Officer, Security Health Plan, Marshfield, WI

Read the hearing announcement here.

Senate HELP Committee Announces Confirmation Hearing for NIH Director

On Wednesday, the Senate Health, Education, Labor and Pensions (HELP) Committee announced the confirmation hearing for Monica Bertagnolli, the Biden administration’s pick to lead the National Institutes of Health (NIH), will be held on Wednesday, October 18. In September, Senate HELP Chair Bernie Sanders (I-Vt.) agreed to the hearing after the administration announced the biotech company Regeneron, which signed a multimillion-dollar contract with HHS, will develop a next-generation monoclonal antibody therapy against COVID-19 with a price equal to or lower than those in other major countries.

Sanders Criticizes Charity Care in Nonprofit Hospitals

On Tuesday, Senate HELP Committee Chair Bernie Sanders (I-VT) released a report questioning whether nonprofit hospitals provide enough charity care to justify their tax-exempt status. The report stated Congress "should take steps to ensure that these hospitals are offering charity care at levels consistent with the enormous tax breaks they receive" and establish "clear, enforceable" standards for non-profit hospital financial assistance programs. Read the report here.

House GOP Doctors Caucus Releases Medicare Payment Policy Proposal

On Monday, the House GOP Doctors Caucus released a discussion draft of legislation to change the Physician Fee Schedule, which is currently limited by a budget neutrality requirement. The proposal also updates Medicare’s practice expense relative value units (RVUS) calculation to address Medicare’s declining reimbursement rates. Co-chair of the caucus Rep. Michael Burgess (R-TX) stated the goal of the draft is “to ensure a stable reimbursement structure by making it easier for physicians to participate in a payment system that best serves them.” Read the discussion draft here.

Carter Pushes Copay Legislation Following Court Ruling

Rep. Earl "Buddy" Carter (R-GA) is trying to revitalize new energy into his bill, the HELP Copays Act (H.R. 830), after a D.C. Circuit Court ruling prohibiting certain copay accumulators. The legislation would prohibit the use of copay accumulator tactics that allow health plans and pharmacy benefit managers to pocket a patient's copay assistance by excluding the cost-sharing assistance from counting towards a patient's deductible or out-of-pocket maximum. So far, Carter's bill has 94 bipartisan co-sponsors in the House. Carter told reporters he's been assured by the Energy and Commerce Committee staff that the legislation will move this Congress.

Executive Branch:

CMS Announces 2024 Medicare Parts A & B Premiums and Deductibles

On Thursday, the Centers for Medicare & Medicaid Services (CMS) released the 2024 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2024 Medicare Part D income-related monthly adjustment amounts. The Department of Health and Human Services (HHS), through CMS, also recently finalized a rule to streamline enrollment in Medicare Savings Programs (MSPs), making coverage more affordable for an estimated 860,000 people. In addition, the Part D low‑income subsidy (LIS) helps pay for the Part D premium and lowers the cost of prescription drugs. Further, the Inflation Reduction Act recently expanded the number of people eligible for full LIS. Read the fact sheet here.

HHS Issues Final Rule Setting Penalties for Medicare Secondary Payers

On Tuesday, the Department of Health and Human Services (HHS) issued a final rule specifying how and when the Centers for Medicare & Medicaid Services must determine and impose civil monetary penalties for Medicare secondary payers that fail to meet federal reporting obligations. The rule applies to group and non-group health plans and Responsible Reporting Entities (RREs) responsible for funding a claim payment to individuals eligible for Medicare benefits. The monetary penalty amount of $1000 per day penalties is initiated when Medicare secondary payers do not register and report as required by Medicare Secondary Payer reporting requirements. Read the rule here.

FDA Announces Advisory Committee on Digital Health Technologies

On Wednesday, the Food and Drug Administration (FDA) announced the creation of a new Digital Health Advisory Committee to help the FDA explore the complex, scientific and technical issues related to digital health technologies (DHTs), such as artificial intelligence/machine learning (AI/ML), augmented reality, virtual reality, digital therapeutics, wearables, remote patient monitoring and software. The Digital Health Advisory Committee will advise the FDA on issues related to DHTs, providing relevant expertise and perspective to help improve the agency’s understanding of the benefits, risks, and clinical outcomes associated with the use of DHTs. The FDA will solicit views from the committee, consisting of individuals with technical and scientific expertise from diverse disciplines and backgrounds. Read the press release here.

DEA Issues Temporary Rule Extending Prescribing of Controlled Substances via Telemedicine

Late last week, the Drug Enforcement Administration (DEA) announced it will extend eased pandemic rules for prescribing controlled substances via telemedicine through the end of 2024. The new regulations would allow all patients to be prescribed controlled substances without an in-person visit. The agency said the extension will allow it, along with HHS, to craft regulations that will “most effectively expand access to telemedicine encounters” while also preventing misuse by fall 2024. Read the rule here.

Legal & Other:

HITRUST Releases the Industry's First AI Assurance Program

On Tuesday, the Certification organization HITRUST announced it is launching an artificial intelligence (AI) framework intended to promote the safe and sustainable use of AI. Starting in 2024, the group will add the AI assurance program to the next iteration of its Common Security Framework, which helps healthcare organizations address information risk management. The new program will enable groups using AI to understand potential risks and measure compliance with principles. The announcement adds to the growing list of groups and lawmakers looking to ensure AI has guardrails while not stifling innovation. Read the HITRUST strategy document here.