THIS WEEK’S DOSE

• Senate HELP Committee Marks Up Public Health Program Reauthorizations. The bills would reauthorize several programs related to older adults, individuals with developmental disabilities and individuals with traumatic brain injuries and passed with broad bipartisan support.
• Senate Commerce, Science & Transportation Committee Advances AI Bills. The legislation relates to protecting innovation and establishing standards.
• Democratic Senators, Representatives Introduce Legislation Impacting Private Equity in Healthcare. The bill would implement new requirements around transparency and accountability.
• Senate Appropriations Committee Advances FY 2025 Labor-HHS Funding Bill. The funding for the US Department of Health & Human Services (HHS) passed with broad bipartisan support but is unlikely to reach the Senate floor in September.
• CMS Publishes FY 2025 Medicare Inpatient PPS Final Rule. The Centers for Medicare & Medicaid Services (CMS) fiscal year (FY) 2025 final rule increases the inpatient prospective payment system (PPS) payments by 2.9%.
• CMS Publishes FY 2025 Medicare Skilled Nursing Facility PPS Final Rule. CMS FY 2025 final rule increases skilled nursing facility PPS payments by 4.2%.
• CMS Publishes FY 2025 Medicare Inpatient Rehabilitation Facility PPS Final Rule. The final rule increases payment rates by 3% and includes updates to the quality reporting program.
• CMS Publishes Additional Final Payment Rules. CMS also published the FY 2025 Medicare inpatient psychiatric facilities PPS final rule, which increases the PPS payment rate by 2.8%, and the FY 2025 Medicare hospice payment rate final rule, which increases the payment rate by 2.9%.

CONGRESS

Senate Health, Education, Labor & Pensions Committee Holds Markup of Several Public Health Program Reauthorizations. Senators advanced three bills out of committee with broad bipartisan support. For more information about the legislation, visit the committee website.

• S. 4776, the Older Americans Act Reauthorization Act of 2024, would reauthorize and increase overall funding by 20% for services and programs for older adults, individuals with disabilities, family caregivers and nursing home residents through FY 2029.
  • Passed 20 – 1. Sen. Paul (R-KY) was the only nay.
• S. 4762, the Autism Collaboration, Accountability, Research, Education, and Support Act of 2024, would reauthorize and expand education, early detection, intervention and research programs related to autism and other developmental disabilities through FY 2029.
  • Passed 20 – 1. Sen. Paul was the only nay.
• S. 4755, the Traumatic Brain Injury Program Reauthorization Act of 2024, would reauthorize traumatic brain injury programs and grants to improve access to rehabilitation through FY 2029.
  • Passed 20 – 1. Sen. Paul was the only nay.

Senate Commerce, Science & Transportation Committee Advances AI bills. The markup advanced 33 pieces of legislation, including eight bills related to AI. Below are details of the vote outcomes for the key bills with healthcare implications. For more information, view the committee website.

• S. 4178, the Future of Artificial Intelligence Innovation Act of 2024, would establish AI standards, metrics and evaluation tools for AI research, development and capacity building activities, and would formally authorize the AI Safety Institute at the National Institute of Standards and Technology.
  • Passed by voice vote.
• S. 3312, the Artificial Intelligence Research, Innovation, and Accountability Act of 2023, would provide a framework for AI innovation and accountability.
  • Passed by voice vote.
• S. 2714, the CREATE AI Act of 2023, would authorize the construction of a cloud computing system that would provide free or low-cost access to datasets and computing resources used in developing AI.
  • Passed with 19 yeas and seven nays. All Democratic senators supported the bill. Sens. Thune (R-SD), Wicker (R-MS), Moran (R-KS), Young (R-IN) and Capito (R-WV) were the only Republicans to vote yea.

Democratic Senators & Representatives Introduce Legislation Impacting Private Equity in Healthcare. S. 4804/H.R. 9156, the Health Over Wealth Act, would implement new transparency and accountability requirements for private equity firms and for-profit companies that own healthcare entities. The legislation is led by Senator Markey (D-MA) and his Democratic colleagues Sens. Baldwin (WI), Welch (VT), Merkley (OR), Warren (MA), Sanders (VT), Booker (NJ), Smith (MN) and Blumenthal (CT). Rep. Jayapal (D-WA) and five Democratic colleagues introduced companion legislation in the House.

Key provisions include the following:

• Transparency. The bill would create new reporting requirements around debt, executive pay, lobbying and political spending, patient costs, and reductions in services to patients or in wages and benefits for staff.
• Patient and Provider Protections. Firms would be required to establish escrow accounts to ensure continuity of care in the event of a closure or service reduction. The bill would establish a licensure requirement to invest in healthcare entities.
• Task Force. The bill would establish an HHS task force to review the role of private equity and consolidation in healthcare.
• Quality, Access & Safety. The bill would prohibit any registered investment company from removing an asset from a healthcare entity. It would require bankruptcy courts to consider continuity of care, and would establish new notification requirements for hospitals prior to the discontinuation of coverage or full hospital closure.
• Taxes. The bill would adjust the tax code with regard to the treatment of rents from qualified healthcare property.

For more information, view the one-pager.

Senate Appropriations Committee Advances FY 2025 Labor-HHS Funding Bill. The bill provides an increase of $8 billion in discretionary funding for HHS, which includes increased funding for biomedical research, pandemic preparedness, substance abuse and mental health programs, maternal health and cybersecurity. Although it was advanced out of committee with broad bipartisan support in a 26 – 2 vote, it is unlikely to reach the Senate floor in September, making a continuing resolution necessary to avoid a government shutdown.

ADMINISTRATION

CMS Publishes FY 2025 Medicare Inpatient PPS Final Rule. The final rule increases Medicare inpatient PPS rates by 2.9%, an increase of approximately $2.9 billion. The rule also includes several other updates, including the below key provisions.

• CMS finalized the Transforming Episode Accountability Model (TEAM), a mandatory episode-based payment model, which would require acute care hospitals in specific geographic regions to be accountable for the cost of care for Medicare beneficiaries during and after certain surgical procedures. As proposed, the mandatory model will begin January 1, 2026.
• To help mitigate future drug shortages, CMS finalized its proposal to establish a separate payment to support small, independent hospitals in establishing and maintaining a buffer stock of essential medicines.
• For the Hospital Inpatient Quality Reporting Program, CMS adopted seven new quality measures, removed five existing quality measures, and modified two current quality measures.

The final rule will go into effect on October 1, 2024. The CMS fact sheet can be found here, and the McDermott+ data dashboard can be found here.

CMS Publishes FY 2025 Medicare Skilled Nursing Facility PPS Final Rule. The final rule increases Medicare Part A skilled nursing facility (SNF) PPS payments by 4.2%, an increase of approximately $1.4 billion. The rule also changes CMS’s enforcement policies for health and safety violations by allowing the agency to impose penalties for violations, both per-day and per-instance. CMS says its previous policy that allowed only one civil money penalty for the same deficiency limited both federal and state authorities’ ability to use multiple penalties.

The rule also includes several updates to the quality reporting program, including:

• Adoption of four new items as standardized patient assessment data elements (SPADES), including one living situation item, two food items and one utilities item.
• Establishment of a data validation process for SNFs.

The final rule will go into effect on October 1, 2024. The CMS fact sheet can be found here.

CMS Publishes FY 2025 Medicare Inpatient Rehabilitation Facility PPS Final Rule. The rule was finalized largely as proposed. It increases inpatient rehabilitation PPS rates by 3%, which is estimated to increase payments by $280 million. The rule also includes several updates to the quality reporting program, including adoption of four new items as SPADES – one living situation item, two food items and one utilities item – beginning with the FY 2028 inpatient rehabilitation facility quality reporting program (October 1, 2026, implementation)

The rule outlines CMS’s intention related to a request for information on a future Medicare Star Quality Rating System. The final rule does not provide any specificity on a development timeframe.

The final rule will go into effect on October 1, 2024. The CMS fact sheet can be found here.

CMS Publishes Additional Final Payment Rules. The FY 2025 Medicare inpatient psychiatric facilities PPS final rule increases the PPS payment rate by 2.8%, which is expected to increase total payments by 2.5% ($65 million). The final rule will go into effect on October 1, 2024. The CMS fact sheet can be found here.

CMS also published the FY 2025 Medicare hospice payment rate final rule, which increases the rate by 2.9%, an estimated $790 million. The rule also adopts the most recent Office of Management & Budget statistical area delineations and a 5% cap on reductions for hospices negatively affected by the change. The final rule will go into effect on October 1, 2024. The CMS fact sheet can be found here.

QUICK HITS

• CMS Approves North Carolina’s Medical Debt Program. The program will use the state’s Medicaid program to incentivize hospitals to relieve up to $4 billion in existing medical debt and prevent accumulation of new debt. For more information, read the press release here.
• CMS Holds National Leadership Call. CMS spoke about the release of the FY 2025 proposed rules, the implementation of the Inflation Reduction Act drug pricing provisions and the status of several CMS Innovation Center models. The webinar slides and transcript will be posted here.
• SAMHSA Releases Annual National Drug Use Survey. The Substance Abuse & Mental Health Services Administration (SAMHSA) report found that 22.8% of adults had a mental illness in 2023 and 3.1% of people misused opioids in 2023. The press release can be found here.
• HRSA Announces Funding to Improve HIV Care Access. The Health Resources & Services Administration (HRSA) awarded $68 million in Ryan White HIV/AIDS Program funding to provide family-centered medical care and essential support services for women with low incomes, infants, children and youth with HIV. The press release can be found here.
• CMS Releases Medicare Part D Bid Information & Announces a Voluntary Premium Stabilization Demonstration. The base premium amount will be $36.78, $2.08 more than 2024, but actual consumer premiums for 2025 won’t be known until fall. CMS has also created a new nationwide demonstration program to improve drug plan premium stability. The fact sheet can be found here.
• House Energy & Commerce Committee Democrats Release Report on Reproductive Healthcare Access. Ranking Member Pallone (D-NJ) released the findings of a committee investigation into the US Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization on healthcare providers and the patients they serve. The findings can be found here.

NEXT WEEK’S DIAGNOSIS

We’ve reached August. Congress will be in recess until September 9, 2024. Following suit, the Check-Up will be on hiatus until September 6, 2024, barring any significant breaking health news.