THIS WEEK’S DOSE

• House Education & the Workforce Health, Employment, Labor, and Pensions Subcommittee Holds Hearing on ERISA’s 50th Anniversary. Members and witnesses assessed how the Employee Retirement Income Security Act of 1974 (ERISA) and employer-sponsored health insurance are affected by increasing healthcare costs and regulatory changes.
• House Budget Committee Examines Possible CBO Improvements. Phillip Swagel, PhD, Director of the Congressional Budget Office (CBO), testified.
• House Education & the Workforce Advances Health-Related Bills. The legislation would bolster employer-sponsored health insurance.
• House Energy & Commerce Oversight Subcommittee Holds Hearing on OPTN. Members voiced concerns about implementation of Organ Procurement and Transplantation Network (OPTN) reforms.
• House Judiciary Administrative State, Regulatory Reform, and Antitrust Subcommittee Holds Hearing on PBMs. The hearing examined the impact of pharmacy benefit managers (PBMs) on drug pricing and access to medications, and highlighted potential solutions to address issues within the pharmaceutical industry.
• HHS, Labor, and Treasury Release Mental Health Parity Final Rule. The agencies finalized requirements that health plans may not impose non-quantitative treatment limitations for mental health and substance use disorder benefits that are more restrictive than for medical or surgical benefits.

CONGRESS

House Education & the Workforce Health, Employment, Labor, and Pensions Subcommittee Holds Hearing on ERISA’s 50th Anniversary. The hearing focused on balancing the advantages of ERISA’s federal preemption with the need for reforms to tackle inefficiencies and rising healthcare expenses.

Many Republicans criticized proposals for government-run healthcare models such as Medicare for All, arguing that they could undermine private insurance and increase costs. Conversely, many Democrats defended government reforms, citing successes in reducing drug prices and increasing coverage through the Affordable Care Act (ACA). Committee members discussed reforms that support small businesses, such as expanding access to association health plans and improving price transparency to help manage costs and enhance coverage options.

House Budget Committee Examines Possible CBO Improvements. During the hearing, some members questioned Swagel on issues related to previous CBO analyses, such as the Inflation Reduction Act’s impact on drug research and development and the impact of permanently extending enhanced advanced premium tax credits. Members and Swagel noted the importance of longer-term CBO analyses, particularly for preventive health policies. The House-passed Preventive Health Savings Act would require CBO, if requested by Congress, to estimate the impact of legislation focused on preventive healthcare over a 30-year period. Swagel indicated that CBO is already working to conduct some health analyses beyond the 10-year budget window to better account for future savings. Members listed a few additional legislative and oversight reforms they support, with which Swagel concurred:

• Creating a more organized structure and schedule for CBO reports.
• Pursuing ongoing oversight by the committee.
• Auditing certain CBO models of importance to the committee to assess and improve accuracy.

House Education & the Workforce Advances Health-Related Bills. The markup included three bills described as bolstering employer-sponsored healthcare. All passed out of committee, although one was passed along party lines. The vote outcomes for these bills are below:

• H.J. Res. 181, the Congressional Review Act resolution to stop the Biden-Harris rule limiting access to association health plans, would prevent the US Department of Labor’s rule entitled Definition of Employer Under Section 3(5) of ERISA – Association Health Plans from taking effect.
  • Passed along party lines with a vote of 23 – 12, with Democrats voting against.
• H.R. 3120, the Healthy Competition for Better Care Act, would ban anticompetitive terms in facility and insurance contracts, including any provision that would require a group health plan or health insurance issuer to enter into any additional contract with an affiliate of the provider as a condition of entering into a contract.
  • Agreed to by voice vote.
• H.R. 9457, the Transparent Telehealth Bills Act of 2024, would amend ERISA to prohibit increased payments under a group health plan or group health insurance coverage for telehealth services furnished by a provider located at a facility.
  • Passed unanimously with a vote of 34 – 0.

For more information about the bills and amendments, view the hearing website.

House Energy & Commerce Oversight Subcommittee Holds Hearing on OPTN. The purpose of this hearing was to hear from experts and stakeholders about how the Securing the U.S. Organ Procurement and Transplantation Network Act is being implemented and what challenges remain. Committee members largely emphasized their support for the legislation but noted their concerns about how effective the statute has been in assisting patients and battling corruption. Members from both parties asked about disparities in the organ transplantation network, particularly among people of color and those living in rural areas, and they appeared to be troubled by threats made to individuals who have expressed criticism of the OPTN process.

House Judiciary Administrative State, Regulatory Reform, and Antitrust Subcommittee Holds Hearing on PBMs. The hearing highlighted the high level of market concentration among PBMs, which many committee members and witnesses argued contributes to reduced competition and potential conflicts of interest in drug pricing and access. Representatives discussed how vertical integration among PBMs, insurance companies, and pharmaceutical manufacturers may negatively impact patient outcomes and increase costs. They emphasized the need for better alignment of financial incentives. The hearing also discussed challenges faced by independent pharmacies, especially in rural areas, with members and witnesses touching on how PBM practices and pricing structures could be adjusted to better support these providers.

ADMINISTRATION

HHS, Labor, and Treasury Release Mental Health Parity Final Rule. The US Departments of Health and Human Services (HHS), Labor, and the Treasury released final rules on September 9, 2024, requiring certain health plans and issuers to collect and evaluate data and take reasonable action to address material differences in access to mental health and substance use disorder benefits compared to medical and surgical benefits. The rules codify changes to the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) made by the Consolidated Appropriations Act, 2021. The final rules add protections against more restrictive non-quantitative treatment limitations (NQTLs) for mental health and substance use disorder benefits compared to medical and surgical benefits. Health plans and issuers subject to the final rules will have to submit an NQTL comparative analysis to demonstrate compliance.

The final rules apply to group health plans and group health insurance coverage on the first day of the first plan year beginning on or after January 1, 2025. The final rules apply to individual health insurance coverage for policy years beginning on or after January 1, 2026. The Departments also issued a request for comments on proposed new templates for states to document compliance with the MHPAEA in Medicaid and the Children’s Health Insurance Program. Comments on these templates are due to the Centers for Medicare & Medicaid Services (CMS) by October 29, 2024.

The press release can be found here, and a fact sheet can be found here.

QUICK HITS

• CMS and HRSA Hold Webinar on Improving Home Visiting for Medicaid and MIECHV. Speakers from Alabama, Oregon, and New Mexico emphasized the importance of the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program and described the home visiting models they use.
• Treasury Department Releases Data on ACA Coverage. The report found that nearly 50 million Americans, or one in seven US residents, have been covered through ACA marketplaces since January 2014. Read the press release here.
• AHRQ Announces Funding Opportunities for State-Based Healthcare Improvement. The Agency for Healthcare Research and Quality’s (AHRQ’s) notice of funding opportunity seeks to establish state-based healthcare extension cooperatives to accelerate healthcare improvement and reduce disparities. The press release can be found here.
• GAO Releases Report on Behavioral Health Cost-Sharing in MA, Medicare. The US Government Accountability Office (GAO) report found that both traditional Medicare and Medicare Advantage (MA) are required to offer basic benefits for behavioral health treatment, and both types of plans had cost-sharing for these benefits in 2024.
• SAMHSA Awards $68 Million for Suicide Prevention, Mental Health Programs. The Substance Abuse and Mental Health Services Administration (SAMHSA) announced awards as part of the Administration’s unity agenda.
• March of Dimes Releases Report on Maternity Care Deserts. The report highlights the growing number of areas without access to obstetrical care and examines policies that could reduce barriers to integrating midwives into the healthcare system and make opening and sustaining birth centers more attainable.
• CMS Approves Request for Community-Based Mobile Crisis Intervention Teams. New Hampshire will now connect Medicaid-eligible individuals experiencing a mental health or substance use disorder crisis with a behavioral health provider 24 hours a day, 365 days a year. Read the press release here.

NEXT WEEK’S DIAGNOSIS

Both the House and Senate are in session next week as lawmakers seek an agreement on a continuing resolution to prevent a government shutdown at the end of the month. Healthcare activity is anticipated at the committee level, including a potential markup in the House Energy & Commerce Committee. The House Ways & Means Health Subcommittee has noticed a hearing on chronic care. The Senate Finance Committee will hold a hearing on implementation of the Inflation Reduction Act, and various Senate Judiciary Subcommittees will hold hearings on reproductive rights and artificial intelligence. The House has also placed several bills on next week’s suspension calendar, including legislation related to chronic disease coverage, Medicaid, public health research and programs, and telehealth.