THIS WEEK’S DOSE

Congress returned from its two-week spring recess, kicking off a busy work period leading up to the Memorial Day recess. The House Energy and Commerce Committee held hearings to receive an update from the Office of Inspector General (OIG) of the US Department of Health and Human Services (HHS), and to examine primary care and healthcare workforce bills. Congressional committees also announced several health-focused actions scheduled for next week. The Centers for Medicare & Medicaid Services (CMS) released its Notice of Benefit and Payment Parameters for 2024 final rule. Abortion-related issues returned to the Supreme Court of the United States.

CONGRESS

House Energy and Commerce Committee Holds Hearing Focused on HHS OIG. On April 18, the House Energy and Commerce Oversight and Investigations Subcommittee held a hearing with testimony from the OIG. The hearing focused on three areas:

• The HHS Office of Refugee Resettlement’s management of the unaccompanied alien children program

• Grant management by the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention

• OIG’s oversight of CMS.

During her testimony, Inspector General Grimm highlighted several OIG reports regarding unaccompanied minors, NIH grant management, and fraud within the Medicare and Medicaid programs. She explained that a lack of funding has made it difficult to keep up with surges in unaccompanied children and the investigation of fraud and abuse cases, and noted that President Biden’s FY 2024 budget request is critical for providing OIG with the increased resources that it needs to conduct oversight.

House Energy and Commerce Committee Holds Hearing on Workforce and Primary Care. On April 19, the House Energy and Commerce Health Subcommittee held a legislative hearing focused on efforts to strengthen and reauthorize healthcare workforce and primary care programs, many of which are due to expire later this year without congressional action.

The hearing included testimony from the administrator of the Health Resources and Services Administration (HRSA), the agency within HHS that administers and supports workforce and primary care programs. The subcommittee examined eight pieces of legislation during the hearing:

• H.R. 2559, the Strengthening Community Care Act, to extend funding for the Community Health Center Fund and National Health Service Corps for five years

• A draft bill to extend funding for the Teaching Health Center Graduate Medical Education Program for three years

• H.R. 2569, the DOC Act, to make the Teaching Health Center Graduate Medical Education program permanent and increase its funding

• H.R. 2547, the Special Diabetes Program for Indians Reauthorization Act, to extend funding for the program for five years

• H.R. 2550, the Special Diabetes Program Reauthorization Act, to extend funding for the program for five years

• H.R. 2544, the Securing the U.S. Organ Procurement and Transplantation Network Act, to allow for additional flexibilities within the Organ Procurement and Transplantation Network

• H.R. 2411, the National Nursing Workforce Center Act, to authorize a pilot program to establish new or enhance existing state-based nursing workforce centers

• A draft bill to amend the Public Health Service Act with respect to public disclosures related to the Covered Countermeasure Process Fund.

The hearing also included significant discussion of the 340B program and pharmacy benefit managers (PBMs). Reps. Carter (R-GA), Griffith (R-VA), Burgess (R-TX) and Joyce (R-PA) pushed for increased transparency and accountability in this space.

Congressional Committees Schedule Flurry of Healthcare Activity. The week of April 24 is shaping up to be a busy one for healthcare on Capitol Hill, with committee activity scheduled in both the House and Senate.

The House Energy and Commerce Health Subcommittee scheduled a legislative hearing for April 26. The 17 healthcare bills on the agenda are focused on transparency and competition, and could have a significant impact on certain providers, plans and PBMs. The policies under consideration include both introduced legislation (all of which is bipartisan) and unintroduced discussion drafts (for which sponsors are unknown). Links to legislative text can be found here. CMS Administrator Chiquita Brooks-LaSure is scheduled to testify during the hearing, along with a to-be-announced second witness panel.

Three additional House committees are scheduled to hold health-related hearings that day. The House Ways and Means Oversight Subcommittee will hold a health-focused hearing to discuss tax-exempt hospitals and the community benefit standard. The House Committee on Education and the Workforce Subcommittee on Health, Employment, Labor and Pensions is scheduled to hold a hearing on reducing healthcare costs that is anticipated to include review of excepted benefits for telehealth services and association health plans. The House Appropriations Labor-HHS Subcommittee is scheduled to hold an oversight hearing on the provider relief fund and healthcare workforce shortages, featuring testimony from the HRSA administrator.

Across the Capitol, the Senate Health, Education, Labor and Pensions (HELP) Committee will reportedly meet to consider bipartisan legislation related to PBMs next week. This comes as the Senate Finance Committee announced a bipartisan legislative framework that the committee will use to pursue legislative solutions to address PBMs and the prescription drug supply chain.

We will cover these events in next week’s Check-Up.

ADMINISTRATION

CMS Issues 2024 Notice of Benefit and Payment Parameters Final Rule. Released on April 17, this final rule sets standards for issuers and Marketplaces, as well as requirements for agents, brokers, web-brokers and assisters that help consumers with enrollment through Marketplaces that use the federal platform.

A CMS fact sheet includes detailed information on the provisions of the final rule, including the following:

• Finalizing revisions to the network adequacy and essential community provider regulations

• Finalizing standardized plan option updates, including limiting issuers to four non-standardized plan offerings per metal level and network type in 2024 and reducing to two such offerings for each year thereafter, but not finalizing proposals limiting drug coverage under standardized plan options because of comments that flexibility is needed

• Finalizing special enrollment periods for those losing Medicaid or Children’s Health Insurance Program (CHIP) coverage

• Finalizing program integrity efforts related to state Marketplaces and agents, brokers and web-brokers.

HHS Releases Ownership Data for All Medicare-Certified Hospice and Home Health Agencies. On April 20, HHS released detailed information on the ownership of more than 6,000 hospices and 11,000 home health agencies certified to participate in the Medicare program.

The data also includes details on mergers, acquisitions, consolidations and changes in ownership since 2016. CMS expects to release updated hospice and home health ownership data on a quarterly basis in a searchable format on data.cms.gov. Click here for hospice data and here for home health agency data.

COURTS

Supreme Court Rules on Abortion Drug Access. On April 19, the Supreme Court issued a second temporary stay on recent decisions from a US district court and the US Court of Appeals for the Fifth Circuit that would restrict access to the abortion pill mifepristone and reverse the US Food and Drug Administration’s approval of the generic version of the drug.

The high court is expected to issue a decision by the end of the day on Friday, April 21. The extension of the temporary stay gives justices additional time to consider two separate emergency appeals from the Biden Administration and Danco Laboratories, the company that manufactures the branded version of the drug.

QUICK HITS

• The Medicare Payment Advisory Commission held a two-day public meeting that included sessions on the cost of Part B drugs, the Medicare wage index, post-acute care prospective payment systems and Medicare telehealth utilization, among other issues. Many of the sessions discussed recommendations that will be included in the June 2023 report to Congress.

• The Medicaid and CHIP Payment and Access Commission held a two-day public meeting focused on recommendations for automatic adjustments to disproportionate share hospital allotments, access to Medicaid coverage and care for adults leaving incarceration, access to covered dental benefits for adult Medicaid beneficiaries, and access to home- and community-based services, among other issues.

• HHS announced the Bridge Access Program For COVID-19 Vaccines and Treatments to maintain broad access to COVID-19 vaccines for millions of uninsured Americans. The program will create a $1.1 billion public-private partnership to help maintain uninsured individuals’ access to COVID-19 care at pharmacies and health centers, and through existing public health infrastructure.

• CMS released guidance to state Medicaid directors on the Medicaid Reentry Section 1115 Demonstration Opportunity for states to better address Medicaid coverage for individuals leaving incarceration.

• HHS will host a mental health summit on May 4. The summit will highlight HHS’s work on strengthening mental health across communities. Interested stakeholders can register here.

• The HHS Cybersecurity Task Force provided new resources to help address the rising threat of cyberattacks in the healthcare sector.

• The CMS Office of Minority Health released a report on healthcare disparities in Medicare Advantage. The report provides national-level data on race, ethnicity and sex disparities in the quality of care received by Medicare Advantage enrollees in 2022.

• The White House announced an executive order that includes more than 50 directives aimed at expanding access to affordable high-quality care and providing support for care workers and family caregivers. The executive order directs HHS to consider issuing several regulations and guidance documents, including building on the minimum staffing standards for nursing homes and conditioning a portion of Medicare payments on how well a nursing home retains workers.

NEXT WEEK’S DIAGNOSIS

The House and Senate will be in session, as pressure builds for Republicans and Democrats to reach an agreement on a budget and debt limit compromise. House Republicans are poised to bring their debt limit package to the House floor; the package contains Medicaid work requirements and provisions to rescind any unspent COVID-19 relief funding. The package is a nonstarter for Democrats. Four House committees are scheduled to hold health-related hearings, and the Senate HELP Committee is expected to take up PBM legislation.