THIS WEEK’S DOSE

• Senate Finance Chair Investigates MA Marketing Practices: Senate Finance Committee Chair Wyden (D-OR) continued an inquiry into Medicare Advantage (MA) marketing practices, sending letters to five third-party marketing organizations that participate in the MA enrollment period.
• Senate Holds Hearing on Long-Term Care: The hearing examined how to improve access to assisted living facilities.
• Senators Call for New Agency to Regulate Digital Platforms: Senators Warren (D-MA), Bennet (D-CO), Graham (R-SC) and Welch (D-VT) wrote to Majority Leader Schumer (D-NY) urging him to support a new federal agency to centralize oversight and regulation of digital platforms.
• White House Holds Briefing on Reproductive Care: The briefing provided guidance to providers.
• HHS Meets with Providers on COVID-19 Therapeutics Commercialization: The meeting with healthcare providers highlighted the pathways for a smooth transition of oral antivirals for COVID-19, including Paxlovid, to the commercial market.

CONGRESS

Senate Finance Chair Continues Inquiry into MA Marketing Techniques. Chairman Wyden (D-OR) sent letters to five third-party marketing organizations that participate in the MA enrollment period. The letters seek information on what tactics the companies use to target, market to, and direct seniors toward certain MA plans. This inquiry follows the committee’s previous work investigating MA practices, including a hearing last fall that examined the upcoming MA enrollment period and marketing rules. The chairman’s press release on this issue can be found here.

Senate Aging Committee Holds Hearing on Long-Term Care. The hearing included discussion from advocates and professionals on how to improve access to and quality of assisted living facilities for older Americans. Witnesses shared experiences with assisted living facilities with poor facility conditions and poor quality of care. They also noted that high costs and understaffing make assisted living facilities inaccessible. Democrats expressed concern about private equity firms gaining ownership of assisted living facilities and lowering quality of care while reducing staffing. Many senators emphasized the need for a national standard for transparency of costs and quality in assisted living facilities. There was agreement that assisted living facilities need a well-trained workforce.

Senators Call for New Agency to Centralize Regulation of Digital Platforms. Senators Warren (D-MA), Bennet (D-CO), Graham (R-SC) and Welch (D-VT) wrote to Majority Leader Schumer (D-NY) to call for a new independent federal agency to oversee and regulate large technology firms. The senators’ call follows Senate Artificial Intelligence (AI) Insight Forums organized by Leader Schumer and others, which underscored the need for a comprehensive approach to AI and the Big Tech companies in this sector. The letter cites the need for one agency to act across sectors, as opposed to a potentially fragmented approach across numerous federal agencies.

As mentioned in Sen. Warren’s press release, Sens. Warren, Bennet, Graham and Welch all have introduced legislation to create a dedicated agency to regulate dominant digital platforms. Last year, Graham and Warren introduced the Digital Consumer Protection Commission Act to establish a new commission to regulate online platforms, promote competition, protect privacy, protect consumers and strengthen national security. In 2022, Bennet and Welch introduced the Digital Platform Commission Act to create an expert federal agency able to regulate digital platforms to protect consumers, promote competition and defend the public interest.

ADMINISTRATION

White House Holds Briefing on Reproductive Healthcare. On January 22, the White House held a briefing regarding reproductive care on the 51st anniversary of Roe v. Wade. Administration officials, including the Centers for Medicare & Medicaid Services (CMS), announced a comprehensive plan to educate all patients about their rights and to help ensure hospitals meet their obligations under the Emergency Medical Treatment and Labor Act. Also, the US Departments of Health and Human Services (HHS), Labor and the Treasury issued new guidance to clarify standards and support expanded coverage of a broader range of US Food and Drug Administration approved contraceptives at no cost under the Affordable Care Act. The briefing also highlighted the fourth convening of the Task Force on Reproductive Healthcare Access, which included discussion on new actions to protect access to reproductive healthcare. A White House fact sheet on the task force can be found here.

HHS Holds Meeting with Healthcare Providers on COVID-19 Therapeutics Commercialization. HHS and Pfizer leadership met with healthcare provider groups to highlight the pathways for a smooth transition of oral antivirals for COVID-19, including Paxlovid, to the commercial market. The meeting emphasized the importance of provider education and clear communication to consumers. HHS leadership reminded providers that no patient should be forced to pay the full out-of-pocket cost to access Paxlovid, regardless of their insurance status. HHS noted that anyone who faces difficulties at the pharmacy counter should be directed to the PAXCESS patient assistance program (PAP).

Per HHS’s agreement with Pfizer announced on October 13, 2023, all individuals who are on Medicare or Medicaid, or who are uninsured, will continue to be able to access Paxlovid for free through the end of 2024. On January 4, 2024, CMS issued guidance describing how Medicare Part D plans can operationalize agreements with Pfizer to allow their enrollees to access Paxlovid at no cost through the plan without needing to enroll in the PAP.

More resources are available for both providers and patients on Paxlovid’s website.

QUICK HITS

• MedPAC and MACPAC Release Duals Data Book. The Medicare Payment Advisory Commission (MedPAC) and the Medicaid and CHIP Payment and Access Commission (MACPAC) released the 2024 Data Book on Beneficiaries Dually Eligible for Medicare and Medicaid, also known as the duals data book. The book describes the dual-eligible population’s composition, service use and spending in calendar year 2021 and, as a new feature, includes data on the overlap in Medicaid and Medicare managed care enrollment, as opposed to just fee-for-service enrollment.
• MACPAC Holds January Meeting. MACPAC hosted its two-day meeting, during which it discussed denials and appeals in Medicaid managed care, Medicaid self-reported disability data collection, transparency of Medicaid financing, state Medicaid agency contracts, access to physician services, Medicaid coverage of physician-administered drugs, the duals data book, Medicare Savings Programs, the American Rescue Plan Act and recommendations for the March report to Congress.
• CMS Releases MA RFI. Further highlighting the Administration’s interest in doing more in the MA arena, CMS is requesting public input on all aspects of data related to the MA program. CMS is also seeking detailed information from beneficiary advocates, healthcare providers, and other stakeholders on common challenges and experiences in the MA program for which limited data are currently available. Comments on the request for information (RFI) are due on May 29.
• CMS Holds National Stakeholder Call. The purpose of this call was for CMS Administrator Chiquita Brooks-LaSure and her leadership team to provide an update on CMS’s recent accomplishments and plans for 2024 to promote health equity, expand coverage and improve health outcomes. Multiple CMS leaders emphasized their continued focus and efforts on improving access to behavioral healthcare. CMS leadership emphasized accomplishments in advancing health equity and reducing health disparities.
• HHS Holds Maternal Health Stakeholder Briefing. The purpose of this webinar was to hear from key agency leaders on departmental activities that advance equity in maternal health outcomes. Multiple government agency leaders expressed urgency to address maternal health disparities and health outcomes. Agencies noted that they are addressing social determinants of health and using community-based initiatives to reduce maternal mortality and morbidity disparities.
• Administration Announces Increase in ACA Marketplace Enrollment. The Administration announced that a record 21.3 million people selected an Affordable Care Act (ACA) Health Insurance Marketplace plan during the 2024 Open Enrollment Period. Total plan selections include more than five million people (about one fourth of total ACA Marketplace enrollees) who are new to the Marketplaces and 16 million people who renewed their coverage. Open enrollment continues in four states and Washington, DC, through January 31.
• HHS Announces Cybersecurity Goals for Health Facilities. HHS published these voluntary healthcare-specific Cybersecurity Performance Goals to help healthcare organizations prioritize implementation of high-impact cybersecurity practices. These goals are a voluntary subset of cybersecurity practices that healthcare organizations, and healthcare delivery organizations in particular, can prioritize to strengthen cyber preparedness, improve cyber resiliency, and ultimately protect patient health information and safety. The American Hospital Association noted its support for this voluntary effort and committed to working with HHS and other federal partners to enhance cybersecurity.

NEXT WEEK’S DIAGNOSIS

The House and Senate are scheduled to be in session next week, with healthcare activity at the committee level, including a Senate Health, Education, Labor & Pensions Committee hearing on prescription drug costs and a House Energy & Commerce hearing on healthcare costs.