THIS WEEK’S DOSE

• House Energy & Commerce Committee Advances 13 Health Bills. The bipartisan legislation dealt with public health, Medicaid fraud and some small telehealth bills, but not the Medicare extension legislation that the committee is still reviewing.
• House Energy & Commerce Subcommittee Holds Hearing on CMS Innovation Center. Center for Medicare and Medicaid Innovation (CMS Innovation Center) Deputy Administrator and Director Elizabeth Fowler fielded questions about increased costs, provider engagement and health equity.
• Senate Finance Committee Examines Youth RTFs. The chairman released a report on child abuse and neglect in youth residential treatment facilities (RTFs) and held a hearing to discuss the findings.
• CMS Chief Actuary Testifies at House Budget Committee Hearing, Releases NHE Projections. Centers for Medicare & Medicaid Services (CMS) Chief Actuary Paul Spitalnic discussed Medicare solvency shortly after releasing national health expenditure (NHE) projections.
• Lawmakers Reintroduce Revised Bipartisan, Bicameral Prior Authorization Legislation. The bill would address prior authorization for Medicare Advantage (MA) plans.
• Votes Related to Protecting Access to Reproductive Rights Continue in the Senate. Votes related to protecting access to contraception and in vitro fertilization both failed to overcome the 60-vote threshold.
• House Passes NDAA. The National Defense Authorization Act (NDAA) was advanced in a vote of 217 – 199 and contained controversial healthcare floor amendments.
• White House Announces Private Sector Partnership to Improve Rural Hospital System Cybersecurity. Microsoft and Google committed to provide various resources to improve rural hospital resilience.
• SCOTUS Rules on Access to Mifepristone. In a unanimous decision, the Supreme Court of the United States (SCOTUS) ruled that the plaintiffs lacked a legal right to challenge the US Food & Drug Administration’s (FDA’s) actions regarding regulation of mifepristone, a drug used in medication abortions.

CONGRESS

House Energy & Commerce Committee Advances 13 Health Bills. The full committee markup unanimously advanced each of the 13 bipartisan bills, including bills to address Medicaid fraud, invest in research about stillbirths, and promote enrollment under the Medicaid program for eligible out-of-state providers to improve enrollees’ access to specialized care. A markup memo with details on each of the bills can be found here, and a recap of the votes can be found here.

Missing from the markup were several bills that advanced out of the Health Subcommittee last month, including legislation addressing the Medicare telehealth flexibilities that expire at the end of calendar year 2024 and the pediatric rare disease priority review voucher program that expires at the end of fiscal year 2024. Committee leadership emphasized that they are working to advance fully paid for packages ahead of the programs’ expirations and noted that part of the delay regarding the telehealth package is due to the lack of official Congressional Budget Office (CBO) score.

House Energy & Commerce Subcommittee Holds Hearing on CMS Innovation Center. In the hearing, CMS Innovation Center Deputy Administrator and Director Fowler was questioned about how the center is meeting its statutory intention of lowering costs and improving quality care. The hearing focused on a recent CBO report, which found that the CMS Innovation Center increased federal spending by $5.4 billion in its first decade. Republicans expressed concern about the large CBO score, lack of consideration of provider feedback, and insufficient number of alternative payment models for specialty care practices. Democrats focused on their appreciation for improvements in care quality and coordination but voiced concern about the ability of the CMS Innovation Center to expand successful models. In response, Dr. Fowler highlighted recent efforts to engage with specialists and advance health equity.

Senate Finance Committee Holds Hearing, Releases Report on Youth RTFs. In the hearing, senators and witnesses spoke about harm suffered by children in federally funded RTFs, stating that the environment is more akin to a detention center than a therapeutic setting. Members discussed the inadequacy of state and federal oversight, which contributes to systemic problems and insufficient corporate structures that allow RTFs to prioritize profit over child welfare.

At the beginning of the hearing, Chair Wyden (D-OR) released a report detailing his findings from a two-year investigation of four major RTF operators. The report found that children in these facilities receive substandard care and are subjected to abuse and neglect. The report recommended that Congress and the Administration take action to enhance health and safety standards, strengthen oversight and invest in community-based services. Chairman Wyden’s press release can be found here.

CMS Chief Actuary Testifies at House Budget Committee Hearing, Releases NHE Projections. In the hearing, the committee examined various approaches to ensure the future viability of both Medicare and Social Security, including proposals for bipartisan commissions and legislation. CMS Chief Actuary Spitalnic stated that the Medicare trust fund has extended its solvency dates because of stronger economic growth, higher productivity and increased labor force participation, but the retirement of the baby boom generation presents ongoing fiscal challenges.

The hearing comes the day after the Office of the Actuary released projections of NHE and health insurance enrollment for the years 2023 – 2032. The report found that average annual growth in NHE (5.6%) will outpace growth in gross domestic product (GDP) (4.3%), leading to an increase in health spending as a portion of GDP from 17.3% in 2022 to 19.7% in 2032. Because of the expiration of both the Medicaid continuous enrollment requirement and the Inflation Reduction Act’s enhanced Marketplace subsidies, the insured share is projected to fall from 93.1% in 2023 to 90.7% by 2032. A press release can be found here, and additional information about the projections can be found here.

Lawmakers Reintroduce Revised Bipartisan, Bicameral Prior Authorization Legislation. A large bipartisan group of representatives and senators reintroduced H.R. 8702/S.4532, the Improving Seniors’ Timely Access to Care Act. This legislation is a revised version of legislation from the 117th Congress that was cosponsored by more than 350 members of the House and 60 senators. That prior bill unanimously passed in the House but failed to move forward after the CBO assessed its cost at $16 billion. The new legislation is revised to build on recently implemented final rules for the use of prior authorization by MA plans.

The bill would:

• Require MA plans to establish an electronic prior authorization process that meets technical standards for transactions and clinical attachments;
• Increase transparency for MA plans around prior authorization requirements and use;
• Clarify CMS’s authority to adopt timeframes for MA plans to notify providers and enrollees of prior authorization decisions; and
• Require the US Department of Health & Human Services (HHS) and other agencies to report to Congress on program integrity efforts and other ways to improve electronic prior authorization.

The bill was reintroduced by 125 original sponsors in the House and 42 original sponsors in the Senate. The bill is also supported by more than 370 national and state organizations representing patients, MA plans, hospitals and other key stakeholders in the healthcare industry.

A section-by-section summary can be found here, and a press release can be found here.

Votes on Reproductive Rights Legislation Continue in the Senate. Senate Majority Leader Schumer (D-NY) continued to call up legislation related to reproductive rights on the Senate floor this week, in an election-year effort to keep the issue front and center. Last week, Schumer called up a bill to protect access to contraception, which failed to overcome the 60-vote threshold needed for consideration given the slim Democratic majority in the Senate. This week, legislation to protect access to in vitro fertilization met a similar fate.

House Passes NDAA. The House advanced the package in a largely party line vote of 217 – 199. Amendments adopted on the floor include the prohibition of abortion travel funds for service members and coverage of transgender healthcare through TRICARE. The amendments are not expected to be maintained given the Democratic-controlled Senate and Biden Administration. Additional information about the amendments can be found here.

ADMINISTRATION

White House Announces Partnership with Private Sector to Improve Rural Hospital System Cybersecurity. Microsoft and Google have partnered with the Administration to provide resources that aim to improve security and resilience in rural hospital systems. For independent critical access hospitals and rural emergency hospitals, Microsoft will extend its nonprofit program to provide grants and a discount of up to 75% on security products. Microsoft will also provide its most advanced security suite for one year at no cost to participating larger rural hospitals, provide cybersecurity assessments and training for rural hospital staff, and extend security updates for Windows 10 to participating hospitals for one year. Google will provide free endpoint security advice to rural hospitals and nonprofit organizations, discounted communication tools and security support, and funding to support software migration. Google also committed to launch a pilot program with rural hospitals to develop a security capability package that fits the hospitals’ needs. Read the fact sheet here.

COURTS

SCOTUS Rules on Access to Mifepristone. The unanimous decision in FDA v. Alliance for Hippocratic Medicine was decided on procedural grounds rather than the merits, but the decision upholds, for the time being, the FDA’s current regulations around mifepristone, a pill used in more than half of all abortions in the United States last year.

QUICK HITS

• ASPE Outlines Administration’s Actions to Improve Healthcare Access. In a recently released issue brief, the Office of the Assistance Secretary for Planning and Evaluation (ASPE) detailed findings of increased access to care, improved health outcomes and financial benefits tied to the Affordable Care Act.
• House Energy & Commerce Committee Republicans Release Report on NIH Misconduct. The report alleges that alongside the National Institutes of Health (NIH) and HHS, the National Institute of Allergy and Infectious Diseases misled the committee in relation to a monkeypox research project. The report also includes a series of recommendations related to biosecurity.
• Massachusetts Senators Introduce Legislation to Address Private Equity in Healthcare. Sens. Warren (D-MA) and Markey (D-MA) introduced the Corporate Crimes Against Health Care Act of 2024, which would impose significant potential penalties on private equity and portfolio company executives, remove tax provisions favorable to real estate investment trusts and impose significant public reporting requirements. The senators’ press release can be found here, and a one pager can be found here.
• CFPB Proposes Banning Medical Bills from Credit Reports. The Consumer Financial Protection Bureau’s (CFPB’s) proposed rule would prevent credit reporting companies from sharing medical debts with lenders, prohibit lenders from making decisions based on medical information and ban repossession of medical devices. The press release can be found here.
• CMS Updates FAQs on New Hospital Price Transparency Requirements. The frequently asked questions (FAQs) provide additional information to hospitals, consumers, and stakeholders ahead of new hospital price transparency requirements, which will take effect July 1, 2024. For more information, view the Hospital Price Transparency website.

NEXT WEEK’S DIAGNOSIS

The Senate is in session next week, while the House will be in a district work period. Senate healthcare activity is expected at the committee level, including a Health, Education, Labor & Pensions executive session during which the committee may vote to authorize an investigation and subpoena related to Novo Nordisk’s pricing for Ozempic and Wegovy.