THIS WEEK’S DOSE

• Senate Finance Committee Holds Hearing on Disability Benefits. The hearing discussed ways to improve work incentives for those on social security disability benefits.
• Senate Finance Committee Chair Releases Draft Bill to Prevent Maternity Deserts. The Keeping Obstetrics Local Act aims to stop labor and delivery unit closures in rural and underserved areas.
• House Energy & Commerce Committee Chair Releases NIH Reform Framework. Committee Chair Rodgers (R-WA) released a framework detailing the current challenges facing the National Institutes of Health (NIH).
• CMS Announces Conclusion of AAP Program for Change Healthcare Cyberattack. The Centers for Medicare & Medicaid Services (CMS) announced that payments under the Accelerated and Advance Payment (AAP) Program for the Change Healthcare/Optum Payment Disruption will conclude on July 12, 2024.
• Administration Releases Results of Study Examining Non-Fatal Overdoses. The federal study highlights the opioid epidemic and identifies effective interventions as well as significant gaps in care.

CONGRESS

Senate Finance Committee Holds Hearing on Disability Benefits. The hearing discussed ways to improve work incentives for those on Social Security disability programs. Senators and witnesses noted that there are currently disincentives for people in Social Security disability programs to begin working, including fear of loss of benefits and the complexity of the work incentive rules. They expressed concern over the Social Security Administration’s continued use of outdated occupational data, despite its investments in developing an alternative to this data. They also expressed concern over the number of large Social Security disability overpayments and their negative financial impact on beneficiaries.

Senate Finance Committee Chair Releases Draft Bill to Prevent Maternity Deserts. Chair Wyden (D-OR) and 15 additional Senate Democrats released a draft bill that seeks to address the growing issue of maternity deserts. The bill notes that between 2012 and 2022, approximately one quarter of all rural hospitals stopped providing obstetrics services. The draft bill is divided into four titles, focused on:

• Enhancing financial support for rural and safety net hospitals providing obstetric services;
• Expanding coverage of maternal healthcare;
• Making new workforce investments; and
• Creating new public communication requirements related to closures.

Specific provisions include:

• Increasing the base Medicaid payment rate for labor and delivery services to 150% of the Medicare rate for rural hospitals and for hospitals where at least 60% of births are paid by Medicaid, the Indian Health Service or through self-pay;
• Increasing the federal medical assistance percentage for labor and delivery services at eligible hospitals; and
• Providing supplemental payments to certain hospitals that have a low volume of births.

The bill would also extend the enhanced payment rate and federal financial participation for maternity, labor and delivery services to the Children’s Health Insurance Program (CHIP). The bill would require 12 months of continuous coverage of full benefits for pregnant and postpartum individuals under Medicaid and CHIP and would create a Medicaid option for health homes for pregnant and postpartum women. Finally, the bill would streamline screening and enrollment for out-of-state obstetrics providers in state Medicaid programs.

A section-by-section summary of the bill can be found here. A press release, which includes the full list of cosponsors and a stakeholder endorsement list, can be found here. The bill currently does not have any announced support from Senate Republicans. Many of the policies set forth in the draft bill are likely to be costly, although the Congressional Budget Office (CBO) has not yet released any estimates. The bill was released in draft form as its sponsors are still seeking input and may refine the 150% payment threshold and other provisions. They intend to formally introduce the bill in the fall.

House Energy & Commerce Committee Chair Releases NIH Reform Framework. The framework for discussion contains several recommendations to reform the NIH, including structural reform, mission and leadership reform, funding reform and grant reform. A one pager on the framework can be found here. Interested individuals may submit feedback and comments in writing to NIHReform@mail.house.gov by August 16, 2024.

Chair Rodgers also wrote a joint opinion piece on this issue with House Appropriations Subcommittee on Labor, Health and Human Services (HHS), and Education Chair Aderholt (R-AL) detailing why NIH reform is necessary. The opinion piece highlights support for the NIH and the role it plays in furthering scientific discovery but also notes the need to work on concerns that have been raised during and after the COVID-19 pandemic.

In related news, the House Energy & Commerce Committee released an interim staff report regarding the committee’s ongoing investigation into a proposed MPXV project at the NIH. The investigation uncovered a lack of oversight and transparency from HHS, NIH, and the National Institute of Allergy and Infectious Diseases. This report includes a series of recommendations related to biosecurity to ensure future transparency and accountability related to similar research.

ADMINISTRATION

CMS Announces Conclusion of AAP Program for Change Healthcare Cyberattack. In its press release, CMS highlights that the payments under the AAP program were designed to ease cash flow disruptions experienced by some Medicare providers and suppliers as a result of the cyberattack that took Change Healthcare offline in February 2024. CMS notes that accelerated payments have been issued to more than 4,200 Part A providers (such as hospitals), totaling more than $2.55 billion. CMS also notes that it issued 4,722 advance payments, totaling more than $717.18 million, to Part B suppliers, including doctors, non-physician practitioners and durable medical equipment suppliers. After July 12, 2024, CMS will no longer accept new applications for Change Healthcare/Optum Payment Disruption accelerated or advance payments. CMS notes that any providers or suppliers that are having difficulty billing or receiving claim payment at this point should contact Change Healthcare and/or their Medicare Administrative Contractor.

Administration Releases Results of Study Examining Non-Fatal Overdoses. Researchers from the Substance Abuse and Mental Health Services Administration, the NIH National Institute on Drug Abuse, the Centers for Disease Control and Prevention, and CMS conducted a study that evaluated 137,000 Medicare beneficiaries who experienced a nonfatal overdose in 2020. Among this cohort, almost 24,000 (17.4%) experienced another nonfatal overdose, and about 1,300 (1%) died from overdose in the following year. The study found that the odds of dying from a subsequent lethal overdose decreased among beneficiaries who received methadone (58% lower odds), buprenorphine (52% lower odds), or behavioral health assessment or crisis services (75% lower odds). The risk of overdose mortality among those who filled a naloxone prescription was reduced by 30%.

The study also noted significant gaps in care. For example, only 4.1% of the beneficiaries received medications for opioid use disorder, and only 6.2% filled a naloxone prescription. Beneficiaries who received medications for opioid use disorder waited an average of 72 days between their overdose and receiving the medication. Researchers concluded that high-quality care interventions are necessary to address the drug overdose crisis. Read the CMS press release here.

QUICK HITS

• CBO Releases US Health Insurance Coverage Projections. CBO noted that 7.7% of the US population is uninsured in 2024. CBO predicted that the uninsured share of the population will increase to 8.9% by 2034 because of the end of COVID-19 pandemic-related Medicaid policies, the expiration of enhanced subsidies available through the Affordable Care Act health insurance Marketplaces, and a surge in immigration that began in 2022. Medicare enrollment is expected to increase from 60 million in 2023 to 74 million in 2034.
• CMS Announces NOFO for IBH Model. The Innovation in Behavioral Health (IBH) Model enables specialty behavioral health practices to integrate behavioral health with physical health care and health-related social needs. CMS will select up to eight state Medicaid agencies to participate in the model. Interested applicants can access the notice of funding opportunity (NOFO) application here. CMS also announced it will host a webinar on the NOFO on July 11, 2024.

NEXT WEEK’S DIAGNOSIS

The House will be in session next week, with the Senate in recess. Healthcare activity will occur at the committee level, including a House Ways & Means Health Subcommittee hearing on value-based care and a possible markup of privacy legislation at the House Energy & Commerce Committee.