THIS WEEK’S DOSE

• House Speaker Vote: The US House of Representatives elected Rep. Mike Johnson (R-LA) as Speaker of the House.
• House Hearings: The House Energy & Commerce Health Subcommittee explored pending rules impacting the long-term care workforce.
• Senate Hearings: US Senate committees held hearings on rare diseases and the hospital staffing crisis.

CONGRESS

House Republicans Elect New Speaker. After weeks of turmoil, the House elected Rep. Mike Johnson (R-LA) as the new Speaker of the House on Wednesday with 220 votes secured on the floor. The House is now able to resume working on legislative priorities, the most pressing of which is funding the government ahead of the November 17 expiration of the current continuing resolution. Speaker Johnson circulated a letter to his colleagues Wednesday outlining his intent for the House to complete consideration of the eight remaining appropriations bills, including the Labor, Health and Human Services and the Agriculture-Food and Drug Administration appropriations bills, prior to the November 17 deadline and then enacting a continuing resolution (CR) that would run to January 15 or April 15, 2024. The idea behind this longer CR is to avoid the pressure of the Christmas holiday, which typically is used to drive passage of omnibus legislation. Delaying a CR until the new year would also provide time for his new operation to get into place and develop consensus within the House Republican Conference.

House Energy & Commerce Health Subcommittee Holds Hearing on Long-Term Care Workforce. The Health Subcommittee met to discuss access to long-term services and supports (LTSS). All panelists and members agreed that there is a workforce shortage for LTSS and home and community-based services (HCBS). The hearing focused on two proposed rules: the nursing facility staffing ratio proposed rule and the Medicaid access proposed rule. Republican members were very opposed to the provision in the Medicaid access rule that would require 80% of Medicaid payments for personal care, homemaker and home health aide services to be spent on compensation for the direct care workforce (as opposed to administrative overhead or profit), and several witnesses focused on this as well. These members noted that it is an unfunded mandate that will not achieve its stated goal of increasing staffing for LTSS and HCBS. They were also very opposed to the nursing staff ratio rule and voiced concerns that it does not address the workforce shortage. Democratic members asked questions on how increased wages will increase recruitment and retention in the fields and highlighted issues of staff burnout and turnover.

Senate Aging Committee Examines Rare Diseases. The committee held a hearing to hear from patients who are impacted by rare, serious and progressive diseases and to discuss solutions to speed the Food and Drug Administraiton (FDA) approval process for new drugs and treatments without disrupting safety and ethics. Ranking Member Mike Braun (R-IN) introduced the Promising Pathway Act, supported by many members and witnesses, which aims to speed the drug and treatment approval processes for patients with rare, serious and progressive diseases. Witnesses noted inconsistencies with the FDA approval process for new drugs and treatments and shared concern that patients with progressive and fatal diseases do not have time to wait for long approval processes.

Senate HELP Committee Holds Field Hearing on Hospital Staffing Crisis. The committee held a controversial field hearing in New Brunswick, New Jersey to discuss hospital staffing issues and how they impact the well-being of patients and overworked nurses. Prior to the hearing, Health, Education, Labor and Pensions (HELP) Ranking Member Cassidy (R-LA) expressed ethical concerns with Chairman Sanders wielding his authority to intervene in a local labor dispute as there is an ongoing nursing strike in New Brunswick.  Chairman Sanders was the only member of the HELP Committee present at the hearing. Testimony was heard from nurses as well as a professor of health workforce equity, and the invited hospital executives were not present to testify, but we understand they provided written testimony which should be posted on the HELP website here. Witnesses expressed support for the establishment of minimum staffing standards at the state and federal level. Witnesses also highlighted the problem of low patient quality of care as a result of understaffing and violence against health workers.

ADMINISTRATION

CMS Holds Making Care Primary (MCP) Office Hour Webinar. CMS staff noted a more technical user guide would be posted on the webpage soon. During the webinar, staff clarified that organizations will not be able to concurrently participate in the Medicare Shared Savings Program and MCP after the first six months of the model. CMS also stated they will provide accepted applicants with projections on beneficiary count across different risk tiers to help determine financial viability. Eligibility requirements and additional model details can be found in the Request for Applications. Interested applicants should submit their application via web portal by November 30 at 11:59 pm EST.

QUICK HITS

• Senate HELP Committee Chair Sanders (I-VT) Sends Letter to HHS Inspector General Urging Investigation of NIH Cancer Therapy. In the letter, Sen. Sanders urged the US Department of Health and Human Services (HHS) Inspector General to conduct a thorough investigation into the National Institutes of Health’s (NIH) proposal granting an exclusive patent license to a company for a treatment for cervical cancer. He argued that the proposal would make this therapy much less affordable and accessible to patients.
• Senate HELP Committee Advances NIH Director Nominee, Monica Bertagnolli. The committee advanced Bertagnolli’s nomination with a vote of 15-6, with Chairman Sanders voting against her. She, however, advanced with bipartisan support and now moves to consideration by the full Senate.
• Administration Launches Window Shopping Ahead of 11th ACA Marketplace Open Enrollment Period. Consumers can preview their healthcare coverage options and see detailed information about 2024 health insurance plans and prices offered in their area through the Affordable Care Act (ACA) Marketplace ahead of the Open Enrollment period that begins November 1. Read the Centers for Medicare & Medicaid Services’ (CMS) press release here and fact sheet here.
• HHS Hosted IRA Roundtable with Healthcare Stakeholders. HHS held a roundtable with stakeholders to discuss how they can work together with the administration to educate consumers about new Medicare prescription drug benefits under the Inflation Reduction Act (IRA). Participants discussed fall outreach plans, as well as challenges they see in educating consumers about the law’s benefits, including issues with language access and the need to prioritize low-income seniors.

NEXT WEEK’S DIAGNOSIS

It remains to be seen whether healthcare activity will occur at the committee level next week. On the regulatory front, CMS is expected to publish final rules for the Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Physician Fee Schedule (PFS). The Medicare Payment Advisory Commission and the Medicaid and CHIP Payment and Access Commission will hold their respective November meetings next week.