Health Care Checkup
April 28, 2023
THE BIG PICTURE
The House voted 217-215 to pass the Limit, Save, Grow Act. Four Republicans— Ken Buck (CO), Andy Biggs (AZ), Tim Burchett (TN) and Matt Gaetz (FL)—voted with all Democrats to oppose the bill. The bill, which was released last week by House Speaker Kevin McCarthy (CA) proposes to increase the debt limit by $1.5 trillion, through May 2024, and provide more than $4.5 trillion in savings. However, the legislation is dead on arrival in the Democratic-led Senate.” President Biden said that he would be “happy to meet with McCarthy,” but declared that raising the debt limit is “not negotiable.”

CMS released two proposed Medicaid rules: the Ensuring Access to Medicaid Services proposed rule and the Managed Care Access, Finance, and Quality proposed rule. Together, the proposals create new requirements for states and managed care plans that would “establish tangible, consistent access standards, and a consistent way to transparently review and assess Medicaid payment rates across states.” The press release and fact sheets can be found here.

CMS also released a fact sheet outlining process updates the agency is making to increase compliance with hospital price transparency requirements. Now, CMS will require hospitals to be in full compliance with the hospital price transparency regulation within 90 days from when CMS issues a corrective action plan (CAP) request, instead of allowing hospitals to propose their own completion date. The fact sheet can be found here.

HHS announced a proposed rule that would reduce barriers to health care for Deferred Action for Childhood Arrivals (DACA) recipients. Specifically, the proposal would “remove the current exclusion that treats DACA recipients differently from other individuals with deferred action who would otherwise be eligible for coverage under select CMS programs.”

The House Energy and Commerce (E&C) Subcommittee on Health held a hearing titled “Lowering Unaffordable Costs: Legislative Solutions to Increase Transparency and Competition in Health Care.” The legislative hearing focused on “prescription drug middlemen” and policies to increase competition in the health care market to bring down costs. CMS Administrator Chiquita Brooks-LaSure testified at the hearing, along with other health care stakeholders. Mehlman Consulting’s summary of the hearing can be found here.

Additionally, the House Education and Workforce Subcommittee on Health, Employment, Labor, and Pensions held a hearing on “Reducing Health Care Costs for Working Americans and Their Families.” Mehlman Consulting’s summary of the hearing is available here.

House Energy and Commerce (E&C) Chair Cathy McMorris Rodgers (WA), Oversight and Investigations Subcommittee Chair Morgan Griffith (VA), and Health Subcommittee Chair Brett Guthrie (KY) sent letters to ten public relations firms, investigating the National Institutes of Health’s (NIH) use of consulting services worth approximately $1 billion. The goal of the investigation is to “determine how the NIH uses contract public relations firms and whether these are an appropriate use of taxpayer dollars.” Republicans are also investigating if the funding was spent to “silence scientific debate or pursue a political agenda.” The press release and letters can be found here.
What to Expect Next Week: The House will be out of session and will reconvene on Tuesday, May 9. The Senate will be in session and will hold several health-related hearings. On Tuesday, the Senate HELP Committee will hold a markup on S. 1067, S. 1114, and S. 1214, S. _, the Pharmacy Benefit Manager Reform Act. On Wednesday, the Senate Finance Committee will hold a hearing titled “Barriers to Mental Health Care: Improving Provider Directory Accuracy to Reduce the Prevalence of Ghost Networks.” On Thursday, the Senate Appropriations Labor HHS Subcommittee will meet to discuss the President’s FY 2024 funding request and budget justification for the National Institutes of Health. Also on Thursday, the Senate HELP Committee will hold a hearing titled, “Preparing for the Next Public Health Emergency: Reauthorizing the Pandemic and All-Hazards Preparedness Act.”
DEEP DIVE
Republican-led House Passes Bill to Raise the Debt Limit
On Wednesday, the House voted 217-215 to pass the Limit, Save, Grow Act. Four Republicans— Ken Buck (CO), Andy Biggs (AZ), Tim Burchett (TN) and Matt Gaetz (FL)—voted with all Democrats to oppose the bill. The bill, which was released last week by House Speaker Kevin McCarthy (CA) proposes to increase the debt limit by $1.5 trillion, through May 2024, and provide more than $4.5 trillion in savings. However, the legislation is dead on arrival in the Democratic-led Senate. Additionally, President Joe Biden has warned that he would veto the bill. Unless action on the debt limit is taken, the Congressional Budget Office estimates that the government’s ability to cover expenses using extraordinary measures will be “exhausted between July and September 2023.” President Biden said that he would be “happy to meet with McCarthy,” but declared that raising the debt limit is “not negotiable.”

House E&C Health Subcommittee Holds Hearing on Lowering Health Care Costs
The House Energy and Commerce (E&C) Subcommittee on Health held a hearing titled “Lowering Unaffordable Costs: Legislative Solutions to Increase Transparency and Competition in Health Care.” The legislative hearing focused on “prescription drug middlemen” and policies to increase competition in the health care market to bring down costs. CMS Administrator Chiquita Brooks-LaSure testified at the hearing, along with other health care stakeholders. In his opening statement, Subcommittee Chair Brett Guthrie (R-KY) advocated for passage of the Transparent PRICE Act, which would build upon the Trump Administration’s hospital and insurer price transparency rules. He also said he strongly supports the bipartisan PBM Accountability Act, which would provide “key information to employers about the drug costs in the coverage for their employees.” Mehlman Consulting’s summary of the hearing can be found here.
 
House W&M Oversight Subcommittee Convenes to Discuss Tax-Exempt Hospitals and the Community Benefit Standard
The House Ways and Means (W&M) Oversight Subcommittee hearing on tax-exempt hospitals and the Community Benefit Standard examined the relationship between community benefits provided by hospitals and the value of hospitals’ tax exemption. At the hearing, Subcommittee Chairman David Schweikert (R-AZ) said that there is a “lack of clear guidelines from Congress and the IRS about what constitutes a community benefit,” which results in varying interpretations of the value of community benefits provided by hospitals. Schweikert’s full opening statement can be found here.

House E&C Republicans to Launch Investigation into NIH Communications Contracts
House Energy and Commerce (E&C) Chair Cathy McMorris Rodgers (WA), Oversight and Investigations Subcommittee Chair Morgan Griffith (VA), and Health Subcommittee Chair Brett Guthrie (KY) sent letters to ten public relations firms, investigating the National Institutes of Health’s (NIH) use of consulting services worth approximately $1 billion. In December 2018, the NIH awarded the “Public Information and Communication Services” (PICS) contract to ten public relations companies. The contract’s initial funding was capped at $500 million, but the contract was doubled in 2021 to $1 billion due to the COVID-19 pandemic. The goal of the investigation is to “determine how the NIH uses contract public relations firms and whether these are an appropriate use of taxpayer dollars.” Republicans are also investigating if the funding was spent to “silence scientific debate or pursue a political agenda.” The press release and letters can be found here.
 
CMS Unveils Two Proposed Rules Aimed at Increasing Access to Medicaid and CHIP
CMS released two proposed Medicaid rules: the Ensuring Access to Medicaid Services proposed rule and the Managed Care Access, Finance, and Quality proposed rule. Together, the proposals create new requirements for states and managed care plans that would “establish tangible, consistent access standards, and a consistent way to transparently review and assess Medicaid payment rates across states.” The proposed rules would establish national maximum standards for appointment wait times, require states to conduct “secret shopper surveys” of Medicaid or CHIP managed care plans, establish new payment transparency requirements for states, create additional transparency requirements for setting Medicaid payment rates for home and community-based services, develop “timeliness-of-access” measures for HCBS, strengthen how states use state Medical Care Advisory Committees, mandate states to conduct annual enrollee experience surveys for managed care plans, and establish a framework for states to enact a Medicaid or CHIP quality rating system. The press release and fact sheets can be found here.

CMS Provides Enforcement Update of its Hospital Price Transparency Regulation
The Centers for Medicare and Medicaid Services (CMS) released a fact sheet outlining process updates the agency is making to increase compliance with hospital price transparency requirements. Now, CMS will require hospitals to be in full compliance with the hospital price transparency regulation within 90 days from when CMS issues a corrective action plan (CAP) request, instead of allowing hospitals to propose their own completion date. In addition, for hospitals that have not made any effort to come into compliance with the Hospital Price Transparency regulation, CMS will no longer give the hospital a warning and will instead “immediately request that the hospital submit a CAP.” The fact sheet can be found here.

HHS Issues Proposed Rule to Increase Access to Health Care for DACA Recipients
The Department of Health and Human Services (HHS) announced a proposed rule that would reduce barriers to health care for Deferred Action for Childhood Arrivals (DACA) recipients. Specifically, the proposal would “remove the current exclusion that treats DACA recipients differently from other individuals with deferred action who would otherwise be eligible for coverage under select CMS programs.” Additionally, it would modify the definition of “lawfully present” to incorporate DACA recipients, which would allow them to sign-up for Medicaid and CHIP. Further, DACA recipients would qualify for a special enrollment period, allowing them to select a plan through a Marketplace during the 60 days “following the effective date of the final rule.” More information can be found here.
 
COVID Crisis Group Says Nation’s Pandemic Response Revealed a "Collective National Incompetence in Governance"
A 34-member team of experts named the “COVID Crisis Group” released a report that delved into America’s response to the COVID-19 pandemic. The team was established by several foundations in 2021 to conduct a “9/11 commission-style assessment” of the pandemic. However, the Biden Administration never formally established the panel, so the team conducted its assessment on its own through listening sessions with approximately 300 people. The group found that Operation Warp Speed was highly successful, but efforts to produce enough protective equipment and antivirals were less fruitful. The team also found that the Centers for Disease Control and Prevention (CDC) does not have enforcement authority over public health in the U.S. Due to state and local authorities granted in the 1800s, the CDC cannot acquire data about threats like COVID-19 without agreements with local jurisdictions. 
CONGRESSIONAL HEARINGS
Senate Health, Education, Labor and Pensions Committee - Executive Session
S. 1067, S. 1114, S. 1214, S. _, Pharmacy Benefit Manager Reform Act
Tuesday, May 2 at 10:00 AM ET

Senate Finance Committee - Hearing
Full Committee Hearing: "Barriers to Mental Health Care: Improving Provider Directory Accuracy to Reduce the Prevalence of Ghost Networks."
Wednesday, May 3 at 10:00 AM ET

Senate Appropriations Committee - Hearing
Subcommittee on Labor, Health and Human Services, Education, and Related Agencies: A Review of the President’s FY 2024 Funding Request and Budget Justification for the National Institutes of Health
Thursday, May 4 at 10:00 AM ET

Senate Health, Education, Labor and Pensions Committee - Hearing
Full Committee Hearing: "Preparing for the Next Public Health Emergency: Reauthorizing the Pandemic and All-Hazards Preparedness Act."
Thursday, May 4 at 1:00 PM ET
ADMINISTRATION ANNOUNCEMENTS
Centers for Medicare & Medicaid Services
 
Food and Drug Administration
 
Guidance Documents from the Centers for Disease Control and Prevention

National Institutes of Health
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Washington, DC 20005
202-585-0258