Health Policy Report (1/30)

January 30, 2023

The House and Senate will both meet for legislative business later today as lawmakers continue organizing various committee and subcommittee rosters for the 118th Congress. Notable announcements over the weekend include: (1) full committee assignments on the Democratic side for each of the House standing committees; (2) Democratic subcommittee rosters for the House Ways and Means Committee; and (3) GOP subcommittee assignments on the House Appropriations Committee, among others. Meanwhile, the Senate is expected to formally adopt its committee organizing resolutions at some point this week after waiver-related issues on the Republican side delayed consideration last week.

On the floor this week, House GOP leadership has teed up several bills related to pandemic-era policies that would: (1) study the impacts of expanded telework and remote work by federal agency employees (H.R. 139); (2) terminate the COVID-19 public health emergency (PHE) (H.R. 382); and (3) eliminate the COVID-19 vaccine mandate for health care providers (H.R. 497). In the upper chamber, senators will resume consideration of pending presidential nominations following passage of the organizing resolution.

CMS Considers Changes in MA Benchmark Calculations

Over the past several years, the Centers for Medicare and Medicaid Services (CMS) has raised concerns over the ways that Medicare Advantage (MA) scores and benchmarks are calculated. Now, the agency is considering a gradual shift in calculations, according to CMS’s Innovation Center (CMMI). MA benchmarks determine payment rates for each plan, though some argue that calculations have become skewed. Plan bids are based on Medicare fee-for-service (FFS) data — which inform benchmarks — though CMS is concerned that FFS spending data has become less indicative of MA populations as more beneficiaries switch from FFS to MA plans. A new benchmark calculation could link payments to gross domestic product (GDP) or another economic indicator, CMS suggests, to better predict spending indicators such as inflation or health care utilization. Notably, the Medicare Payment Advisory Commission (MedPAC) outlined a similar recommendation for MA benchmark calculations in its June 2021report to Congress. However, the agency emphasized that any agreed upon changes would be implemented slowly to avoid upsets in the MA program.

Lawmakers Mull Over Next Steps for Behavioral Health Care Policy

The Republican-controlled House has put the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) for Patients and CommunitiesAct on its radar for 2023, as numerous policies in the overarching addiction and behavioral health legislation are set to expire later this year. Advocates and behavioral health stakeholders are keeping an eye on upcoming bipartisan negotiations as priorities continue to emerge, and there is a general consensus that many SUPPORT Act policies have bipartisan support for reauthorization. The House Energy and Commerce Committee — which has jurisdiction over the legislation — will hold a hearing on fentanyl this Wednesday that signals the caucus’ focus on the issue of addiction and overdose.

The House Committee on Oversight and Accountability will be holding a similar hearing next week centered around fentanyl trafficking and immigration, although this hearing suggests a divide between Democrats’ and Republicans’ priorities in addressing addiction; namely while Republicans aim to address drug trafficking concerns, Democrats are generally more focused on harm reduction. With regard to harm reduction, the Bipartisan Policy Center recently called on Congress to provide more funding for community-based behavioral health centers (CCBHC), as well as offering to help the Biden administration provide CCBHCs with more regulatory flexibilities and create a national certification process for support specialists.

Buchanan, Guthrie Selected to Run Key Health Subcommittees

Last week, House Ways and Means Committee Vice Chair Vern Buchanan (R-FL) was announced as the Chair of the Committee’s Health Subcommittee, which maintains jurisdiction over Medicare, Medicaid, health care delivery systems, health care tax law, and other subject matter influencing the health sphere. Buchanan has experience on the Committee, serving on Ways and Means for over ten years and leading as Ranking Member of the Health Subcommittee in the 117th Congress. He also chairs the GOP’s health Future Task Force with Energy and Commerce Health Subcommittee Chair Brett Guthrie (R-KY). The task force is focused on a wide array of health care initiatives, ranging from value-based payments to telehealth. 

On the House Energy and Commerce Committee, Guthrie aims to address medical product innovation, price competition and transparency, and oversight of health agencies. He also has signaled his intent to examine the Food and Drug Administration’s (FDA) implementation of emergency use authorization (EUA) and lessons learned from the COVID-19 pandemic, as well as the agency’s handling of drug supply chain issues and reauthorization of the Pandemic and All Hazards Preparedness Act (PAHPA). The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) for Patients and Communities Act is also top of mind for Guthrie, and he specifically intends to encourage the development of non-opioid pain medication alternatives as part of the SUPPORT reauthorization process.

CMS to Offer 16-Month Special Enrollment Period During Unwinding

As states begin the Medicaid unwinding process, the Centers for Medicare and Medicaid Services (CMS) announced that it will create a special enrollment period (SEP) for those who lose Medicaid coverage during the eligibility determination process. The SEP will open on March 31, 2023 and close when Medicaid maintenance of effort (MOE) ends on July 31, 2024. Eligibility for the SEP will require consumers to submit an application confirming they will lose Medicaid or Children’s Health Insurance Program (CHIP) coverage by July 31, 2024, though documentation will not be required. Customers will then have 60 days to choose a plan, and coverage may begin the first day of the following month.

To help spread the word about this new sign-up opportunity, CMS will notify private sector partners who have been involved in unwinding efforts, as well as provide training to plan navigators and enrollment agents. However, the unwinding period is the first time in years that coverage is ending for many beneficiaries, and states are concerned about the challenges inherent in making consumers sufficiently aware of how to effectively utilize the SEP.