Health Policy Report (12/5)

December 5, 2022

Capitol Hill Update

Both chambers will return for votes today as negotiations on a year-end omnibus funding package continue. The “four corners” leaders of the House and Senate Appropriations Committees are expected to resume their deliberations over the course of the next few days in the hopes of striking a deal on topline funding figures for fiscal year (FY) 2023 — an important precursor to the development of a broader year-end spending package. If negotiators do not make significant progress over the course of the next two weeks, another continuing resolution (CR) will be needed to keep the government funded past Friday, December 16.

Lawmakers are also poised to move on a final compromise version of the National Defense Authorization Act (NDAA), starting with the House today. As one of the last moving legislative vehicles for the 117th Congress, the annual defense authorization measure could include key bipartisan priorities such as the Water Resources Development Act (WRDA) or cannabis banking legislation. House lawmakers will also take up final passage of the Respect for Marriage Act — a vote that would send the bill to the president’s desk for signature.

Senate Finance Releases Discussion Draft of Mental Health, SUD Parity Legislation

On Thursday, the Senate Committee on Finance released a bipartisan discussion draft (TRP analysis) of the mental health and substance use disorder (SUD) parity provisions to be included as part of the Committee’s broader legislative effort to improve mental health care for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries. Policy proposals within the discussion draft pertain to: (1) providing guidance to health care providers on partial hospitalization services for Medicare beneficiaries with SUD; (2) strengthening the accuracy and searchability of provider directories in Medicaid and Medicare Advantage (MA) plans; and (3) directing the Government Accountability Office (GAO) to conduct a study on coverage parity between behavioral and nonbehavioral health services in MA as well as provide a report on Medicaid payment rates for behavioral health services compared to medical and surgical services.

Earlier this year, the Finance Committee identified five areas in which it intends to focus on with regard to mental health care, including: (1) the health care workforce; (2) integration of care; (3) mental health parity; (4) telehealth; and (5) services for youth. Last week’s discussion draft is the fifth and final legislative discussion draft released by Committee staff after the Senate Finance Committee announced its mental health care initiative in February of 2022. At this time, it is unclear whether the Committee intends to hold a markup on these provisions and introduce them as a single package within the next Congressional session. Alternatively, some of these provisions could be included in a potential omnibus spending package for fiscal year (FY) 2023.

HHS Notices Proposed Revisions to the 340B Program Administrative Dispute Resolution Process

Last week, the Department of Health and Human Services (HHS) issued (TRP analysis) a notice of proposed rulemaking (NPRM) on the administrative dispute resolution (ADR) process for the 340B Drug Pricing Program. The NPRM proposes to modify the December 2020 340B ADR final rule (TRP analysis) — in effect as of January 2021 — as a result of policy and operational challenges with the implementation of the final rule encountered by the Health Resources and Services Administration (HRSA). The Department is seeking public comment on all components of the NPRM, including whether specific alternatives should be considered.  

Notably, the NPRM proposes to: (1) provide for a “more accessible” ADR process; (2) restructure the 340B ADR Panel to include 340B Program subject-matter experts; (3) require parties to undertake good faith efforts prior to initiating the ADR process; (4) better align the ADR process with the 340B statute; and (5) establish a reconsideration process for 340B ADR Panel decisions, among other items.  Comments on the NPRM are due within 60 days of publication in the Federal Register.

HHS Provides Update on Behavioral Health Integration

On Friday, the Department of Health and Human Services (HHS) provided an update to its Roadmap for Behavioral Health Integration, outlining work that the agency has done to further its mission. HHS officials detailed additional aspects of its goals for behavioral health integration in a Health Affairs article. HHS officials detailed barriers to accessing integrated services, focusing on the importance of improving workforce training for providers and enhancing reimbursement to cover non-traditional settings. Additionally, HHS will continue its attention to value-based and integrated care models, including the development of behavioral health integration quality measures and models. The agency also intends to wrap behavioral health care into primary care, strengthen pay parity, and promote early pediatric screenings and treatments. Engaging high-risk populations is another area of focus for the agency to home in on, as well as investing in research on prevention programs.

Senate Pandemic Preparedness Legislation Faces Steep Road Ahead

As the lame-duck session continues, Sens. Patty Murray (D-WA) and Richard Burr (R-NC) are reportedlypushing to get the PREVENT Pandemics Act (TRP analysis) past the finish line. Support for more pandemic-related spending is unlikely in a divided 118th Congress, making this bill a “must-pass” item for proponents of more pandemic avoidance investment. Specifically, many public health stakeholders have raised concerns that the U.S.’s public health infrastructure needs to improve its data sharing and workforce shortage issues.

The sprawling package includes several provisions that give some. lawmakers pause, however.  The bill provides greater oversight of federal public health agencies, addresses racial disparities, investigates the origins of COVID-19, and provides funding for Long-COVID, among other controversial policies. On the House side, Republicans are displeased that the bill was only marked up in the Senate. Additionally, members of the House would not have a chance to speak on the bill, since the legislation would likely be attached to an end-of-year omnibus package. Despite these impasses, the larger issue is considered to be the myriad of competing priorities for the end of the year. With so many policies to legislate, limited time, and limited funding to go around, the PREVENT Pandemics Act could fall victim to competing priorities.

Lawmakers Continue Advocacy for Mitigated Physician Pay Cuts

As Congress continues to weigh its end-of-year policy priorities, Medicare physician payment cuts are front of mind for the GOP Doctors Caucus. House Republican Committee leaders heard from the caucus last week, as lawmakers are growing increasingly concerned about pay cuts to physicians ranging up to 15 percent, depending on the specialty. Republican House Energy and Commerce Committee leadership — Reps. McMorris Rogers (R-WA) and Kevin Brady (R-TX) — sat in on the Doctors Caucus’ weekly meeting, during which some lawmakers expressed their desire to halt the entirety of the pay cuts.