Health Policy Report (4/12)

April 12, 2021

Congress will return this week to kick off the April legislative session as lawmakers turn their attention to crafting legislation that closely aligns with President Joe Biden’s “American Jobs Plan” for infrastructure. The Senate will open later this afternoon to resume consideration of the President’s pending nominees, starting with Polly Trottenberg’s nomination to be Deputy Secretary of Transportation. In the month ahead, Senators are poised to take up several House-passed bills — as well as Congressional Review Act (CRA) resolutions that seek to overturn Trump era regulatory actions — that will face a narrow path to passage in the 50-50 Senate.

Meanwhile, House lawmakers are set to return tomorrow (Tuesday) to begin their April session. When the chamber reconvenes, Members will swiftly clear a Senate-passed bill that would extend a moratorium on a two percent cut to Medicare for the next nine months. The lower chamber originally passed a “pay-as-you-go” measure last month to avert the Medicare sequester, as well as address a series of automatic spending cuts that are set to go into effect across the board as a result of increase deficit spending from the American Rescue Plan. However, the Senate amended the bill to narrow its scope so as to focus on the Medicare cuts only, thus punting the additional PAYGO issues to a separate legislative effort. For the month ahead, Majority Leader Steny Hoyer (D-MD) announced that the House plans to vote on legislation pertaining to: (1) equal pay; (2) immigration; (3) D.C. statehood; and (4) preventing workplace violence.

Supreme Court Halts Medicaid Work Requirements Case as CMS Revokes More States’ Waivers

The Supreme Court announced last Monday that it would temporarily halt its review of the Medicaid work requirements case concerning Arkansas and New Hampshire, pending action from the Biden administration. SCOTUS previously removed oral arguments for the case from its March calendar, and the Biden administration revoked Arkansas’ and New Hampshire’s Medicaid work requirement waivers March 17. Georgia and Arkansas had stated they would sue the administration if their Medicaid work requirement waivers were revoked, claiming revoking the waiver this late would be “arbitrary and unlawful.” If the case is not heard later this month, it is likely to be heard when the Supreme Court oral argument calendar restarts in October. Alternatively, the court could remand the case back to the Department of Health and Human Services (HHS).

Also last week, the Centers for Medicare and Medicaid Services (CMS) revoked Wisconsin’s and Michigan’s Medicaid work requirement waivers. In letters to the states released last Tuesday, the administration explained they had serious concerns about “testing policies that create risk of substantial loss of health care coverage and harm to beneficiaries even after the ban on disenrolling beneficiaries.” Michigan and Wisconsin have not defended their work requirement program to CMS like several other states did in March and will have 30 days to appeal CMS’s decision.

Over 500K Americans Gain Health Coverage Under Special Enrollment Period

The Biden administration announced last Wednesday that 528,000 Americans have signed up for health care coverage under the COVID-19 special enrollment period that began February 15, noting that the number is expected to grow as additional consumers gain coverage in the coming months. Additionally, the data only encompasses the 36 states covered by the federal Exchange, and national enrollment will be higher when enrollment from state-run Exchanges is accounted for.

Department of Health and Human Services Secretary Xavier Becerra explained that 15 million Americans became eligible for additional subsidies toward their premiums April 1, and the special enrollment period is open until August 15. Several state-based Exchanges have also extended their special enrollment periods to align with the federal government. The administration pointed to increased enrollment rates among historically underserved communities, noting a six percent increase in individuals identifying as black compared to the same time periods in 2020 and 2019. Furthermore, 41 percent of consumers reported being at or slightly above the poverty level, compared to 38 percent in 2020 and 33 percent in 2019.

Study Finds One in Three COVID-19 Patients Diagnosed with Neuropsychiatric Conditions

A study published in The Lancet Psychiatry last Tuesday fond that six months after being diagnosed with COVID-19, one in three patients also had experienced a psychiatric or neurological illness — mostly mood disorders, but also strokes and dementia. The study adds that about one in eight of the patients were diagnosed with such an illness for the first time, most commonly anxiety or depression. Compared to control groups encompassing individuals with flu or other non-covid respiratory infections, COVID-19 patients reported first-ever neuropsychiatric diagnoses almost two times more. Specifically, patients overall had a 44 percent higher risk of neurological and mental health diagnosis after COVID-19 than after flu, and a 16 percent higher risk after COVID-19 than other respiratory tract infections. The study examined real-world data from millions of individuals to track reporting of 13 brain disorders, and the researchers stressed the urgent need for additional research to better understand how and why neuropsychiatric illness is occurring in COVID-19 patients. Smaller studies have hinted at the issue, and the researchers warned health services need to be prepared for the increased demand the data is showing.

CMS Release Annual Payment Updates for SNFs, Hospices, and IPFs

Last Wednesday and Thursday, the Centers for Medicare and Medicaid Services (CMS) announced its annual updates to Medicare payments for skilled nursing facilities (SNF) (rule, fact sheet), hospices (proposed rule, fact sheet), inpatient rehabilitation facilities (IRF) (rule, fact sheet),and inpatient psychiatric facilities (proposed rule, fact sheet). CMS’ proposed updates to SNF payment would increase payments by 1.3 percent, or a projected $445 million increase over FY 2021. CMS proposes boosting Hospice payment rates by 2.3 percent, or $530 million, and sets the FY 2022 aggregate cap at $31,389.66 per patient annually. Furthermore, CMS is proposing to boost payments to inpatient psychiatric facilities by 2.3 percent for fiscal year 2022 and update IRF payment rates by 2.2 percent.

In addition to routine payment updates, the proposed rules include revisions to quality measures in the respective Quality Reporting Program (QRP), such as a new quality measure for COVID-19 vaccine uptake among facility staff in rules pertaining to post-acute care (PAC). In addition, two RFIs were included in the rules — one concerning using Fast Health Interoperability Resources (FHIR) to support digital quality measures (dQM) and another on health equity. CMS is soliciting comments on the proposed rules. Comments will be open for 60 days, closing at 5:00 p.m. Eastern on June 7, 2021. Following public comment, CMS will evaluate feedback and will finalize the rules.