Health Policy Report (7/5)

July 5, 2022

Both chambers of Congress have adjourned for the Independence Day state work period, and will return next week. The Senate returns first on Monday, July 11, followed by the House on Tuesday, July 12. ‘

Energy and Commerce Subcommittee Discusses 11 Public Health Bills

Last Wednesday, the House Energy and Commerce Subcommittee on Health held ahearing (TRP analysis) to discuss several bills related to public health efforts. The legislation addressed several topics, spanning from foreign interference in U.S. biomedical research to women’s health and equity issues, including uterine fibroids, clinical trial diversity, and maternal health care. Lawmakers also deliberated on measures that would improve access to telehealth and mobile health care, enhance pediatric research opportunities and trauma care planning, and improve community health care worker shortages.

In general, Democrats encouraged support for workforce and mobile health legislation, as well as clinical trial diversity. Conversely, Republicans focused their efforts on bills that would protect U.S. biomedical discoveries, circumvent foreign interference in U.S.-funded research, and secure intellectual property (IP). Members on both sides of the aisle mentioned their support for telehealth access, especially calling for reimbursement parity for audio-only telehealth visits.

House VA Considers Veteran Health Care Legislation

Last week, the House Veterans’ Affairs Subcommittee on Health held ahearing (TRP summary) to consider six pieces of legislation that address the health needs of veterans. Conversations between members and witnesses from the Department of Veterans Affairs (VA) and veteran organizations (VO) focused primarily on access to reproductive health services in addition to mental health services and suicide prevention for veterans. The VA witnesses largely supported the intent and goals of the bills being considered, however, they provided technical changes and suggestions, claiming duplicity of VA initiatives and a lack of clarity within the legislative language. The third panel of witnesses from VOs voiced the need to reduce barriers to health care and promote equity and inclusion within all services for veterans.

During the hearing, Democrats supported bills that would expand access to reproductive health services for veterans, while Republicans raised opposition to these policies and further promoted legislation to reduce costs for the VA and modernize VA health care eligibility requirements. While the discussion around reproductive health services remained partisan, bipartisan agreement arose around the necessity to reduce veteran suicide rates.

House Appropriations Committee Marks Up FY 2023 Labor-HHS-Education Funding Bill

On Thursday, the House Appropriations Committee held amarkup (TRP analysis) of the Labor, Health and Human Services (HHS), Education, and Related Agencies (Labor-HHS-Education) fiscal year (FY) 2023 appropriations legislation (bill text; press release; bill report). The bill would provide $242.1 billion for the Departments, representing a $28.5 billion increase — roughly 13 percent — over FY 2022. Within the bill, $124.2 billion is directed towards HHS, which is $15.6 billion over FY 2022 enacted levels and $298 million below President Biden’s FY 2023 request. This bill includes provisions which seek to: (1) create jobs; (2) invest in education, childcare, and research; (3) bolster public health infrastructure; and (4) advance equal treatment for women. Despite Republican opposition to the proposed spending measure, the bill as amended was reported favorably out of the Committee by a vote of 32-24, along party lines. Throughout the hearing, 14 amendments in total were offered, of which four were adopted by voice vote.

House Energy and Commerce Discusses Oversight of Private Sector Medicare Advantage Plans

Also last week, the House Energy and Commerce Subcommittee on Oversight and Investigations held ahearing (TRP analysis) to consider the inner workings of the Medicare Advantage (MA) program and the value that such plans provide to beneficiaries as currently structured. Members and witnesses were largely critical of the practices of MA plans as compared to traditional Medicare fee-for-service (FFS) plans, noting that MA plans enjoy a work-around of sorts that allows them to utilize internal clinical coverage criteria that go beyond the scope of Medicare coverage rules in certain circumstances. While both Democrats and Republicans to this opportunity to vent various critiques of the MA program and its real world implementation, Republicans were generally less interested in encouraging a complete overhaul of the program. 

Throughout the duration of the hearing, members examined the quality of care that seniors receive through MA plans, pointing towards barriers to access to services that presumably result from utilization management techniques — namely prior authorization and step therapy. Notably, bipartisan support emerged for the implementation of electronic prior authorization. Witnesses additionally provided several recommendations for the Centers for Medicare and Medicaid Services (CMS) in seeking to improve the MA program.

CMS Issues Updates to Guidance on Minimum Health and Safety Standards for LTC Facilities

The Centers for Medicare and Medicaid Services (CMS) issued updates toguidance (TRP analysis; fact sheetpress release) on minimum health and safety standards that long-term care (LTC) facilities must meet in order to participate in Medicare and Medicaid. These updates can be found in the State Operations Manual (SOM) Appendix. Notably, the guidance updates arbitration agreements and encourages nursing homes to reduce the number of patients per room. While CMS continues to review responses to its April request for information (RFI) related to nursing home staffing regulations, last week’s guidance requires surveyors to consider Payroll-Based Journal (PBJ) staffing data in its evaluations in an effort to improve inspections surrounding facility staffing based on such payroll data. Following the comment period, CMS will consider public input and will move to finalize the rule — possibly with modifications — in the Fall of 2022.

In light of high rates of nursing home deaths during the COVID-19 pandemic, the Biden administration released a plan in February to improve safety in LTC facilities. Last week’s updates from CMS are in line with this initiative. In the accompanying press release, CMS Administrator Chiquita Brooks-LaSure said that “as the COVID-19 pandemic highlighted, we have a pressing moral responsibility to ensure that residents of long-term care facilities are treated with the respect and dignity they deserve.”