Both chambers of Congress will return to Washington after the November 8 midterm elections. The next votes in the House and Senate are scheduled to occur during the week of November 14.<\/p>\n\n\n\n\n\n\n\n
HHS Extends COVID-19\nPHE for Another 90 Days<\/strong><\/p>\n\n\n\n On Thursday, Department\nof Health and Human Services (HHS) Secretary Xavier Becerraannounced<\/a> an extension\nof the COVID-19 public health emergency (PHE) for an additional 90 days.\nEffective October 13, 2022,<\/strong> this extension marks the continuation\nof several temporary authorities afforded under the PHE, including continuous\nenrollment requirements, waivers of telehealth restrictions, and additional\nfederal medical assistance percentage (FMAP) increases, among other items. <\/p>\n\n\n\n Former HHS Secretary\nAlex Azar issued a PHE declaration<\/a> on\nJanuary 27, 2020, for COVID-19 and renewed it four times until the\nadministration changed. Secretary Xavier Becerra has renewed the PHE an\nadditional seven times, including last week\u2019s announcement. For more detail\nabout Medicare- and Medicaid-specific flexibilities afforded under the\nCOVID-19 PHE, read TRP’s Special Report<\/a> outlining\nthese provisions. <\/p>\n\n\n\n CMS Announces Medicare\nDrug Rebate and Negotiations Group<\/strong><\/p>\n\n\n\n Last week, the Centers\nfor Medicare and Medicaid Services (CMS)announced<\/a> (TRP analysis<\/a>) the\nreorganization of the Center for Medicare to establish a new Medicare Drug\nRebate and Negotiations Group. This new group will run point on implementing\nseveral key policy provisions in the Inflation Reduction Act (IRA<\/a>), including the Drug\nPrice Negotiation Program and the Medicare Parts B and D Inflation Rebate Program.\nAccording to the notice, the group will be responsible for negotiating drug\nprices with manufacturers each year by identifying eligible drugs for\nnegotiation. <\/p>\n\n\n\n This effort will\nrequire the group to create processes for: (1) entering into agreements with\nmanufacturers; (2) collecting data; (3) calculating fair prices and ceilings;\nand (4) renegotiating prices. Regarding CMS\u2019 inflationary rebate\nresponsibilities, the Medicare Drug Rebate and Negotiations Group is instructed\nto \u201cidentify the universe of rebatable drugs,\u201d identify drug prices rising\nfaster than inflation, and track and invoice manufacturers\u2019 rebates. More\nguidance and opportunities for stakeholder engagement regarding implementation\nare expected to be released in the coming weeks and months.<\/p>\n\n\n\n Biden Calls on CMMI to\nLower Drug Prices, Explore Value-Based Care<\/strong><\/p>\n\n\n\n On Friday, President\nBiden issued an Executive Order (EO<\/a>) to \u201ccomplement\u201d\nhealth care policies in the Inflation Reduction Act (IRA). The EO directs the\nDepartment of Health and Human Services (HHS) to consider testing new health\ncare payment and delivery models within the Center for Medicare and Medicaid\nServices (CMS) innovation center (CMMI). Specifically, HHS is tasked with\nidentifying potential CMMI models that would lower the cost of prescription\ndrugs and improve access to \u201cinnovative drug therapies.\u201d President Biden\u2019s EO\nalso instructs HHS to examine the merit of models that would reduce beneficiary\ncost-sharing for drugs with high utilization and models that would support\nvalue-based payment (VBP) arrangements to improve the quality of care. <\/p>\n\n\n\n Some Democrats worry\nthat manufacturers and other drug industry stakeholders may find pathways\naround IRA regulations, and the EO assuages those concerns by signaling the\nBiden administration\u2019s commitment to keeping costs at bay through its executive\npower. Last year, CMMI Director Liz Fowler said that CMS would wait to act on\nnew payment models until Congress passed its drug pricing package. Since the\nlegislative package has a comparatively limited effect on Medicare Part B, some\ninsiders suggest that Part B payment structure would be an obvious area for\nCMMI to address. The agency may also consider applying the $35 insulin cap to\nother drugs that treat chronic conditions. HHS has until December 12, 2022, to\ncraft a report for the Assistant to the President for Domestic Policy in\nresponse to the EO.<\/p>\n\n\n\n Treasury, IRS Fix ACA\n\u201cFamily Glitch\u201d to Improve Health Care Coverage Access, Affordability<\/strong><\/p>\n\n\n\n Just after the\nColumbus Day\/Indigenous Peoples Day break, the Treasury Department and the\nInternal Revenue Service (IRS) issued a final rule<\/a> (TRP analysis<\/a>; press release<\/a>) that\nexpands eligibility for premium tax credits (PTC) to assist individuals and <\/em>their\nfamilies in purchasing health insurance coverage through the Affordable Care\nAct (ACA) Marketplace. The \u201cfamily glitch\u201d refers to an interpretation of the\nACA in which eligibility for PTCs to purchase market-based coverage is\ndetermined by the cost for the individual employee, not the employee\u2019s family. <\/p>\n\n\n\n In addition to the\nstandard comment collection process, the agencies held a public hearing to\ngarner feedback on the proposed rule. In response to public input, the\nagencies finalized the family glitch regulations as proposed. Department of\nHealth and Human Services (HHS) Secretary Xavier Becerra predicted that this\nregulatory change will improve health plan access and affordability for about\none million U.S. residents. HHS is also considering targeted outreach to\nconsumers ahead of the 2023 plan year. <\/p>\n\n\n\n