Weekly Roundup: February 10, 2023

Our team of experts at Healthsperien are proactively working to support your organization’s ongoing strategic objectives by providing real-time policy updates and analysis, strategic insights, legislative and regulatory advocacy.

Don’t forget to visit our Resources page and follow us on our social media channels.

LinkedIn | Twitter | YouTube 

Senators Crapo and Cardin Outline Senate Finance Committee Priorities and Staff

Today, Politico reported Senator Mike Crapo’s (R-ID) healthcare policy priorities as he prepares to serve as the new Ranking Republican on the Senate Finance Committee.  Senator Crapo mentioned targeting rising healthcare costs, frontline provider shortages, the need for long-term reforms to improve telehealth access for seniors with high-deductible plans, Medicare payment reforms in line with the success of the Medicare Advantage model, and providing oversight of the Inflation Reduction Act’s drug price negotiation program. Senator Crapo’s new Finance Committee health care team includes:

  • Rebecca Alcorn, policy adviser
  • Gable Brady, senior health policy adviser
  • Erin Dempsey, deputy health policy adviser
  • Kellie McConnell, health policy director
  • Stuart Portman, senior health policy adviser
  • Charlotte Kaye Rock, health policy adviser
  • Conor Sheehey, senior health policy adviser

Senator Ben Cardin (D-MD) was also announced as the chair of the Senate Finance Committee’s health care subcommittee. He also supports expanding telehealth access, in addition to prioritizing behavioral health, expanding coverage for oral healthcare in both Medicare and Medicaid, and coordinating with the Senate Foreign Relations Committee to curb fentanyl trafficking. Senator Debbie Stabenow (D-MI) chaired the subcommittee in the previous Congress and remains on the subcommittee. Senator Steve Daines (R-MT) remains as the subcommittee’s ranking member.

HHS Releases COVID-19 Public Health Emergency Transition Roadmap

Yesterday, the Department of Health and Human Services (HHS) released a roadmap detailing their transition plan for the unwinding of the COVID-19 Public Health Emergency (PHE). Specifically, the Department clarifies policies that will be affected by the unwinding and those that will not.

HHS stated that certain Medicare and Medicaid waivers and broad flexibilities for providers are no longer necessary and will end. States, hospitals, nursing homes, and others are currently operating under hundreds of waivers, which were deemed necessary to expand facility capacity for the health care system; given the current state of COVID-19, HHS notes this excess capacity is no longer necessary.

HHS highlighted there will be continued access to pathways for emergency use authorizations (EUAs) for COVID-19 products (tests, vaccines, and treatments) through the Food and Drug Administration. In addition, major telehealth flexibilities will continue to exist for those participating in Medicare or Medicaid. Most Medicare telehealth flexibilities will continue through December 2024 due to the Consolidated Appropriations Act, 2023. HHS also emphasized that Medicaid telehealth flexibilities will not be affected as states already have significant flexibility with respect to covering and paying for Medicaid services delivered via telehealth. Medicaid programs will continue to cover COVID-19 treatments without cost sharing through September 30, 2024.

CMS Examines Ways to Address Rural Health Inequities in New Blog Post

Today, the Centers for Medicare and Medicaid Services (CMS) released a blog post on addressing rural health inequities in Medicare, which is an element of their larger work to improve health equity and reflected in their Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated Communities. The 61 million Americans who live in rural, tribal, and geographically isolated communities across the United States are more likely to have heart disease, stroke, cancer, unintentional injuries, suicide risk, chronic lung disease, and higher death rates from COVID-19 than urban Americans.  

The authors detail a three-pronged approach and specific policies that aim to improve access to high-quality, coordinated care for people in rural communities, which include 1) supporting rural providers, 2) expanding access to care in rural areas, and 3) transforming the rural health delivery system. Importantly, they note that partnerships with rural health providers, rural communities, beneficiaries, caregivers, and other payers, like Medicaid, will be essential in their approach.  

Execution Action
  • On Tuesday, President Biden gave his first State of the Union Address to a divided Congress. President Biden plans to revisit the Unity Agenda he laid out during his first State of the Union Address. His remarks will highlight steps Congress and the Administration have already taken towards the four goals identified last year as well as new policies to continue advancing the agenda, which include accelerating progress to end cancer as we know it today, supporting America’s veterans and their families, caregivers, and survivors, tackling the mental health crisis, and beating the opioid and overdose epidemic. 
Administrative Action
  • On Thursday, HHS released a roadmap detailing their transition plan for the unwinding of the COVID-19 Public Health Emergency (PHE). The Department clarified policies that will be affected and those that are not. HHS highlighted there will be continued access to pathways for emergency use authorizations (EUAs) for COVID-19 products (tests, vaccines, and treatments) through the FDA, and major telehealth flexibilities will continue to exist for those participating in Medicare or Medicaid. Medicaid programs will continue to cover COVID-19 treatments without cost sharing through September 30, 2024.  
  • CMS announced that they are beginning to update their CMS Emergencies Page with resources to help providers and states as the COVID-19 public health emergency (PHE) declaration ends. The Biden Administration announced that it intends to allow the COVID-19 national emergency declaration to expire on May 11, 2023. CMS and states implemented numerous flexibilities to preserve access to essential health care during the PHE. The Consolidated Appropriations Act of 2023 extended several key telehealth and Acute Hospital Care at Home waivers beyond the end of the PHE, but other flexibilities are still set to expire with the PHE declaration. CMS states they will continue to update the resources on the emergencies page as the end of the PHE approaches. 
  • On Thursday, CDC and Prevention Advisory Committee on Immunization Practices (CDC ACIP) released updated vaccination schedules for children and adolescents as well as adults that include COVID-19 vaccines. CDC generally recommends healthy adults and children receive two doses of the vaccine followed by a booster dose, and immunocompromised individuals should receive three doses of the vaccine followed by a booster. The updated vaccination schedule has been approved by the American Academy of Pediatrics, American Academy of Family Physicians, and other leading medical associations. However, states and local governments are not mandated to require the complete vaccination schedule for students, so some school districts still may not require COVID-19 vaccinations. 
Congressional Action
  • Recently, 74 House lawmakers sent a letter to Department of Health and Human Services (HHS) Secretary, Xavier Becerra and Centers for Medicare & Medicaid Services (CMS) Administrator, Chiquita Brooks-LaSure, urging Medicare to reconsider its determination of certain Alzheimer’s drugs, including the newly approved Leqembi. Representatives noted they are encouraged that CMS is open to reconsidering the National Coverage Determination (NCD) of monoclonal antibodies treating Alzheimer’s and other dementia, and hope Coverage with Evidence Development (CED) requirements for Food and Drug Administration (FDA)-approved monoclonal antibodies (mAbs) directed against amyloid for the treatment of Alzheimer’s disease will be reconsidered.  
  • Health Affairs published an article on potential payment for comprehensive dementia care. More than 6.5 million older Americans are living with Alzheimer’s disease today, a number projected to double by 2050. The Alzheimer’s Association estimates that Medicare spent $146 billion on Alzheimer’s disease in 2022.  
  • CMS announced (fact sheet) the release of two guidance documents implementing the Inflation Reduction Act (IRA) inflation rebate provisions for both Medicare Part B and Medicare Part D drugs. The guidance documents specify the initial requirements and procedures for implementation of the program. Under the IRA, drug companies will be required to pay rebates to Medicare when drug prices rise higher than the rate of inflation. Comments on the guidance are due March 11, 2023. 
  • On Wednesday, the Center for Health Care Strategies and Association for Community Affiliated Plans jointly released a new report reviewing how twelve states have utilized Medicaid managed care organizations (MCOs) to address the health-related social needs (HRSN) of beneficiaries. The report also notes that states are increasingly using value-based payment or community reinvestments to direct Medicaid funding from managed care organizations to providers and community-based organizations to support their SDOH-related activities. Finally, the report offers recommendations on how federal policymakers and the CMS can continue to support states and MCOs, which include continuing to use Medicaid funds to expand access to HRSN services, supporting accurate medical loss ratio (MLR) reporting and capitation rates, and allowing states to test new approaches to financing HRSN services and infrastructure.  
  • Last month, the Medicaid and CHIP Payment and Access Commission (MACPAC) held its January policy meeting. The Commissioners discussed several issues related to Medicaid payment policy. Healthsperien was there to cover the January MACPAC meetings. Click here to access Healthsperien’s comprehensive summary. 
  • On Tuesday, a Federal District court ruled in favor of the Texas Medical Association (TMA) that a final rule on the independent dispute resolution (IDR) process conflicts with the Administrative Procedure Act. In August 2022, the Administration had issued a rule that directed arbiters to consider all factors listed in statute when determining the payment amount but still ensure these additional factors are not incorporated into the Qualifying Payment Amount. The Federal District Court agreed with the plaintiffs that the updated rule continues to favor insurers. TMA has filed four lawsuits challenging the implementation of the No Surprises Act, and this is the second time the same court has decided in favor of TMA.  
  • A recent survey commissioned by the Alliance for Women’s Health and Prevention (AWHP) found that 45 percent of American women skip preventative care services including check-ups, cancer screenings and vaccinations, often due to the cost of care. The poll found that the top two reasons that women skipped care were out-of-pocket costs (25 percent) and time restraints (23 percents). The study found that social determinants of health contribute to disparities in preventative care. The survey comes as the Affordable Care Act requirement that insurers cover preventive services that are “A” or “B” grade by the U.S. Preventive Services Task Force cost-free is at risk due to a pending district court decision in Braidwood v. Becerra. 
Scroll to Top