McDermott+Consulting is pleased to provide the McDermottPlus Check-Up, your regular update on health care policy from Washington, DC.

This Week’s Dose

President Biden delivered his first State of the Union address, which outlined a number of health-related priorities, including: lowering drug prices, making increased ACA subsidies permanent,  addressing mental health needs, greater scrutiny of nursing homes and a continued emphasis on COVID-19.  The House and Senate were in session this week and continued work on FY 2022 omnibus appropriations and the new need for funding for Ukraine.

Congress

President Biden Delivers State of the Union.  On March 1, President Biden delivered his first State of the Union address.  While the President did not specifically address the sidelined Build Back Better (BBB) Act, he emphasized a number of its components and also utilized the opportunity to reframe his healthcare policy priorities, including:

• Addressing nursing home qualify and safety by outlining a minimum nurse staffing ratio and increasing Medicare oversight.  More details can be found in this  February 28 announcement by the White House.

• Expanding access to mental health services by increasing funding for prevention, treatment, and recovery to beat the opioid pandemic; holding social media platforms accountable for harm to children by strengthening privacy protections, banning targeted advertising and preventing collection of personal data; enforcing mental health parity.  More details can be found in this March 1 announcement outlining a mental health strategy to strengthen America’s capacity and create healthier environments.

• Continuing to mitigate COVID-19 by adopting additional anti-viral treatments; launching a “Test to Treat” initiative; and announcing that the Department of Justice will name a chief prosecutor to oversee pandemic fraud cases.

• Funding the Cancer Moonshot and ARPA-H to cut the cancer death rate by 50% over 25 years and calling on Congress to fund the Advanced Research Projects Agency for Health (ARPA-H).

• Lowering prescription drug prices, specifically by allowing Medicare to negotiate drug prices. 

• Improving the Affordable Care Act by making permanent Advance Premium Tax Credits included in the American Rescue Plant Act.

The address highlighted many of the priorities that we can expect to see in the President’s annual budget that is anticipated later this month or in early April.  In the coming weeks, additional details and opportunities for stakeholder feedback are also expected to be announced.  Components of many of these proposals can be implemented through administrative authority, but others require Congressional action.

Manchin Talks About a Reconciliation Deal.  Senator Joe Manchin (D-WV) announced in an interview on March 2 that he is drafting a counteroffer package to the BBB that emphasizes deficit reduction by enacting prescription drug savings and tax reform and using some of those revenues to fund climate and social programs.  Expectations are that Manchin’s bill will not come close to the original package's $1.7 trillion price tag, but the changes could be significant, nonetheless. 

Congress Scrambles to Meet FY 2022 Appropriations Deadline.  Congress returned from recess and continued work on an omnibus appropriations bill to fund the government for the rest of FY 2022.  Congress has until March 11 to pass a funding bill or face a government shutdown.

House Majority Leader Steny Hoyer (D-MD) announced this week that he wants to see the House take up a package as soon as March 8, and while progress has been made, lawmakers hit snags related to supplemental funding for Ukraine and other areas.  The Administration has requested $10 billion in additional funds for Ukraine and dialed back their COVID ask from $35 billion to $22.5 billion. They have also signaled that more will likely be needed for both down the road. Agreements are not final on these fronts nor on other additions like potential extensions of healthcare-related flexibilities that are tied to the Public Health Emergency (PHE).  We continue to monitor this situation closely, with the expectation that developments in these areas may occur in the coming days.

Administration

White Houses Unveils Next Phase of Pandemic Response.  The Administration on March 2  released its National Covid-19 Preparedness plan, a 96-page document that outlines the Administration’s strategy to combat the pandemic in a way that “does not disrupt our daily lives.”  The plan coalesces around four key goals: protecting against and treating COVID-19, preparing for new variants, preventing economic and educational shutdowns, and continuing to lead the effort to vaccinate the world and save lives.  To be fully effectuated, this plan requires Congress to fund programs that were announced in the President’s State of the Union Address, but the Administration has existing authority to implement much of the plan.   

CDC Relaxes Masking Guidance. The Centers for Disease Control and Prevention (CDC) released updated masking guidance on February 25, making masks now optional for low transmission areas as well as throughout the Capitol, as COVID-19 trends down significantly. CDC Director Rochelle Walensky said in a press conference this week that guidance is subject to change and the agency plans to update its policy based on transmission rates and hospitalization capacity.  The White House also announced that it is evaluating whether masks will continue to be required on airplanes and other public transit, as the Transportation Security Administration (TSA) mask mandate is set to expire mid-month.

President Biden Announces Supreme Court Nominee. Judge Ketanji Brown Jackson, a former defender and judge on the D.C. Circuit Court of Appeals, was nominated to succeed retiring Justice Stephen Breyer.  If confirmed, Jackson will be the first Black woman to serve on the nation’s highest court. She kicked off her appearance on Capitol Hill this week by meeting with the Senate Majority and Minority leaders as well as Members of the Senate Judiciary Committee.  Senate Majority Leader Chuck Schumer (D-NY) hopes to have Jackson confirmed before the Senate’s spring recess in April.

CMS Aims to Curb Mass Medicaid Disenrollment Post-PHE. In a letter to state officials, CMS has provided additional guidance and toolkits to states on how to address the Medicaid eligibility redetermination and renewal process once the COVID-19 PHE ends.

As background, under the Families First Coronavirus Response Act (FFCRA) states qualify for the temporary Federal Medical Assistance Percentage (FMAP) by satisfying a “continuous enrollment condition” for most Medicaid beneficiaries who were enrolled in the program as of or after March 18, 2020. States are required to keep these beneficiaries enrolled in Medicaid during the PHE to maintain the increase FMAP.  However, with the eventual ending of the PHE, additional guidance was needed for states to reprocess Medicaid eligibility.  In the letter released Thursday, CMS said it would give Medicaid programs 14 months to complete redetermination and process renewals once the PHE ends, an increase from the original 12 months announced last August.  The agency recommends states only process one ninth of their total renewal caseload in a given month.  CMS has had concerns with states that have indicated plans to move quickly through the reenrollment process once the PHE ends. 

Quick Hits

• The Centers for Medicare and Medicaid Services (CMS) released on February 28 the Part D Senior Savings (PDSS) Model Calendar Year (CY) 2023 Sponsor Request for Applications.  The program, designed to provide Medicare beneficiaries with Part D plan choices that offer insulin at an affordable price, has entered its third year.  The PDSS Team will host a webinar on March 9, to provide an overview of the model and application process, registration is required to attend.  The application deadline for new Part D Sponsors and those already participating is Friday, April 8, 2022.

• The House Energy and Commerce Subcommittee on Oversight and Investigations held a hearing on “Lessons from the Frontline: COVID-19's Impact on American Health Care”.  The hearing was focused on how providers, patients, and the healthcare system as a whole can prepare for future COVID variants and future public health emergencies, based on lessons learned over the past two years.

• The House Ways and Means Committee held a hearing on “Substance Use, Suicide Risk, and the American Health System.” The hearing was focused on mental health issues, substance use disorders, overdose deaths, and suicides, all of which have been exacerbated by the COVID-19 pandemic.

• The House Energy and Commerce Committee Chairman Frank Pallone (D-NJ) and House Education and Labor Committee Chairman Bobby Scott (D-VA) introduced legislation entitled “No Surprises for COVID-19 Tests Act” on February 25. The legislation would extend the PHE-related mandate that commercial insurance plans cover COVID-19 diagnostic testing with no patient cost-sharing through January 1, 2024; ensure that commercial patients do not receive surprise medical bills for COVID testing; sunsets the CARES Act provision that allows providers to bill commercial payers at any publicly-posted “cash price.”  

• The Senate voted (49-44) on March 2 to roll back President Biden’s vaccine mandate for healthcare workers. While the vote is largely symbolic and unlikely to pass with Democrats in the House majority, vaccine mandates, among other things, are expected to be a key rallying cry for Republicans in the midterm elections.

• Senate Republicans used a technical process to bring a joint resolution to the floor to end the COVID-19 PHE.  Due to absences, it passed the Senate by a vote of party line vote of 48-47 on March 3. While the bill is unlikely to pass the Democratic-controlled House, it marks the second symbolic vote by Senate Republicans in just two days to rebuke the Biden Administration’s pandemic policies.

• An article published in Health Affairs, entitled “CMS Innovation Center Launches New Initiative to Advance Health Equity,” outlines the Center’s activities, including developing new models to promote and incentivize equitable care, increasing participation of safety net providers, increasing collection and analysis of equity data, and evaluating health equity impact. Additionally, the Center will host an equity-focused roundtable event on March 16, 2022, to discuss how CMS can support safety net providers in value-based care and CMS Innovation Center models.

• The Department of Health and Human Services (HHS) posted in a Federal Register notice on March 3 that it will delay implementation of the “Securing Updated and Necessary Statutory Evaluations Timely (SUNSET) rule” until September 22, 2022, giving the agency more time to complete a review of the rule amid ongoing litigation.  This rule would require agency review of rules every ten years or the rules would expire.  This delay may signal the Trump era rule will never be implemented.

• Next Week’s Diagnosis

  The House is scheduled to be in session Monday through Thursday and the Senate Monday through Friday. The main focus will be on passing an omnibus package before the Friday, March 11 deadline to avoid a government shutdown.