Health Care Checkup
December 2, 2022
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Please note: This updated version includes a new story regarding a pending rule at OMB on prior authorizations.
On Wednesday, House Democrats elected Rep. Hakeem Jeffries (NY) to be Minority Leader for the 118th Congress. Jeffries will make history as the first Black person to fill the role. Rep. Katherine Clark (MA) was elected as Whip and Rep. Pete Aguilar was elected as Caucus Chair. Rep. Ted Lieu (CA) was elected to replace Aguilar as Vice Chair. On Thursday, Rep. Jim Clyburn (SC) was elected Assistant Minority Leader, after his challenger, Rep. David Cicilline (RI), dropped out of the race.
Senate Finance Committee Chair Ron Wyden (D-OR), Ranking Member Mike Crapo (R-ID) and Senate Finance Committee members Michael Bennet (D-CO) and Richard Burr (R-NC) released a discussion draft aimed at strengthening mental health parity in Medicare and Medicaid and improving access to mental health and substance use disorder (SUD) services.
Stakeholders, including the American Hospital Association (AHA) and the American Medical Association (AMA), wrote a letter to Congressional leaders, urging Congress to prevent the Statutory Pay-As-You-Go Act of 2010 (Statutory PAYGO) sequester from taking effect in 2023. If Congress does not prevent the sequester from taking effect, there will be a 4% reduction in Medicare spending in the new year. The letter can be accessed here.
The Office for Civil Rights (OCR) at HHS issued a bulletin to detail the requirements of HIPAA on covered entities and business associates when using online tracking technologies. The bulletin details “what tracking technologies are, how they are used, and what steps regulated entities must take to protect electronic protected health information when using tracking technologies to comply with HIPAA.”
HHS also released a proposed rule to better align substance use disorder (SUD) protections with the Health Insurance Portability and Accountability Act (HIPAA). The press release can be found here and the fact sheet can be found here.
CMS issued a request for information (RFI) to get stakeholder feedback on issues related to the Essential Health Benefits (EHB) under the Affordable Care Act (ACA). CMS is looking to gather information regarding benefits in health plans that are subject to the EHB requirements under the ACA. Comments must be submitted by January 31, 2023.
A proposed rule that would place new requirements on Medicare Advantage (MA) organizations, Medicaid managed care plans, Children’s Health Insurance Program (CHIP) managed care entities, state Medicaid and CHIP fee-for-service (FFS) programs, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs) is getting ready to clear the Office of Management and Budget (OMB). The new requirements aim to streamline the electronic prior authorization process.
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What to Expect Next Week: The House will take up the Respect for Marriage Act as early as Tuesday, which was revised and passed this week by a vote of 61 to 36 in the Senate, and send the bill to President Biden's desk. The House is also expected to take up the FY 23 National Defense Authorization Act (NDAA) sometime next week. The Senate will continue to focus on considering administration nominations.
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House Democratic Leadership Takes Shape for the 118th Congress
On Wednesday, House Democrats elected Rep. Hakeem Jeffries (NY) to be Minority Leader for the 118th Congress. Jeffries will make history as the first Black person to fill the role. Rep. Katherine Clark (MA) was elected as Whip and Rep. Pete Aguilar was elected as Caucus Chair. Rep. Ted Lieu (CA) was elected to replace Aguilar as Vice Chair. On Thursday, Rep. Jim Clyburn (SC) was elected Assistant Minority Leader, after his challenger, Rep. David Cicilline (RI), dropped out of the race. Additionally, Rep. Joe Neguse (CO) will Chair the Democratic Policy and Communications Committee, along with newly elected Co-Chairs Veronica Escobar (TX), Dean Phillips (MN), and Lauren Underwood (IL). Rep. Sara Jacobs (CA) will serve as the leadership representative for members serving five terms or less. Among the caucuses, Rep. Steven Horsford (NV) will serve as Chair of the Congressional Black Caucus and Rep. Annie Kuster (NH) won a closely contested race to Chair the House New Democrat Coalition. The Congressional Hispanic Caucus and Progressive Caucuses will have their elections in the coming weeks.
Electronic Prior Authorization Regulation Ready to Clear OMB
A proposed rule that would place new requirements on Medicare Advantage (MA) organizations, Medicaid managed care plans, Children’s Health Insurance Program (CHIP) managed care entities, state Medicaid and CHIP fee-for-service (FFS) programs, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs) is getting ready to clear the Office of Management and Budget (OMB). The new requirements aim to streamline the electronic prior authorization process.
Stakeholders Urge Congress to Avert PAYGO Sequester
Stakeholders, including the American Hospital Association (AHA) and the American Medical Association (AMA), wrote a letter to Congressional leaders, urging Congress to prevent the Statutory Pay-As-You-Go Act of 2010 (Statutory PAYGO) sequester from taking effect in 2023. The letter referenced the challenges health care providers are currently facing due to high inflation and workforce shortages, and expressed that, “Now is not the time for reductions in Medicare payments to providers.” If Congress does not prevent the sequester from taking effect, there will be a 4% reduction in Medicare spending in the new year. The letter can be accessed here.
Senators Wyden, Crapo, Bennet, and Burr Release Mental Health Parity Discussion Draft
Senate Finance Committee Chair Ron Wyden (D-OR), Ranking Member Mike Crapo (R-ID) and Senate Finance Committee members Michael Bennet (D-CO) and Richard Burr (R-NC) released a discussion draft aimed at strengthening mental health parity in Medicare and Medicaid and improving access to mental health and substance use disorder (SUD) services. More on these initiatives can be found here.
HHS Proposes Rule to Align SUD Protections with HIPAA
The Department of Health and Human Services (HHS), through the Office for Civil Rights (OCR) and the Substance Abuse and Mental Health Services Administration (SAMHSA), issued a proposed rule to update the Confidentiality of Substance Use Disorder (SUD) Patient Records under 42 CFR part 2 (“Part 2”). Part 2 “protects patient privacy and records concerning treatment related to substance use challenges from unauthorized disclosures.” Currently, Part 2 includes different protection requirements for SUD treatment records than the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. HHS noted that these differences can “create barriers to information sharing by patients and among health care providers and create dual obligations and compliance challenges for regulated entities.” Under the CARES Act, SUD privacy protections are required to be better aligned with the HIPAA Privacy rule. Proposed changes include “expanded prohibitions on the use and disclosure of Part 2 records in civil, criminal, administrative, and legislative proceedings,” and new patient rights. The press release can be found here and the fact sheet can be found here.
Nearly 3.4 Million People Have Enrolled in ACA Marketplace Plans Since November 1 when Open Enrollment Began for 2023
The Centers for Medicare and Medicaid Services (CMS) announced that approximately 3.4 million people have enrolled in an Affordable Care Act (ACA) Marketplace health plan since the start of the 2023 Marketplace Open Enrollment Period (OEP) on November 1. CMS reports that this number includes 19% of customers who are new to the Marketplace, and 81% who returned to renew or select a new plan for 2023. The OEP runs through January 15, 2023. Additional information can be found here.
White House Pushes Back on Senator Thune’s Proposed Medicare Cuts
Senate Minority Whip John Thune (R-SD) has been urging his Republican colleagues to use the debt limit increase to make cuts and changes to Social Security and other entitlement programs. Deputy White House press secretary Andrew Bates rejected Thune’s proposal, and said in a statement, “President Biden has been emphatic about wanting to work across the aisle to build on the progress he has made cutting costs for families, and the midterms showed that voters expect congressional Republicans to do the same. Telling the middle class out of the gate, before the new Congress has even begun, that working to override their will and hollow-out the benefits they have earned throughout their lives is a stone-cold nonstarter.” Midterm exit polling released by Navigator Research found that one of the most concerning potential outcomes of a House Republican majority for voters included ending the guarantee of Social Security and Medicare.
HHS Office for Civil Rights Releases Bulletin on Requirements under HIPAA for Online Tracking Technologies
The Office for Civil Rights (OCR) at HHS issued a bulletin to detail the requirements of HIPAA on covered entities and business associates when using online tracking technologies. The bulletin details “what tracking technologies are, how they are used, and what steps regulated entities must take to protect electronic protected health information when using tracking technologies to comply with the HIPAA.” Specifically, the bulletin gives examples of tracking on webpages and mobile apps, and compliance requirements for regulated entities when using tracking technologies. Additional information can be found here.
CMS Seeks Public Feedback on ACA Essential Health Benefits
CMS issued a request for information (RFI) to get stakeholder feedback on issues related to the Essential Health Benefits (EHB) under the Affordable Care Act (ACA). CMS is looking to gather information regarding benefits in health plans that are subject to the EHB requirements under the ACA. CMS is specifically looking for input on, “the description of the EHB, the scope of benefits covered in typical employer plans, the review of EHB, coverage of prescription drugs, and substitution of EHB.” Comments must be submitted by January 31, 2023.
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ADMINISTRATION ANNOUNCEMENTS |
Centers for Medicare & Medicaid Services
Food and Drug Administration
Guidance Documents from the Centers for Disease Control and Prevention
National Institutes of Health
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