Health Care Checkup
April 29, 2022
THE BIG PICTURE
Congress returned from spring recess this week and there was a flurry of both legislative and administrative activity. Congress held several hearings on President Joe Biden’s fiscal year (FY) 2023 budget proposal. On Wednesday, the House Energy and Commerce Subcommittee on Health held a hearing with HHS Secretary Xavier Becerra to discuss the Administration’s HHS budget request for FY 2023. Topics covered at the hearing ranged from drug pricing to climate change. The hearing also delved into the President’s $5 billion request for the Advanced Research Projects Agency for Health, ARPA-H, as well as the President’s Cancer Moonshot initiative. MCRT’s full summary of the hearing can be found here.

On Thursday, the House Ways and Means Committee also held a hearing with HHS Secretary Becerra to discusses the FY 2023 budget proposal. At the W&M hearing, House Republicans expressed concern over the potential for Part A of the  Medicare trust fund to become insolvent by 2026.

The HHS Office of Inspector General (OIG) released a new report this week. The report found that Medicare Advantage Organizations (MAOs) sometimes “delayed or denied Medicare Advantage beneficiaries’ access to services, even though the requests met Medicare coverage rules.” The report also found that MAOs denied payments to providers for some services that met “both Medicare coverage rules and MAO billing rules.” Insurers responded that the vast majority of MA prior authorization requests are approved. The full report can be found here.

HHS released the Notice of Benefit and Payment Parameters for 2023 final rule. The rule “makes regulatory changes in the individual and small group health insurance markets and establishes parameters and requirements issuers need to design plans and set rates for the 2023 plan year.” These measures include advancing standardized plan options, implementing new network adequacy requirements, increasing value and access, removing barriers to coverage, expanding access to essential community providers, and streamlining HealthCare.gov. The press release can be found here and the fact sheet can be found here.

On Wednesday, the Biden Administration sounded the alarm for the urgent need of additional COVID-19 aid. The Administration warned that the consequences of Congress’ inaction to pass an additional funding package include fewer vaccines, treatments, and tests. As a reminder, just before Congress left for spring recess, Senate Majority Leader Chuck Schumer (D-NY) announced that the Senate had reached a $10 billion deal on an additional COVID-19 funding package. However, progress on the bill stalled due to opposition to the Biden Administration’s announcement that it will end the Trump-era Title 42 Order that allowed for border agents to turn migrants at the border away. Since Congress’ return from recess this week, no real progress on the package has been made.

On Tuesday, the Biden Administration announced a new set of efforts to help ensure Americans can easily access COVID-19 treatments. These efforts include nearly doubling the number of places oral antivirals are available, launching additional federally-supported Test-to-Treat sites, providing medical clinicians with more guidance and tools to understand and prescribe treatments, and educating the public on the COVID-19 treatments that are widely available. The Administration’s fact sheet on these new initiatives can be found here.
 
Also this week, the Medicaid and CHIP Payment and Access Commission (MACPAC) named Kate Massey as its new executive director. Massey is currently the director of the Medicaid program in Michigan and will start in her new role later next month.
What to Expect Next Week: Next week, the Senate will be in session, but the House will not be.
DEEP DIVE
Biden Administration Sounds Alarm for Urgent COVID-19 Funding Need
 
On Wednesday, the Biden Administration released a fact sheet highlighting the urgent need for additional COVID-19 response funding and the “severe consequences of congressional inaction.” The Administration said that the consequences of Congress’ inaction include fewer vaccines, treatments, and tests. As a reminder, just before Congress left for spring recess, Senate Majority Leader Chuck Schumer (D-NY) announced that the Senate had reached a $10 billion deal on an additional COVID-19 funding package. However, progress on the bill stalled due to opposition to the Biden Administration’s announcement that it will end the Trump-era Title 42 Order that allowed for border agents to turn migrants at the border away. Since Congress’ return from recess this week, no real progress on the package has been made.

New HHS OIG Report Finds that Medicare Advantage Plans Frequently Deny Medically Necessary Care
 
A new report released by the HHS Office of Inspector General (OIG) this week found that Medicare Advantage Organizations (MAOs) sometimes “delayed or denied Medicare Advantage beneficiaries’ access to services, even though the requests met Medicare coverage rules.” The report also found that MAOs denied payments to providers for some services that met “both Medicare coverage rules and MAO billing rules.” Based on the findings, OIG recommends that CMS issue new guidance on the appropriate use of MAO clinical criteria, update its audit protocols, and direct MAOs to take steps to identify vulnerabilities that can lead to system errors. Insurers responded that the vast majority of MA prior authorization requests are approved. The full report can be found here.
 
Biden Administration Announces New Efforts to Help Increase Access to COVID-19 Treatments
 
On Tuesday, the Biden Administration announced a new set of efforts to help ensure Americans can easily access COVID-19 treatments. These efforts include nearly doubling the number of places oral antivirals are available, launching additional federally-supported Test-to-Treat sites, providing medical clinicians with more guidance and tools to understand and prescribe treatments, and educating the public on the COVID-19 treatments that are widely available. The Administration’s fact sheet on these new initiatives can be found here.
 
HHS Announces New Policy to Improve Access to Coverage and to Make Coverage More Affordable

On Thursday, the Department of Health and Human Services (HHS) released the Notice of Benefit and Payment Parameters for 2023 final rule. The rule “makes regulatory changes in the individual and small group health insurance markets and establishes parameters and requirements issuers need to design plans and set rates for the 2023 plan year.” These measures include advancing standardized plan options, implementing new network adequacy requirements, increasing value and access, removing barriers to coverage, expanding access to essential community providers, and streamlining HealthCare.gov. The press release can be found here and the fact sheet can be found here.

House Energy and Commerce Health Subcommittee Holds Hearing with Secretary Xavier Becerra on Biden Administration’s FY 2023 Budget Request

On Wednesday, the House Energy and Commerce Subcommittee on Health held a hearing to discuss President Biden’s HHS Budget request for fiscal year 2023. Topics covered at the hearing ranged from drug pricing to climate change. Full Committee Chairman Frank Pallone (D-NJ) said that “the impact and ongoing response to COVID-19 has helped to crystalize the importance of adequately funding public health and I am pleased the budget makes critical investments in our public health infrastructure.” Additionally, several members expressed dissatisfaction over the Administration’s plan to end the Trump-era Title 42 border policy, and Subcommittee Chairwoman Anna Eshoo (D-CA) told Becerra “You have a responsibility to plan … so that there is not any public health disaster relative to those at the border.” The hearing also delved into the President’s $5 billion request for the Advanced Research Projects Agency for Health, ARPA-H, which Eshoo said holds the potential for transformational, advanced, biomedical research to address diseases like Alzheimer's, diabetes, cancer, and ALS. Eshoo told HHS Secretary Xavier Becerra that she disagrees with his decision to place ARPA-H within the National Institutes of Health (NIH). Representative Nanette Barragán (D-CA) asked Becerra how cancer moonshot could expedite research to improve the lives of people with rare, aggressive diseases. Becerra said that HHS is trying to help launch President Biden’s moonshot proposal by getting people back into doctor's offices to get screened. Becerra’s full written testimony can be found here, and MCRT’s summary of the hearing can be found here
SENATE HEARINGS AND EXECUTIVE SESSIONS
Senate Homeland Security and Governmental Affairs Committee - Hearing
Permanent Subcommittee on Investigations: "Medical Mistreatment of Women in ICE Detention."
Tuesday, April 5 at 10:00 AM ET
HOUSE HEARINGS AND EXECUTIVE SESSIONS
N/A
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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