Health Care Checkup
April 8, 2022
THE BIG PICTURE
On Thursday, the Senate voted 53-47 to confirm Judge Ketanji Brown Jackson as the next Supreme Court Justice of the United States. Jackson makes history as the first Black woman to be confirmed as a Supreme Court Justice. Three Republican Senators, Mitt Romney (R-UT), Lisa Murkowski (R-AK), Susan Collins (R-ME), crossed party lines to vote in favor of Jackson. Jackson will fill the vacancy that will be left by Justice Stephen Breyer, when he retires from the Court this summer.

Earlier in the week, Senate Majority Leader Chuck Schumer (D-NY) announced that the Senate had reached a $10 billion deal on an additional COVID-19 funding package. Much of the funding in the bill is earmarked for additional COVID vaccines, tests, and other therapies to treat the virus. However, progress on the bill has 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. Republicans, as well as various Democrats, are opposed to ending Title 42, and have said that they will not vote to pass the COVID legislation unless the Senate votes on an amendment requiring the Administration to keep Title 42 in effect. With Congress embarking on recess, we expect consideration of a covid supplemental package to resume at the end of April.

The Biden Administration released a proposal, which builds off of an ACA Executive Order from January 2021. The proposal would fix a longtime ACA loophole, known as the “family glitch.” The loophole has prevented approximately 5 million people from being able to use premium tax credits to purchase Marketplace plans. The Treasury Department and the Internal Revenue Service are proposing the new rule, and if the rule gets finalized, “family members of workers who are offered affordable self-only coverage, but unaffordable family coverage may qualify for premium tax credits to buy ACA coverage.” The Administration expects 200,000 uninsured people would gain coverage under the rule. More information can be found here.

Also on Thursday, CMS finalized a National Coverage Determination for coverage of Aduhelm and any future monoclonal antibodies directed against amyloid approved by the FDA with an indication for use in treating Alzheimer’s disease. The announcement from CMS can be found here and a fact sheet can be found here.

Additionally, CMS published a proposed rule in the Federal Register, which proposes to delay the current start date of the Radiation Oncology (RO) Model to a date to be “determined through future rulemaking.”
What to Expect Next Week: For the next two weeks, Congress will be in recess. Both chambers will return to session on April 25. 
DEEP DIVE
Senate Confirms Ketanji Brown Jackson as 116th U.S. Supreme Court Justice
On Thursday, the Senate voted 53-47 to confirm Judge Ketanji Brown Jackson as the next Supreme Court Justice of the United States. Jackson makes history as the first Black woman to be confirmed as a Supreme Court Justice. Three Republican Senators, Mitt Romney (R-UT), Lisa Murkowski (R-AK), Susan Collins (R-ME), crossed party lines to vote in favor of Jackson. Jackson will fill the vacancy that will be left by Justice Stephen Breyer, when he retires from the Court this summer. Jackson currently serves on the U.S. Court of Appeals for the District of Columbia Circuit. Jackson was born in D.C. and grew up in Miami. She attended Harvard College and Harvard Law School and clerked for Justice Breyer from 1999-2000.

Additional COVID Funding Legislation Stalls Over Opposition to Border Policy
Earlier in the week, Senate Majority Leader Chuck Schumer (D-NY) announced that the Senate had reached a $10 billion deal on an additional COVID-19 funding package. Much of the funding in the bill is earmarked for additional COVID vaccines, tests, and other therapies to treat the virus. However, progress on the bill has 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. Republicans, as well as various Democrats, are opposed to ending Title 42, and have said that they will not vote to pass the COVID legislation unless the Senate votes on an amendment requiring the Administration to keep Title 42 in effect. With Congress embarking on recess, we expect consideration of a covid supplemental package to resume at the end of April.

President Biden Directs HHS Secretary to Develop New Action Plan on “Long COVID”
On Tuesday, President Joe Biden released a memorandum, directing HHS Secretary Xavier Becerra to coordinate an interagency national research action plan on “Long COVID.” Long COVID is classified as “prolonged illness from COVID-19.” The Biden Administration expects that this new effort will advance the diagnosis and treatment of Long COVID, as well as provide supports for individuals dealing with Long COVID. The President’s memorandum also directs HHS to outline services across federal agencies to help support people with Long COVID, and people who are experiencing negative mental health issues related to the pandemic. A fact sheet on President Biden’s memo can be found here.

CMS Finalizes Medicare Coverage Policy for Monoclonal Antibodies
CMS finalized a National Coverage Determination for coverage of Aduhelm and any future monoclonal antibodies directed against amyloid approved by the FDA with an indication for use in treating Alzheimer’s disease. The announcement from CMS can be found here and a fact sheet can be found here.

CMS Releases CY23 Medicare Advantage and Part D Rate Announcement
CMS released its 2023 Medicare Advantage (MA) and Part D rate announcement. CMS expects MA plans to see an 8.5% increase in payment, which is higher than the agency’s prior 7.98% prediction. The growth rate for MA plans is expected to be 4.88%. For CY 2023, CMS is still finalizing the revised risk adjustment model for enrollees with End Stage Renal Disease (ESRD). The revised model will be calibrated on more recent data. Additional information can be found here.

New Medicare Initiative Will Cover up to Eight Over-the-Counter COVID-19 Tests Per Month
On Monday, the Centers for Medicare and Medicaid Services (CMS) announced that Medicare Advantage and Part B beneficiaries will be able to get up to eight free COVID tests per month from participating pharmacies and health care providers until the public health emergency (PHE) ends. A list of pharmacies and health providers participating in this initiative can be found here, and a fact sheet can be found here.

Biden Administration Proposes Rule to Fix ACA “Family Glitch”
Earlier this week the Biden Administration released a proposal, which builds off of an ACA Executive Order from January 2021. The proposal would fix a longtime ACA loophole, known as the “family glitch.” The loophole has prevented approximately 5 million people from being able to use premium tax credits to purchase Marketplace plans. The Treasury Department and the Internal Revenue Service are proposing the new rule, and if the rule gets finalized, “family members of workers who are offered affordable self-only coverage, but unaffordable family coverage may qualify for premium tax credits to buy ACA coverage.” The Administration expects 200,000 uninsured people would gain coverage under the rule. More information can be found here
SENATE HEARINGS AND EXECUTIVE SESSIONS
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HOUSE HEARINGS AND EXECUTIVE SESSIONS
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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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