On Thursday, the Senate voted 71-19 to pass a one-week continuing resolution (CR) to keep the Federal government funded until next Friday. The House passed the CR on Wednesday in a vote of 224-201. The one-week extension will give Congress additional time to continue negotiations on a larger omnibus funding package. House Committee Appropriations Chair Rosa DeLauro (D-CT) said that an agreement has been reached on a “framework that provides a path forward to enact an omnibus next week.” On Tuesday, Senate Minority Leader Mitch McConnell (R-KY) said that lawmakers are “very close to getting an omnibus appropriations bill,” and that the bill is expected to pass by December 22. Several health policy items are expected to ride along with the omnibus, including drug and device user fee policy riders, an extension of Medicare telehealth waivers, various Medicare extenders for rural hospitals and other providers, maternal and child health programs, Medicaid improvements, relief from scheduled Medicare physician payment reductions, and relief from across-the-board PayGo cuts. Details are still being negotiated with bill language expected to be released early next week. 

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that aims to streamline the prior authorization process and promote health equity in the Star Ratings program. The rule would require that an approved prior authorization remain valid for an enrollee’s full course of treatment and would require Medicare Advantage (MA) plans to review utilization management policies annually. The press release can be found here and the fact sheet can be found here.

CMS also released the 2024 Notice of Benefit and Payment Parameters Proposed Rule, which aims to expand access to health care, simplify the plan selection process, and make it easier to enroll in coverage. To improve access to care, CMS proposes to revise the network adequacy and essential community provider (ECP) standards to provide that all individual market qualified health plans (QHPs) use a network of providers that complies with the standards. The revision would remove the exception that certain sections of the standards do not apply to plans that do not use a provider network. The press release can be found here and the fact sheet can be found here.

On Wednesday, Axios held a virtual event on the future of telehealth. Reporters from Axios spoke with House Representatives Cathy McMorris Rodgers (R-WA) and Mike Thompson (D-CA). Cathy McMorris Rodgers is currently the Ranking Member of the House Energy and Commerce Committee and is slated to be the Chair in the 118th Congress. Mike Thompson is a Member of the House Ways and Means Committee and Co-Chair of the Congressional Telehealth Caucus. Our summary of the event can be found here.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is proposing to expand access to treatment for opioid use disorder (OUD) by updating the federal regulations pertaining to OUD treatment standards. Specifically, SAMHSA proposes to allow individuals to take home doses of methadone. Additionally, it would allow for the use of telehealth in initiating buprenorphine at opioid treatment programs.

The Biden Administration released its plan to “stay ahead of an increase in COVID-19 cases this winter.” The plan includes expanding access to COVID-19 testing, making free at-home tests available through COVIDTests.gov, making vaccines and treatments widely available for all Americans, preparing clinical personnel for deployment as needed, and focusing on protecting the highest-risk populations. The fact sheet can be found here. 

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that aims to streamline the prior authorization process and promote health equity in the Star Ratings program. The rule would require that an approved prior authorization remain valid for an enrollee’s full course of treatment and would require Medicare Advantage (MA) plans to review utilization management policies annually. Additionally, CMS proposes to establish a health equity index in the Star Ratings program that would reward “excellent care” for underserved populations by MA and Medicare Part D plans. The proposal also implements a drug provision from the Inflation Reduction Act (IRA) that makes prescription drugs more affordable for low-income individuals. CMS intends to expand eligibility under the low-income subsidy (LIS) program, and individuals with incomes up to 150% of the federal poverty level would qualify for full LIS. Under this change, eligible individuals would have no deductible, no premiums, and fixed, reduced copayments for certain medications. Comments on the proposed rule will be accepted until February 13, 2023. The press release can be found here and the fact sheet can be found here.

On Monday, CMS released the 2024 Notice of Benefit and Payment Parameters Proposed Rule, which aims to expand access to health care, simplify the plan selection process, and make it easier to enroll in coverage. To improve access to care, CMS proposes to revise the network adequacy and essential community provider (ECP) standards to provide that all individual market qualified health plans (QHPs) use a network of providers that complies with the standards. The revision would remove the exception that certain sections of the standards do not apply to plans that do not use a provider network. The proposal also adds Substance Use Disorder Treatment Centers and Mental Health Facilities to the essential community provider (ECP) categories, which are “critical to delivering needed behavioral health care.” In addition, the proposed rule would give Marketplaces the option to “implement a new rule for the special enrollment period for people losing Medicaid or Children’s Health Insurance Program (CHIP) coverage.” The option would give consumers 60 days before, or 90 days after, their loss of Medicaid or CHIP coverage to select a Marketplace plan. The agency believes that this option would help “mitigate coverage gaps” when consumers lose Medicaid or CHIP. The press release can be found here and the fact sheet can be found here.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is proposing to expand access to treatment for opioid use disorder (OUD) by updating the federal regulations pertaining to OUD treatment standards. Specifically, SAMHSA proposes to allow individuals to take home doses of methadone. Additionally, it would allow for the use of telehealth in initiating buprenorphine at opioid treatment programs. Public comment is due February 14, 2023. More information can be found here.

On Thursday, the Biden Administration released its plan to “stay ahead of an increase in COVID-19 cases this winter.” The plan includes expanding access to COVID-19 testing, making free at-home tests available through COVIDTests.gov, making vaccines and treatments widely available for all Americans, preparing clinical personnel for deployment as needed, and focusing on protecting the highest-risk populations. The fact sheet can be found here.