Health Care Checkup
November 5, 2021
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Today, the House plans to vote on the $1.75 trillion Build Back Better (BBB) social spending bill and the Infrastructure Investment and Jobs Act. Since the Senate already voted to approve the infrastructure legislation, it will get sent to President Joe Biden for his signature if the House also votes to pass it. Once the House votes on the BBB bill, it will head to the Senate where it is expected to go through some changes. The situation remains fluid, so stay tuned.
On Tuesday, Democrats reached an agreement regarding the proposed Build Back Better bill. They agreed to include provisions allowing Medicare to negotiate the prices of certain prescription drugs, which Senator Ron Wyden (D-OR) called the “most expensive drugs.” This deal would permit Medicare to begin negotiating drug prices beginning in 2023, with those prices taking effect in 2025. Since last week’s “Build Back Better Framework” released by the White House did not include plans to address prescription drug pricing for the Medicare program, Tuesday’s news was seen as a victory for Democrats who have been fighting to include such provisions in the social spending bill. The deal also includes a $2,000 annual cap on drug spending for Medicare beneficiaries and a $35 monthly cap on insulin costs.
Also on Tuesday, CMS released multiple final rules. The rules include updates to the Medicare Physician Fee Schedule, home health payment rates, and hospital outpatient and ambulatory surgical center payment rates. Details of these updates can be found in our “deep dive” section below.
On Wednesday, House Speaker Nancy Pelosi (D-CA) announced that four weeks of paid family and medical leave will be added back into the Democrats’ social spending bill. Progressive Democrats had originally proposed twelve weeks of paid family and medical leave, but last week, the provision was struck from the package altogether. Now, Pelosi said that the provision will be added back into the bill, albeit with fewer weeks of paid family and medical leave than the original proposal.
On Thursday, the Biden Administration released details of the Occupational Safety and Health Administration’s (OSHA) requirement for companies with 100 or more employees to require their personnel to either get fully vaccinated against COVID-19 or submit to weekly testing. If the employee opts for the vaccination route, they must complete their full vaccine series by January 4, 2022. Employers must provide paid leave for their employees to get vaccinated and, if needed, sick leave to recover from the side effects. Employees who choose the weekly testing route “may be required to pay” for their tests and will need to wear a facemask in the workplace. A summary of OSHA’s emergency temporary standard can be found here.
CMS will require that workers at health care facilities participating in Medicare or Medicaid be fully vaccinated against COVID-19 by January 4 as well. The rule applies to all employees, regardless of whether their positions are clinical or non-clinical. Health care facilities impacted by this new requirement include hospitals, ambulatory surgery centers, dialysis facilities, home health agencies, and long-term care facilities. Further details on this regulation can be found here.
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What to Expect Next Week: Both the House and Senate will be out of session next week. There will be no health-related hearings.
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Democrats Reach Agreement on Drug Pricing
On Tuesday, Democrats reached an agreement regarding the proposed Build Back Better bill. They agreed to include provisions allowing Medicare to negotiate the prices of certain prescription drugs, which Senator Ron Wyden (D-OR) called the “most expensive drugs.” This deal would permit Medicare to begin negotiating drug prices beginning in 2023, with those prices taking effect in 2025. Since last week’s “Build Back Better Framework” released by the White House did not include plans to address prescription drug pricing for the Medicare program, Tuesday’s news was seen as a victory for Democrats who have been fighting to include such provisions in the social spending bill. The deal also includes a $2,000 annual cap on drug spending for Medicare beneficiaries and a $35 monthly cap on insulin costs. In response to the deal, Senate Majority Leader Chuck Schumer (D-NY) said, “Fixing prescription drug pricing has consistently been a top issue for Americans year after year, including the vast majority of both Democrats and Republicans who want to see a change because they simply cannot afford their medications. Today, we’ve taken a massive step forward in helping alleviate that problem.”
Speaker Pelosi Adds Paid Family Leave Back into Build Back Better Bill
On Wednesday, House Speaker Nancy Pelosi (D-CA) announced that four weeks of paid family and medical leave will be added back into the Democrats’ social spending bill. Progressive Democrats had originally proposed twelve weeks of paid family and medical leave, but last week, the provision was struck from the package altogether. Now, Pelosi said that the provision will be added back into the bill, albeit with fewer weeks of paid family and medical leave than the original proposal. Pelosi stated that her intention is to put forth a House bill that can also pass the Senate in the same form, and she stressed the importance of finding common ground in the legislation.
White House Announces Details of New OSHA and CMS Vaccine Policies
On Thursday, the Biden Administration released details of the Occupational Safety and Health Administration’s (OSHA) requirement for companies with 100 or more employees to require their personnel to either get fully vaccinated against COVID-19 or submit to weekly testing. If the employee opts for the vaccination route, they must complete their full vaccine series by January 4, 2022. Employers must provide paid leave for their employees to get vaccinated and, if needed, sick leave to recover from the side effects. Employees who choose the weekly testing route “may be required to pay” for their tests and will need to wear a facemask in the workplace. Employers will need to keep records and report data to OSHA. The testing requirement for unvaccinated workers will begin after January 4th, but employers “must be in compliance with all other requirements” (such as providing paid sick leave) by December 5. A summary of OSHA’s emergency temporary standard can be found here.
CMS will require that workers at health care facilities participating in Medicare or Medicaid be fully vaccinated against COVID-19 by January 4 as well. The rule applies to all employees, regardless of whether their positions are clinical or non-clinical. Health care facilities impacted by this new requirement include hospitals, ambulatory surgery centers, dialysis facilities, home health agencies, and long-term care facilities. Further details on this regulation can be found here.
CDC Authorizes Pfizer’s COVID-19 Vaccine for Pediatric Population
The Centers for Disease Control and Prevention (CDC) Director Dr. Rochelle Walensky endorsed the CDC’s Advisory Committee on Immunization Practices’ (ACIP) recommendation that children ages 5 to 11 receive Pfizer’s pediatric COVID-19 vaccine. The CDC’s authorization will allow for approximately 28 million children in the United States get vaccinated. The CDC’s recommendation can be viewed here.
CMS Releases Final Rule on Medicare Hospital Outpatient and Ambulatory Surgical Center Payment Rates for 2022
On Tuesday, the Centers for Medicare and Medicaid Services (CMS) finalized its Medicare payment rates for hospital outpatient and Ambulatory Surgical Center (ASC) services. Medicare payments to hospitals for outpatient services will increase by 2.0% in 2022. The rule will also strengthen civil monetary penalties for hospitals that do not make their pricing publicly available online (as they have been required to do since January 1, 2021). The penalty will be $300 per day for hospitals with a bed count of 30 or fewer, and $10 per bed per day for hospitals with a bed count greater than 30, not to exceed $5,500 per day. Under this approach, the minimum total penalty amount would be $109,500 per hospital, and the maximum total penalty amount would be $2,007,500 per hospital. The increased penalties will take effect on January 1, 2022. The final rule can be found here, the press release can be found here, and the fact sheet can be found here.
Updates to CY 2022 Medicare Physician Fee Schedule Final Rule Released
On Tuesday, CMS issued a final rule that includes updated policies for Medicare payments under the Physician Fee Schedule (PFS) that will take effect on January 1, 2022. CMS made various updates, including finalizing coverage for certain Medicare telehealth services through December 31, 2023. The agency noted that it is continuing to evaluate the inclusion of telehealth services that were temporarily added to the Medicare telehealth services list during the COVID-19 pandemic. The rule will also continue the additional payment of $35.50 for COVID-19 vaccines administered in certain patients’ homes. The 2022 PFS also finalizes changes to the Medicare Diabetes Prevention Program (MDPP) model. The final rule can be found here, and the fact sheet can be found here.
CMS Unveils CY 2022 Home Health Prospective Payment System Final Rule
Under the Medicare home health payment rule that CMS released Tuesday, payment rates for Medicare-certified Home Health Agencies (HHAs) are expected to increase by 3.2% in 2022 (an approximate $570 million increase). The rule also updates the payment rates for home infusion therapy services, and it is predicted that there will be an increase in payments to home infusion therapy suppliers of 5.1%. Additional details on the rule can be found in the press release here, and the fact sheet here.
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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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