Health Care Checkup: October 8, 2021

Health Care Checkup

October 8, 2021

THE BIG PICTURE

On Thursday, the Senate voted 50-48 to extend debt ceiling through early December. On Wednesday, McConnell offered the short-term suspension of the debt ceiling and said, “This will moot Democrats’ excuses about the time crunch they created and give the unified Democratic government more than enough time to pass standalone debt limit legislation through reconciliation.” The bill will be sent to the House for approval, and then to President Joe Biden to be signed into law.

Also on Thursday, Pfizer requested Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA) for use of its COVID-19 vaccine in children ages 5-11. If approved, kids could begin receiving the vaccine in a matter of weeks. The FDA’s Vaccines and Related Biological Products Advisory Committee is slated to meet on October 26 to discuss Pfizer’s request.

On Tuesday, the Director of the National Institutes of Health (NIH), Dr. Francis Collins, announced that he would step down from his role at the end of the year. Collins was originally appointed to the role in 2009 by former President Barack Obama, and he was asked to continue in the position by former President Donald Trump. He has worked at the agency for nearly three decades and has been a leader in the fight against COVID-19. While it is unclear who will take Collins’ place, it has been reported that Principal Deputy Director Lawrence Tabak could become the Acting Director.

The Centers for Medicare & Medicaid Services (CMS) released a set of frequently asked questions (FAQs) regarding implementation of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Affordable Care Act (ACA). The FAQs address various topics, such as whether group health plans can offer plan participants a discount on their premium for receiving a COVID-19 vaccination. The FAQs also delve into whether group health plans or health insurance issuers can condition eligibility for benefits or coverage on enrollees being vaccinated against COVID-19.

House Ways and Means Committee leaders, Richard Neal (D-MA) and Kevin Brady (R-TX), sent a letter to the Department of Health and Human Services (HHS) Secretary Xavier Becerra, Treasury Secretary Janet Yellen and Labor Secretary Marty Walsh. The letter expresses their concerns over the implementation of the No Surprises Act by the Administration. The lawmakers wrote, “We are concerned that the regulation published on September 30, 2021, as well as the decision to delay full implementation of the Advanced Explanation of Benefits (AEOB) and other patient protections, do not reflect the law that Congress passed.” As a reminder, last week, the Biden Administration released an interim final rule to further implement the No Surprises Act on surprise medical billing. Meanwhile, Congressman Frank Pallone (D-NJ), Chairman of the House Energy and Commerce Committee, and Senator Patty Murray (D-WA), Chair of the Senate Health, Education, Labor, and Pensions Committee, applauded the interim final rule. The duo wrote, “[The] rule implements the No Surprises Act just as we intended and is a significant new protection for families across the country that will save countless patients from being forced to foot the bill for care they thought was covered by their insurance. It establishes a fair payment resolution process between providers and insurers while finally taking patients out of the middle.”

What to Expect Next Week: Next week, the Senate will not be in session. The House will be in session Tuesday through Friday and is expected to consider the debt limit increase sent over by the Senate. There have been no health-related hearings reported at this time.

DEEP DIVE

Democrats and Republicans Reach Compromise on Short-Term Debt Ceiling

NIH Director Francis Collins to Step Down

On Tuesday, the Director of the National Institutes of Health (NIH), Francis Collins, announced that he would step down from his role at the end of the year. Collins was originally appointed to the role in 2009 by former President Barack Obama, and he was asked to continue in the position by former President Donald Trump. He has worked at the agency for nearly three decades and has been a leader in the fight against COVID-19. While it is unclear who will take Collins’ place, it has been reported that Principal Deputy Director Lawrence Tabak could become the Acting Director.

Children Ages 5-11 May be Able to Receive COVID-19 Vaccine as Soon as First Week of November

On Thursday, Pfizer requested Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA) for use of its COVID-19 vaccine in children ages 5-11. If approved, kids could begin receiving the vaccine in a matter of weeks. The FDA’s Vaccines and Related Biological Products Advisory Committee is slated to meet on October 26 to discuss Pfizer’s request.

House Ways and Means Committee Leaders Write Letter to Biden Administration Over Surprise Billing Rule

On Monday, House Ways and Means Committee leaders, Richard Neal (D-MA) and Kevin Brady (R-TX), sent a letter to the Department of Health and Human Services (HHS) Secretary Xavier Becerra, Treasury Secretary Janet Yellen and Labor Secretary Marty Walsh. The letter expresses their concerns over the implementation of the No Surprises Act by the Administration. The lawmakers wrote, “We are concerned that the regulation published on September 30, 2021, as well as the decision to delay full implementation of the Advanced Explanation of Benefits (AEOB) and other patient protections, do not reflect the law that Congress passed.” As a reminder, last week, the Biden Administration released an interim final rule to further implement the No Surprises Act on surprise medical billing. The new regulations create a process by which providers, health plans, and issuers can settle payment rate disputes. Specifically, under the new regulations, unresolved disputes between providers and insurers are solved by third-party arbiters who will determine a payment rate based on the median in-network rate. Neal and Brady wrote that this new process “affronts the provisions enacted into law” and “biases the [independent dispute resolution] entity toward one factor (a median rate) as opposed to evaluating all factors equally as Congress intended.” The lawmakers also requested a written follow-up from the Administration explaining how the regulation issued last week “comports with the law Congress enacted.”

Meanwhile, Congressman Frank Pallone (D-NJ), Chairman of the House Energy and Commerce Committee, and Senator Patty Murray (D-WA), Chair of the Senate Health, Education, Labor, and Pensions Committee, applauded the interim final rule. The duo wrote, “[The] rule implements the No Surprises Act just as we intended and is a significant new protection for families across the country that will save countless patients from being forced to foot the bill for care they thought was covered by their insurance. It establishes a fair payment resolution process between providers and insurers while finally taking patients out of the middle.”

CMS Releases FAQs About ACA, HIPAA and CARES Act Implementation

Kentucky, Maine, and New Mexico Transition from HealthCare.gov to State based Marketplaces 2022 Plan Year

CMS reports that Kentucky, Maine, and New Mexico have transitioned from HealthCare.gov to their own State-based Marketplaces for the 2022 plan year. These new Marketplaces include kynect, CoverME.gov, and beWellnm. Consumers in these states will now be able to comparison shop for plans on the State-based Marketplace websites. Information on the open-enrollment periods for these Marketplaces can be found here.

Medicaid Expansion in Missouri Makes More than 275,000 Residents Eligible for Health Coverage

CMS announced that an estimated 275,000 Missourians are now eligible for health coverage, due to Medicaid expansion in the state. According to the agency, Missouri will be eligible to receive approximately $968 million in additional federal funding for its Medicaid program over the next two years through the American Rescue Plan. As a reminder, Missouri voters approved Medicaid expansion via a ballot initiative in August 2020. Shortly after the measure passed, Missouri Governor Mike Parson announced that the state would not implement expansion because the ballot measure did not include a revenue source. However, a lawsuit was then filed against the state and the Supreme Court of Missouri ultimately upheld the expansion.