Health Care Checkup
September 30, 2022
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Congress passed a short-term funding bill that will keep the federal government funded through December 16, averting a partial government shutdown. The House voted 230-201 on Friday to approve the continuing resolution (CR), a day after the Senate voted 72-25 to approve it. Major provisions of H.R. 6833 include $12.3 billion in military and economic aid for Ukraine, billions of dollars for disaster relief, and a five-year extension of the Food and Drug Administration’s (FDA’s) user fee agreements. Given the fact that the user fee agreements passed without any “riders” it is likely that there will be an attempt to pass some of them as part of an end-of-the-year package in the lame duck. Republicans objected to additional funding for monkeypox and COVID-19, due to the funds not being offset before being included in the package. The CR also does not contain Senator Joe Manchin’s (D-WV) permitting reform legislation. A section-by-section summary of the short-term funding bill can be found here.
On Wednesday, the White House held its first summit on hunger in more than five decades. The summit focused on new investments and initiatives the Biden Administration will take to help achieve its goal of “ending hunger and reducing diet-related disease by 2030.” Through public and private sector commitments, $2.5 billion will be invested in “start-up companies that are pioneering solutions to hunger and food insecurity,” and more than $4 billion will be “dedicated toward philanthropy that improves access to nutritious food, promotes healthy choices, and increases physical activity.” A fact sheet can be found here.
A U.S. District Court Judge for the District of Columbia ruled that the Department of Health and Human Services (HHS) must immediately cease reimbursement cuts for certain hospitals participating in the 340B Drug Pricing Program. As a background, in June, the Supreme Court of the United States (SCOTUS) unanimously ruled that HHS's 2018 and 2019 reduced drug reimbursement rates for 340B hospitals were unlawful.
HHS released two new reports on prescription drug pricing and spending. One report, titled “Price Increases for Prescription Drugs, 2016-2022” found that if the Inflation Reduction Act had been in place from July 2021 to July 2022, over 1,200 prescription drugs would potentially have been subject to the new requirement that drug manufacturers pay rebates to Medicare if they enact price increases higher than the rate of inflation. The other report, “Trends in Prescription Drug Spending, 2016-2021” found that spending growth on drugs was largely due to growth in spending per prescription, and to a “lesser extent by increased utilization.”
The Biden Administration announced that premiums will be nearly 8% lower in 2023 for Medicare Advantage (MA) plans. The expected average premium for MA plans in 2023 will be $18 per month, as compared to $19.52 in 2022. Additionally, the monthly premium for Medicare Part D coverage is projected to be $31.50 in 2023, compared to $32.08 in 2022. The press release can be found here.
The Centers for Medicare and Medicaid Services (CMS) approved Medicaid section 1115 waivers in Massachusetts and Oregon to help improve coverage for disadvantaged populations. The Oregon waiver would keep children continuously enrolled in Medicaid up to age six without the need for reenrollment. The waivers will also allow both states to test coverage for “medically tailored meals” and “clinically-tailored housing supports.”
In an effort to make nursing home data more accessible, CMS will make additional data public on the ownership of Medicare-certified nursing homes. CMS believes the enhanced transparency will give stakeholders the opportunity to identify common owners of nursing homes across nursing home locations. The data file will be updated monthly on data.cms.gov.
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What to Expect Next Week: The House and Senate will be in recess until the week of November 14. However, a small group of Senators are expected to begin debate on the National Defense Authorization Act (NDAA) on October 11. A final vote on the NDAA is not expected until after the midterm elections.
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Congress Passes Continuing Resolution to Fund the Federal Government through Mid-December
Congress passed a short-term funding bill that will keep the federal government funded through December 16, averting a partial government shutdown. The House voted 230-201 on Friday to approve the continuing resolution (CR), a day after the Senate voted 72-25 to approve it. Major provisions of H.R. 6833 include $12.3 billion in military and economic aid for Ukraine, billions of dollars for disaster relief, and a five-year extension of the Food and Drug Administration’s (FDA’s) user fee agreements. Given the fact that the user fee agreements passed without any “riders” it is likely that there will be an attempt to pass some of them as part of an end-of-the-year package in the lame duck. The legislation also makes various public health investments, including an additional $62 million for the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) 988 Suicide and Crisis Lifeline to continue to expand suicide prevention services. It also extends Medicare’s increased inpatient payment adjustment for certain low-volume hospitals and extends the Medicare Dependent Hospital Program. Additionally, the stop-gap funding package reduces the Medicare Improvement Fund from $7.5 billion to $7.308 billion. Republicans objected to additional funding for monkeypox and COVID-19, due to the funds not being offset before being included in the package. The CR also does not contain Senator Joe Manchin’s (D-WV) permitting reform legislation. A section-by-section summary of the short-term funding bill can be found here.
Judge Orders HHS to Immediately Vacate 340B Reimbursement Cuts
On Wednesday, a U.S. District Court Judge for the District of Columbia ruled that the Department of Health and Human Services (HHS) must immediately cease reimbursement cuts for certain hospitals participating in the 340B Drug Pricing Program. As a background, in June, the Supreme Court of the United States (SCOTUS) unanimously ruled that HHS's 2018 and 2019 reduced drug reimbursement rates for 340B hospitals were unlawful. The justices ruled the reduced reimbursement rates unlawful because HHS did not survey hospital costs before adjusting payments for 340B, which cut payments to hospitals in the program by approximately 30%. However, SCOTUS did not specify the remedy for HHS’s payment cuts and remanded the case to the D.C. District Court.
Medicare Advantage and Prescription Drug Plan Premiums to be Lower in 2023
The Biden Administration announced that premiums will be nearly 8% lower in 2023 for Medicare Advantage (MA) plans. The expected average premium for MA plans in 2023 will be $18 per month, as compared to $19.52 in 2022. Additionally, the monthly premium for Medicare Part D coverage is projected to be $31.50 in 2023, compared to $32.08 in 2022. The press release can be found here.
Biden Administration Announces $8 Billion Investment to Improve Hunger, Nutrition, and Health
On Wednesday, the White House held its first summit on hunger in more than five decades. The summit focused on new investments and initiatives the Biden Administration will take to help achieve its goal of “ending hunger and reducing diet-related disease by 2030.” Through public and private sector commitments, $2.5 billion will be invested in “start-up companies that are pioneering solutions to hunger and food insecurity,” and more than $4 billion will be “dedicated toward philanthropy that improves access to nutritious food, promotes healthy choices, and increases physical activity.” Among the private sector companies participating in these initiatives are Publix and Google. Publix will donate $3.85 million to 22 Feeding America food banks and Google will facilitate Supplemental Nutrition Assistance Program (SNAP) enrollment by making it easier for users to find “detailed and locally-specific information on how to check their eligibility and apply for SNAP benefits.” A fact sheet can be found here.
HHS Invests $266 Million in Public Health Workforce
The Department of Health and Human Services (HHS) awarded $225.5 million to community health workers and $40.7 million in public health scholarships to expand and strengthen the public health workforce. The funding, which came from the American Rescue Plan, will be used to fund a new program called the Community Health Worker Training Program, which will support training and apprenticeship to support over 10,000 new community health workers. The funds will also be awarded to the Public Health Scholarship Program, which is a program that incentivizes individuals to pursue training and careers in public health. A list of the award recipients can be found here.
Reports Released by HHS Show the Potential Positive Impact of Inflation Reduction Act on Prescription Drug Prices
HHS released two new reports on prescription drug pricing and spending. One report, titled “Price Increases for Prescription Drugs, 2016-2022” found that if the Inflation Reduction Act had been in place from July 2021 to July 2022, over 1,200 prescription drugs would potentially have been subject to the new requirement that drug manufacturers pay rebates to Medicare if they enact price increases higher than the rate of inflation. The other report, “Trends in Prescription Drug Spending, 2016-2021” found that spending growth on drugs was largely due to growth in spending per prescription, and to a “lesser extent by increased utilization.”
CMS Approves Medicaid Waivers in Massachusetts and Oregon to Expand Access to Coverage and Addressing Nutrition and Housing Needs
The Centers for Medicare and Medicaid Services (CMS) approved Medicaid section 1115 waivers in Massachusetts and Oregon to help improve coverage for disadvantaged populations. The Oregon waiver would keep children continuously enrolled in Medicaid up to age six without the need for reenrollment. The waivers will also allow both states to test coverage for “medically tailored meals” and “clinically-tailored housing supports.” Additionally, in an effort to eliminate gaps in coverage for vulnerable populations, Massachusetts will provide “up to 12 months of continuous coverage for Medicaid and Children's Health Insurance Program (CHIP) beneficiaries upon release from correctional settings and 24-months of continuous eligibility for beneficiaries with a confirmed status of chronic homelessness.” More can be found here.
CMS Increases Public Availability of Medicare Nursing Home Ownership Data
In an effort to make nursing home data more accessible, CMS will make additional data public on the ownership of Medicare-certified nursing homes. CMS believes the enhanced transparency will give stakeholders the opportunity to identify common owners of nursing homes across nursing home locations. Additionally, it will help stakeholders identify which owners have nursing homes associated with records of good or poor performance. The data file will be updated monthly on data.cms.gov.
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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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