The Senate returned this week to focus on nominations and voting rights legislation but not the Build Back Better (BBB) bill. The chamber provided no more clarity on the path forward for on this massive domestic investment priority. The House remained in recess with plans to return on Monday, January 10. In addition, both chambers somberly commemorated the events of January 6, 2021.
Senate Turns Focus to Voting Rights. While Senator Joe Manchin (D-WV) effectively side-lined BBB in its current form prior to the holidays, Senate Majority Leader Chuck Schumer (D-NY) kept hope alive by expressing strong interest in continuing negotiations.
Without clarity on BBB, the Senate shifted focus to voting rights legislation this week, with Majority Leader Schumer declaring the Senate will vote before Martin Luther King Day. The Freedom to Vote Act has support from all 50 Democratic senators, but no Republicans. The John Lewis Voting Rights Advancement Act has 223 Democratic cosponsors in the House and 48 in the Senate, but both pieces of legislation will require 60 votes to overcome an anticipated filibuster. Therefore, this key Democratic priority may jump-start conversations over changing the filibuster.
Congress Faces Upcoming Budget Deadline. Congress is yet again facing an upcoming deadline to fund the federal government along with key programs. The current continuing resolution (CR) funding the government expires on February 18, 2022. Democrats would like to see a comprehensive funding bill pass rather than another short-term extension, as agencies are currently operating under Trump Administration funding levels. There is also some interest in an emergency supplemental funding bill to provide relief for tornado-ravaged parts of the South and Midwest, and the fires that destroyed parts of Colorado. The supplemental could also become an opportunity to include an extension of the monthly child tax credit that expired at the end of 2021, and COVID-19 relief items.
Looking ahead, the Biden Administration is scheduled to release its FY 2023 Presidential budget proposal next month, though there is some uncertainty around timing. While the President’s Budget is non-binding and isn’t implemented as written, it typically kicks off the congressional budget process and provides the Administration’s recommendations and priorities for federal funding levels across the policy spectrum.
CMS Releases 2023 MA/Part D Technical Rule. The Center’s for Medicare and Medicaid Services proposed technical policy changes to the 2023 Medicare Advantage (MA) and Part D programs for 2023. The proposed rule would require pharmacy price concessions be used to lower out-of-pocket prescription drug costs for Medicare beneficiaries and seeks to improve health equity in both Medicare Advantage (MA) and Part D.
The proposed rule would also set maximum out-of-pocket limits for dual-eligibles in MA plans and revise timeframes associated with care and provider access for beneficiaries under MA during disasters and emergencies. Finally, the rule contains provisions on past performance considerations for new contracts, network adequacy requirements for MA plans, greater marketing and communications oversight, and more.
If finalized, the proposed changes would be effective January 1, 2023, meaning that Part D plans would need to account for these changes in bids submitted for contract year 2023.
HHS Releases Notice of Benefit and Payment Rule. This week, the Department of Health and Human Services released the 2023 Notice of Benefit and Payment proposed rule, which would require every state issuer participating in the federal exchange to offer at least one standardized plan option at each metal level in which it offers plans. The agency also announced that it plans to conduct network adequacy reviews in every state using healthcare.gov and will refine the Affordable Care Act Essential Health Benefits as a part of the Administration’s move toward advancing healthcare equity. The agency is accepting comments on the proposed rule for the next 30 days.
CMS Rescinds MFN Rule. The Centers for Medicare and Medicaid Services (CMS), posted a final rule in late December, rescinding the November 2020 Most Favored Nations (MFN) Model interim final rule and removed the associated regulatory text.
The MFN rule would have created a mandatory, seven-year payment model for the 50 highest-cost drugs and biologics in Medicare Part B to replace the current reimbursement formula for these drugs. Instead of adding a 6 percent administration fee to the average sale price (ASP) of the drug, the new reimbursement system would have been based on international pricing information from 22 different countries.
Following significant pushback from industry stakeholders as well as several court challenges, the agency announced that it will no longer implement the rule, which was scheduled to take effect January 1, 2022.
CMS Ends the SIP Component of the PCF Model. The Seriously Ill Population (SIP) component of Primary Care First (PCF) was designed to have advanced primary care practices, including providers whose clinicians are enrolled in Medicare and who typically provide hospice or palliative care services, coordinate care for high need, seriously ill beneficiaries. CMS has determined that the proposed SIP outreach method, which was designed to comply with statutory beneficiary privacy protections, is unlikely to result in sufficient beneficiary uptake to allow for model evaluation.
As of January 1, 2022, federal law bans many types of out-of-network medical bills and puts the onus on doctors and health insurance companies to resolve their payment disputes. The new law also establishes certain transparency and disclosure requirements. Eric Zimmerman shares the outlook for Surprise Billing this year. Listen here
Both the House and Senate will be returning to Washington next week. Former Senate Majority Leader Harry will lie in state in the Capitol Rotunda. Ongoing consideration of both potential voting rights legislation and the confirmation of Food & Drug Administration (FDA) Commissioner nominee Robert Califf are also expected to occur.
For more information, contact Debra Curtis, Madeline Hodge, Kristen O’Brien or Erica Stocker.
To subscribe to the McDermottPlus Check-Up, please CLICK HERE.
