Congress was in session this week as lawmakers continued to seek an agreement on an omnibus appropriations bill to keep the government funded for the remainder of FY 2023, along with a package of year-end policy provisions to add to the spending bill. The House also took up the annual defense authorization bill, which includes a provision to end the military vaccine mandate for COVID-19. The White House has indicated opposition to ending the mandate, but has not threatened to veto the must-pass defense bill. In election news, Senator Warnock (D-GA) won his runoff election against Republican candidate Herschel Walker, giving Democrats an outright 51–49 majority in the 118th Congress. However, Senator Sinema’s (I-AZ) subsequent departure from the Democratic party to become an independent raises some questions about the strength of Democrats’ working majority in the Senate.
Efforts Intensify to Prevent Medicare Provider Cuts. As appropriators continue to work toward an agreement on the year-end omnibus spending package, lawmakers and stakeholders are intensifying efforts to ensure that the package includes provisions to halt impending Medicare provider cuts.
On December 5, a group of more than 100 healthcare stakeholders sent a letter to congressional leadership, urging them to prevent the looming payment cut of nearly 4.5% under the Medicare physician fee schedule that, without action, goes into effect on January 1, 2023.
This follows the November 30 letter to congressional leadership, signed by the American Hospital Association, American Medical Association and other large healthcare groups, urging Congress to prevent the 4% Medicare cut from the statutory Pay-As-You-Go Act of 2010 sequester.
Members of Congress are stepping up their efforts as well, with two sign-on letters currently circulating urging congressional leaders to stop the provider cuts—one bipartisan letter that is open to all representatives, and one from the GOP Doctors Caucus.
CMS Issues Proposed Rule on Prior Authorization. On December 6, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule addressing the prior authorization (PA) process. The proposed rule includes several proposals aimed at reducing the administrative burden on patients, providers, payers and other stakeholders tied to PA. The proposed requirements would generally apply to Medicare Advantage (MA) plans, state Medicaid and Children’s Health Insurance Program (CHIP) agencies, Medicaid managed care plans, CHIP managed care entities and qualified health plan issuers offering coverage through the federal marketplace.
The proposed rule would require certain payers to implement an electronic PA process, shorten the timeframes for certain payers to respond to PA requests, and establish policies to make the PA process more efficient and transparent. Most of the proposals, including proposals related to electronic PA processes, certain decision timeframes and certain reporting requirements, would not take effect until 2026.
This regulatory activity occurs as Congress considers the Improving Seniors’ Timely Access to Care Act, which would mandate that MA plans establish electronic PA processes and require MA plans to report information on PA processes (e.g., approval, denial and overturn rates). The bill has wide bipartisan support and passed the House by voice vote earlier this year, but stalled after the Congressional Budget Office released a costly implementation estimate of more than $16 billion in September 2022. The bill is not expected to be included in an end-of-year package.
Comments on the proposed PA rule are due on March 13, 2023.
The House and Senate will be in session as congressional leaders continue to work toward an agreement on a year-end legislative package. A new stopgap continuing resolution (CR) is expected, as work will not be completed by the current CR’s December 16 expiration.
For more information, contact Debra Curtis, Kristen O’Brien or Erica Stocker.
To subscribe to the McDermottPlus Check-Up, please CLICK HERE.
