House Ways & Means Committee Marks Up Telehealth and More. The bills considered in the markup support expanding access to telehealth as well as access to healthcare in rural areas. All six bills passed out of the committee, but only the telehealth bill passed with bipartisan support. More information on amendments and vote outcomes can be found here. One pagers on each of the bills can be found here.
Below is a brief review of each bill and the vote count:
Senate Finance Committee Chair and Ranking Member Release Prescription Drug Shortage Discussion Draft. The discussion draft put forth by Chair Wyden (D-OR) and Ranking Member Crapo (R-ID) would establish a new Medicare Drug Shortage Prevention and Mitigation Program. Beginning in 2027, this voluntary program would make payment incentives available to hospitals, physician practices, and other Medicare providers of services or suppliers that utilize, through wholesalers, GPOs, nonprofits, other entities or directly, certain contacting and purchasing practices to acquire genetic sterile injectables and infused medications, with the potential for expansion to additional multiple-source drugs over time.
The proposal would also make a change to the Medicaid Drug Rebate Program enabling reductions or waivers to the inflation rebate for certain generic drugs in the event of shortage risk, modeled on current law under Medicare.
A press release on the discussion draft can be found here. A one-page summary of the discussion draft can be found here. A section-by-section summary can be found here.
Comments on the proposal may be submitted to DrugShortages@finance.senate.gov no later than June 6, 2024.
Senate Budget Committee Holds Hearing on Administrative Burdens in Healthcare. The hearing discussed solutions to reduce administrative burden in healthcare, including addressing burdens tied to prior authorization. Senators and witnesses also agreed that quality metrics need to be restructured to eliminate arbitrary metrics. Witnesses and members raised concerns about the large burden placed on physicians to complete paperwork and called on using artificial intelligence (AI) to alleviate this burden. Members noted that cutting down waste, abuse and fraud in the Medicare program is essential to alleviating administrative costs.
Senate HELP Committee Ranking Member Releases NIH White Paper. Sen. Cassidy, Ranking Member of the Senate Health, Education, Labor & Pensions (HELP) Committee released a white paper to improve the National Institutes of Health (NIH). The white paper follows a request for information (RFI) he issued from stakeholders in September 2023 seeking feedback on NIH’s current activities and statutory framework.
The white paper includes solutions to maximize the effectiveness of current NIH funding, sustain the United States’ competitive advantage in biomedical research and restore public trust in science. The report also recommends holding NIH accountable to carry out its grants management responsibilities while balancing more effective oversight with reducing unnecessary burden on researchers. Read the Ranking Member’s press release here.
Medicare Board of Trustees Releases Annual Report to Congress. The report includes information on the financial operations and actuarial status of Medicare – including the Hospital Insurance (HI) program (Medicare Part A) and the Supplementary Medical Insurance (SMI) program (Medicare Part B and prescription drug coverage).
Notably, the HI Trust Fund will be able to pay scheduled benefits until 2036, five years later than projected last year. According to the report, this is due to economic and job growth along with lower-than-expected healthcare spending. After 2036, that fund’s reserves will become depleted and continuing program income will be sufficient to pay 89% of total scheduled benefits. The report notes that over the last 35 years the total number of Medicare beneficiaries approximately doubled, and the Trustees expect the total to increase by 39% over approximately the next 35 years. While beneficiaries in the program are projected to increase, the number of workers paying into the trust fund is projected to decrease.
The report found that, in 2023, Medicare covered 66.7 million people: 59.1 million people aged 65 and older, and 7.6 million disabled people. About 48% of these beneficiaries chose to enroll in Part C private health plans that contract with Medicare to provide Part A and Part B health services (Medicare Advantage). Total Medicare expenditures, according to the Centers for Medicare & Medicaid Services’s (CMS) report, were $1,037 billion in 2023. The Trustees project that expenditures will increase in future years at a faster pace than either aggregate workers’ earnings or the economy overall and that, as a percentage of GDP, spending will increase from 3.8% in 2023 to 6.2% by 2098 – substantially increasing the strain on the nation’s workers, the economy, Medicare beneficiaries and the federal budget.
A press release is available here and a fact sheet is available here.
CMS Issues Proposed Rule Creating a New Kidney Transplant Mandatory Model. CMS issued a proposed rule titled, “Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model,” which would create a mandatory Medicare payment model to test whether performance-based incentive payments paid to or owed by participating kidney transplant hospitals increase access to kidney transplants for patients with end-stage renal disease while preserving or enhancing the quality of care and reducing Medicare expenditures.
The proposed mandatory model would last for six years, from January 1, 2025, through December 31, 2030. CMS would randomly select approximately half of the donation service areas (DSAs), and all eligible kidney transplant hospitals within the chosen DSAs would be required to participate. The other half of the DSAs would serve as the comparison group. CMS would then measure and assess the participating hospitals’ performance during each performance year (PY) across three domains:
The final performance score, compiled across the three domains, would determine the corresponding performance-based payment that would be paid to CMS or the participating hospital. At the end of each PY, an upside risk payment would be paid to each participating hospital that scores above 60 points, and a downside risk payment would be owed by any participating hospital that scores below 40 points. The downside risk payment is not proposed to start until PY2.
A CMS press release can be found here and fact sheet can be found here. Our team is continuing to review the proposed rule and plans to write a more in-depth summary in the coming days.
Congress is in session next week, with healthcare activity expected at the committee level, including a Senate Finance Committee hearing on rural health and an anticipated House Energy and Commerce Committee markup that includes telehealth legislation.
For more information, contact Debra Curtis, Kristen O’Brien, Julia Grabo, Priya Rathakrishnan or Erica Stocker.
To subscribe to the McDermottPlus Check-Up, please CLICK HERE.
