This Week in Washington: House and Senate pass continuing resolution; House Energy and Commerce Health Subcommittee reports out 21 healthcare bills; Senate Finance Healthcare Subcommittee holds hearing on telehealth flexibilities; White House launches Women’s Health Research initiative.



House and Senate Pass Continuing Resolution

Last week, the House and Senate passed a “laddered” continuing resolution (CR) that will extend funding at current levels through early next year. The CR, which was proposed by the Speaker of the House, will extend funding for Agriculture, Military Construction-VA, Energy-Water and Transportation-HUD appropriations until Jan. 19.

In addition, it will extend funding for Commerce-Justice-Science, Defense, Financial Services, Homeland Security, Interior-Environment, Labor-HHS-Ed., Legislative Branch and State-Foreign Ops appropriations until Feb. 2. If no long-term funding is approved, a 1 percent across-the-board cut will occur. This was agreed to as part of the deal reached to avoid the government defaulting earlier in the year.

House Considers Labor-HHS Appropriations Bill But Postpones Vote on Final Passage

On Nov. 15, the House was scheduled to vote on the Labor-HHS appropriations bill after it considered several amendments to the bill. However, House Republican leadership determined they would not vote on final passage and decided to recess early for the Thanksgiving break because it was unclear whether the bill would pass.

The Labor-HHS bill would cut social spending programs by $60 billion by implementing reductions to 50 programs and eliminating 60.

House Energy and Commerce Committee Subcommittee on Health Reports Out 21 Healthcare Bills

On Nov. 15, the House Energy and Commerce Committee Subcommittee on Health marked up and reported out of committee 21 healthcare bills. Among them were three bills concerning pharmacy benefit managers (PBMs) and one bill regarding home infusion drugs. They are:

H.R. 2880, Protecting Patients Against PBM Abuses Act
This legislation would ban PBM spread pricing and would delink PBM compensation from the cost of medications. It would also prohibit PBMs from compensating a network pharmacy less than affiliated pharmacies and would increase data transparency of PBM rebates and administrative fees.

H.R. 5393, To amend title XVIII of the Social Security Act to ensure fair assessment of pharmacy performance and quality under Medicare part D, and for other purposes
This legislation would require prescription drug plans (PDPs) to only use pharmacy performance measures that are established by the Secretary of the Department of Health and Human Services (HHS Secretary). It would also establish a process to allow PDPs to submit information about pricing prescription drug claims to their network pharmacies. 

H.R. 5385, Medicare PBM Accountability Act
This legislation would strengthen reporting requirements for PBMs and would require them to submit to the HHS Secretary information on drug costs and pricing, generic and biosimilar formulary placement, PBM affiliates, conflicts of interest, drug dispensing and Part D drugs.

H.R. 5397, Joe Fiandra Access to Home Infusion Act of 2023
This legislation would codify a proposed Centers for Medicare and Medicaid Services (CMS) durable medical equipment (DME) policy that clarifies coverage of an external infusion pump under the Medicare DME benefit.

The other bills are:

H.R. 5372, Expanding Seniors’ Access to Lower Cost Medicines Act of 2023
This legislation would allow changes in insurance plan formularies for biosimilar products to be made mid-year beginning in 2025.

H.R. 5386, Cutting Copays Act
This legislation would set copays for generic drugs to $0 for low-income patients in the Medicare Low-Income Subsidy program. 

H.R. 4881, To amend title XVIII of the Social Security Act to limit cost sharing for drugs under the Medicare program
This legislation would limit patient cost-sharing for Medicare Part D drugs beginning in 2027 and would limit beneficiary out-of-pocket costs to no more than what an insurance company pays for highly rebated drugs once all discounts are accounted for.

H.R. 5389, National Coverage Determination Transparency Act
This legislation would require the HHS Secretary to determine whether a request for a National Coverage Determination (NCD) is complete within 30 days of receiving a request. It would also require the Secretary to make all NCD applications public on the CMS website and would allow the Secretary to work directly with entities that submit NCD applications.

H.R. 133, Mandating Exclusive Review of Individual Treatments (MERIT) Act
This legislation would clarify that NCDs for Medicare-covered drugs and biologics must be made with respect to each drug or biologic and not the class of the drug or biologic.

H.R. 5396, Coverage Determination Clarity Act of 2023
This legislation would prohibit Local Coverage Determinations (LCDs) from being more restrictive than NCDs and would require the HHS Secretary to review LCDs annually to evaluate their consistency.

H.R. 5371, Choices for Increased Mobility Act of 2023
This legislation would clarify that expenses for titanium or carbon fiber materials used in the construction of wheelchair bases are not covered under Medicare Part B. It would also clarify that Medicare Part B beneficiaries may pay out-of-pocket for wheelchair upgrades if they wish.

H.R. 5388, Supporting Innovation for Seniors Act
This legislation would expand a flexibility under the Medicare Advantage (MA) Value-Based Insurance Design Model that allows MA plans to expand access to innovative medical devices and technologies using their existing supplemental benefit funds.

H.R. 5380, To amend title XVIII of the Social Security Act to increase data transparency for supplemental benefits under Medicare Advantage
This legislation would require MA plans to report on the utilization of supplemental benefits by enrollees.

H.R. 3842, Expanding Access to Diabetes Self-Management Training Act of 2023
This legislation would require the Center for Medicare and Medicaid Innovation to test a model covering virtual diabetes outpatient self-management training services and would remove patient cost-sharing and deducible requirements for Medicare Part B diabetes outpatient self-management training services.

H.R. 6366, To amend title XVIII of the Social Security Act with respect to the work geographic index for physician payments under the Medicare program and to revise the phase-in of clinical laboratory test payment changes under such program
This legislation would delay cuts and reporting under the clinical lab fee schedule and would increase the work geographic index to 1.00 for any locality where the index would be less than 1.00, until Jan. 1, 2025.

H.R. 6369, To amend title XVIII of the Social Security Act to extend incentive payments for participation in eligible alternative payment models
This legislation would extend incentive payments for participation in eligible alternative payment (APM) models for one year and would adjust the size of payment to the length that a provider has participated in an APM.

H.R. 5555, DMEPOS Relief Act of 2023
This legislation would require the HHS Secretary to make payment adjustments to certain Medicare items and durable medical equipment included in the 2021 Durable Medicare Equipment, Prosthetics/Orthotics and Supplies competitive bidding program.

H.R. 6371, Provider Reimbursement Stability Act of 2023
This legislation would increase the Physician Fee Schedule budget neutrality threshold and require the HHS Secretary to update prices and rates for direct cost inputs for practice expense relative value units no less than every five years. It would also limit year-to-year conversion factor variance.

H.R. 6364, Medicare Telehealth Privacy Act of 2023
This legislation would prohibit the HHS Secretary from publicly disclosing the addresses of physician and practitioner residences from which telehealth services are provided.

H.R. 1352, Increasing Access to Biosimilars Act of 2023
This legislation would create a pilot program to evaluate the benefits of providing additional shared savings payments to Medicare biosimilar providers.

H.R. 1691, Ensuring Patient Access to Critical Breakthrough Products Act of 2023
This legislation would provide four years of temporary or transitional Medicare coverage to medical breakthrough devices and enable the HHS Secretary to assign coding for approved products.

For more information, click here.


Senate Finance Committee Subcommittee on Healthcare Holds Hearing on Telehealth Flexibilities

On Nov. 14, the Senate Finance Committee Subcommittee on Healthcare held a hearing to discuss telehealth flexibilities issued during the COVID-19 public health emergency and to evaluate whether flexibilities set to expire next year should be made permanent. Witnesses included:

  • Nicki Perisho, BSN, R.N., Principal Investigator and Program Director of the Northwest Regional Telehealth Resource Center
  • Eric Wallace, M.D., FASN, Professor of Medicine and Medical Director at UAB EMedicine, Co-Director of Home Dialysis and Director of the Division of Nephrology Rare Kidney Disease Clinic at the UAB Department of Medicine
  • Chad Ellimoottil, M.D., M.S., Associate Professor and Medical Director of Virtual Care at the University of Michigan
  • Ateev Mehrotra, M.D., MPH, Professor of Health Care Policy at the Harvard Medical School Department of Health Care Policy

For more information, click here.

Senate HELP Committee Ranking Member Requests Information on Use of 340B Program Revenue

On Nov. 16, Senate Health, Education, Labor and Pensions (HELP) Committee Ranking Member Bill Cassidy (R-LA) sent letters to two federally qualified community health centers, requesting information on how they use the revenue they generate from the 340B Drug Pricing Program. The Ranking Member is concerned over reports that reveal some 340B entities are not passing on the revenue they generate from the 340B program to improve healthcare services for low-income patients.

For more information, click here.

Read more on healthcare policy in McGuireWoods Consulting’s Washington Healthcare Update.