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Unseasonably cool weather in Washington last week left us feeling less than springy. However, we did see a thawing of relations between Republicans and Democrats on a foreign aid package. Additionally, the endorsement of Speaker Mike Johnson (R-LA) by former President Trump likely brings some feelings of rejuvenation to the embattled Speaker. The forecast this week calls for a return of Congress, a response to the Biden administration’s nursing home staffing mandate, and a possible rule on lab-developed tests (LDTs). Welcome to the Week Ahead!
The Administration
While Congress was out of session, the Administration dispatched several highly-anticipated final rules, including the nursing home staffing ratio rule, the Medicaid managed care rule, the Medicaid access rule, and an FTC ban on non-compete agreements, among others.
Banning menthol in cigarettes did not get finalized. On April 26, Health and Human Services (HHS) Secretary Xavier Becerra acknowledged the need for more time, likely in part due to concerns that the rule would lead to increased law enforcement activity in minority communities.
4-1-1 on LDTs: Despite all the regulatory activity, we are still waiting on a proposed rule granting the Food and Drug Administration (FDA) explicit authority to regulate LDTs. We expect that rule any day now.
The Senate
UnitedHealth Group CEO Comes to Town
United Healthcare Group CEO Andrew Witty testifies before Congress about the Change Healthcare cyberattack. His first stop will be a Senate Finance Committee hearing.
Some things we will be watching:
• Will GOP members use the hearing to criticize the Biden Administration’s response to the cyberattack, or will they focus their attention on UnitedHealth Group’s response?
• Will any members discuss or propose legislative action to address broader concerns about cybersecurity? In particular, we will be watching to see if Sen. Mark Warner (D-VA) uses the hearing to advocate for legislation he introduced earlier this year that would tie federal payments to health care providers after a cyberattack to the adoption of cybersecurity standards.
• How will Mr. Witty respond to allegations that United Healthcare has not done enough to help providers in the wake of the attack?
Other Notable Senate Hearings
- April 30: Senate Armed Services Subcommittee on Personnel hearing on access to pharmaceuticals
- May 2: Senate HELP Committee hearing on the shortage of minority health care professionals and the maternal health crisis
The House
Movement on Appropriations
What’s happening: Last week, the House Appropriations Committee released guidance for members on FY 2025 Community Project Funding (earmarks). This comes as the House just finished FY 2024 appropriations only one month ago.
The House Labor, Health and Human Services Appropriations Subcommittee holds its Member Day on April 30.
What it means: The pace is quick: members must submit programmatic and language requests by May 1 and Community Project Funding Requests by May 3. We know how deadlines drive activity in DC!
House Energy and Commerce GOP Looks to Strike Back on Nursing Home Staffing Rule
What’s happening: On April 30, The House Energy and Commerce Health Subcommittee will consider the Protecting America’s Seniors Access to Care Act (H.R. 7513), which would block the implementation of the recently finalized minimum staffing rule during its legislative hearing entitled “Legislative Proposals to Increase Medicaid Access and Improve Program Integrity.”
Some Democrats have crossed the aisle to support this bill. Rep. Jared Golden (D-ME) is one of the bill’s cosponsors, and Rep. Terry Sewell (D-AL) supported the bill’s passage out of Ways and Means. That being said, most Democratic members are supporting the administration’s action. Given the small majority Republicans hold in the House, not to mention the Democratic majority in the Senate and Democratic President, getting this bill across the finish line may be a tall order.
In Other House Committee News
- The House Oversight Select Subcommittee on the Coronavirus Pandemic will hold a hearing on May 1 with the president of EcoHealth Alliance. EcoHealth Alliance has been accused by some House GOP members of funding risky gain-of-function research so this hearing will certainly be feisty.
- After his appearance before the Senate Finance Committee on the morning of May 1, UnitedHealth Group CEO Andrew Witty will be crossing over to the House for an Energy and Commerce Oversight Subcommittee hearing about the Change Healthcare cyberattack.
There You Have It
What are your favorite springtime activities? Did you get to do any spring break traveling this year? Reach out to share and compare. Here’s to a great Week!
It’s Patriots’ Day, and our very own Jennifer Bell is taking this whole marathon-not-a-sprint thing seriously by tackling the Boston Marathon again. In DC this week, the drone and missile attack on Israel from Iran will dominate floor activity even as Congress has a slew of hearings ahead of the April 22 break for Passover. So, let’s see what the week holds – welcome to the Week Ahead!
The Administration
The Iranian attack will have big implications for Washington – putting pressure on Congress to move on stalled foreign aid packages and on the Biden administration to stand with Israel as some progressive critics call for him to condition aid on efforts to prevent civilian casualties.
Everybody Wants to Rule the World…
What’s happening: On the health care front, the hospital lobby is criticizing the FY 2025 Inpatient Prospective Payment System Proposed Rule for not keeping up with inflation. The proposed rule came out just ahead of this week’s American Hospital Association Annual Meeting.
What’s on deck: While still under review at OMB, we are keeping our eyes peeled for the Medicaid access rule. We aren’t feeling the final versions of the laboratory-developed test rule or the minimum-staffing standards for long-term care rule coming out this week since OMB is still conducting stakeholder meetings.
The Senate
Senate Subcommittee Weighs in on HHS Budget
What’s happening: With the 2024 appropriations process now in the rearview mirror, the Senate Appropriations Committee will hold several budget-related hearings this week—including one with Health and Human Services Secretary Xavier Becerra. Sec. Becerra will be testifying on the President’s proposed FY2025 HHS budget before the Senate Labor, Health and Human Services Subcommittee on April 16.
Why it matters: This will be the 4th appearance by the Secretary on the budget, with one additional one later in the week in the House. Will the Secretary be pressed on the administration’s response to the cyberattack on Change Healthcare or funding related to the Medicare drug negotiations in the Inflation Reduction Act? Will he be checked out as rumors fly about his potential exit to run for governor of California? We are betting the Secretary will be fully engaged.
Another Impeachment Senate Hearings
What’s Happening: While leaders debate how to respond to the attacks on Israel, we doubt the Senate will have much appetite to take up impeachment articles against Homeland Security Secretary Alejandro Mayorkas. The House voted to impeach the Secretary in February, but they have yet to send the articles over to the Senate.
Senate Hearings
Other notable hearings this week include:
- April 16: Senate Aging Committee hearing on the Long-Term Care Workforce
- April 17: Senate HELP Primary Health and Retirement Security Subcommittee hearing on food as medicine
- April 17: Senate Armed Services Subcommittee on Personnel hearing on servicemembers’ access to safe, quality pharmaceuticals
- TBD: Last week, during a Senate Finance Health Subcommittee hearing on substance use disorder care in federal health care programs, Subcommittee Chair Ben Cardin (D-MD) said that Committee Chair Ron Wyden (D-OR) plans to have a full hearing on opioids and fentanyl
The House
Mike Gets a Win
What’s happening: Last week, the House of Representatives passed legislation to renew the Foreign Intelligence Surveillance Act (FISA) after opposition from some Republicans caused previous votes to fail.
Why it matters: Beyond the significance of the legislation itself, this vote shows (at least for now) that Speaker Mike Johnson (R-LA) can still get things through Congress. Before the weekend, the question was about whether he could maintain control of his caucus as he seeks to pass potential Ukraine aid legislation. Now, with the schedule to be dominated by yet-to-be-announced legislation regarding Israel, we expect threats to oust the Speaker will die down for a few days at least.
Jam-Packed Tuesday
What’s happening: The House is starting the week off hot with several health care-related hearings.
- April 16: House Energy and Commerce Health Subcommittee hearing on cybersecurity in the health care sector following the Change Healthcare attack
- April 16: House Education and Workforce HELP Subcommittee hearing on ERISA
- April 16: House Energy and Commerce Oversight and Investigations Subcommittee hearing on Medicare and Medicaid fraud
- April 16: House Veterans’ Affairs Health Subcommittee Markup of health care legislation
Why it Matters: Even though the House is spending a lot of floor time on issues than health care these days, health care legislation is still on the front burner in the committees.
Becerra Returns to the House
What’s happening: HHS Sec. Becerra is scheduled to testify before the House Energy and Commerce Health Subcommittee on April 17 about the FY25 HHS budget.
Does it matter? Even as Energy and Commerce gets its time with the Secretary, the bigger impact on the President’s budget proposal is arguably last week’s selection of Rep. Tom Cole (R-OK) as the new House Appropriations Chair.
House Energy & Commerce Subcommittee Considers Privacy Legislation
What’s happening: The House Energy and Commerce Innovation, Data, and Commerce Subcommittee is scheduled to consider several legislative proposals related to data privacy on Wednesday. Among the proposals to be considered is a draft of the American Privacy Rights Act, which includes provisions related to health care data.
Why it matters: This bill was introduced by House Energy and Commerce Chair Cathy McMorris-Rodgers (R-WA) and Senate Commerce Committee Chair Maria Cantwell (D-WA). That means this bill is bipartisan, bicameral, and has support from two committee chairs. These facts bolster chances for success. The question is, will that be enough to move this bill during an election year?
So, there you have it! Did you get your taxes in? Did you know 2 states celebrate Patriots’ Day? Reach out to us if you know the other one that is not Massachusetts. Here’s to a great week!
On April 12, 2024, the Medicare Payment Advisory Commission (MedPAC) met to discuss work for their June 2024 report on drugs and 340B hospital payments. The June report contains recommendations and research on where Medicare should go in the future – and is usually filled with new ideas and innovations.
Well the Gamecocks of South Carolina finish their 10th undefeated women’s basketball season, beating the Iowa Hawkeyes in double digits. We have the men facing off tonight with Purdue being in the finals for the 1st time since 1969. And we have the only total solar eclipse in the 21st century where totality will be visible in Mexico, the U.S., and Canada EVER. It will be an amazing week in DC – let’s get to it!
The Administration
What’s Happening: Much like the players getting ready for the big game tonight, President Biden is getting ready for his upcoming rematch with former President Trump. One way he is doing that is by outlining his Administration’s positions on health care and contrasting those positions with the former president and Republicans. In the last two weeks, President Biden
- Published a document attacking the House Republican Study Committee’s Budget for cuts to Medicare and Social Security
- Hosted and spoke at a White House event on health care with Senator Bernie Sanders (I-VT)
- Held a campaign event in North Carolina and gave remarks focused on health care policy
Why It Matters: Polls show that the American people want to hear from 2024 presidential candidates about health care policy even if other issues may be ranked higher in importance. President Biden’s recent flurry of activity around health care tells us that he and his team are working to respond to that call. We expect this activity to continue, if not increase, as the campaign heats up.
Rule-o-Rama: Even though Congress has been on recess, the Administration has been busy publishing and finalizing several health care-related rules. Some highlights include:
- A rule with the goal of making it easier for eligible individuals to maintain Medicaid coverage during the unwinding process.
- A rule aimed at what the president has labeled “junk health insurance plans”
- The Contract Year (CY) 2025 Medicare Advantage and Part D final rule
- The 2025 Notice of Benefit and Payment Parameters final rule
Why It Matters: Rules finalized thus far have generally been focused on protecting and improving existing programs (i.e. the rule making it easier for individuals to maintain Medicaid coverage). However, what we find more interesting are the rules that have not been introduced such as the nursing home staffing mandate or the ban on menthol cigarettes and flavored cigars. We are watching to see if President Biden will try to score a few more regulation points before the final buzzer goes off and the other team can use the Congressional Review Act to more quickly undo recent agency action.
We also expect the Hospital Inpatient Prospective Payment Rule to come out in the next week or so. It will be interesting to see if CMS follows MedPAC’s advice to increase payments by market basket update plus 1.5% or if CMS will be more austere.
The Senate
What’s Happening: The Senate is skipping the warm-up drills and going right into the game his week with two prime-time hearings.
- April 9 – Senate Finance Committee Health Subcommittee Hearing: “Closing Gaps in the Care Continuum: Opportunities to Improve Substance Use Disorder Care in the Federal Health Programs.”
- April 10 – Senate Finance Committee Full Committee Hearing: “Bolstering Chronic Care through Medicare Physician Payment.”
Why It Matters: The Senate Finance Committee hearings both focus on issues which have garnered support from both sides of the aisle. This makes sense given how difficult it is to move partisan priorities with a divided Congress. Here are some things we will be watching for:
- Will committee members show support for efforts like those in the House to reform how physicians are paid under Medicare?
- Will the committee stay focused on physician payments or go off on tangents related to other Medicare priorities?
- Will the GOP members use the subcommittee hearing on oversight of SUD care to criticize the Administration’s efforts to utilize harm reduction strategies?
- Will Democratic members follow the White House’s line of attack against House Republicans for proposed reductions in opioid response programs?
Don’t Forget: Senate Finance is also expected to hold a hearing to examine the Change Healthcare cyberattack. Advocacy groups have been critical of UnitedHealth’s and the federal government’s response so far.
The House
A Ukraine funding bill is expected this week: Speaker Mike Johnson (R-LA) said he would introduce legislation this week to aid Ukraine in its war against Russia. The Senate passed $60 billion to support Ukraine in February but nothing has been resolved because of opposition in the House.
Will the Next Appropriations Chair Please Stand Up: House Appropriations Committee Chair Kay Granger (R-TX) announced she would be stepping down from her post after the completion of the FY24 appropriations bills. She sent a letter to Speaker Johnson asking that the GOP Steering Committee and Conference begin the process of choosing a new chair.
Why it Matters: Only 1 member has officially put his hat in the ring, Rep. Tom Cole (R-OK). However, Rep. Robert Aderholt (R-AL), who has seniority over Rep. Cole on the committee, has called for a time out in the selection process. Any delay over choosing a new appropriations chair has consequences, including:
- Time taken away from working on FY25 appropriations
- Time taken away from legislating on other issues, such as telehealth
What’s Happening on Health Care: The House Energy & Commerce Committee Health Subcommittee will hold a hearing on April 10 titled “Legislative Proposals to Support Patient Access to Telehealth Services.” Next week, we are looking ahead to a House Oversight Committee hearing on the FDA, where Commissioner Califf will testify.
Overtime: MedPAC and MACPAC Meet
Both MedPAC and MACPAC will be working on their June reports to Congress. These reports provide recommendations for improvements or innovations to the program. We will be especially interested in the following:
- MedPAC’s looking into telehealth and also Medicare physician fee schedule – just like the House
- MACPAC’s scheduled vote on Friday morning on recommendations for the June report to Congress
Here’s to a great week ahead – were you disappointed by Caitlin Clark’s loss even as she played amazingly, did you see the last eclipse in the US in 2017, are you looking forward to the Master’s golf tournament this week – let us know your questions and feedback!
