Category: Administration

Administration Proposes New Mental Health Parity Rule

The Biden administration issued a proposed rule that would require mental health benefits on commercial heath plans to resemble traditional medical benefits more closely. While 2008’s Mental Health Parity and Addiction Equity Act (MHPAEA) required insurers to provide the same level of coverage for both mental and physical health care, critics say lack of awareness and enforcement has restricted access to mental health care coverage. If finalized, the rule would require insurers to evaluate coverage based on several benchmarks, including the plan’s provider network, how plans pay for out-of-network coverage, and how often prior authorization is required and approved.

Hospitals Are Having Trouble Discharging Patients

It’s becoming harder for hospitals to discharge patients to post-acute care settings, according to a report by health technology company Wellsky. While referrals for post-acute settings like nursing homes and home care have increased since last year, so have rejections for these referrals. The report cited staffing shortages in nursing homes and home care providers as one reason why patients are staying hospitalized longer than necessary. Another factor behind longer hospital stays is the rise in the number of older patients, who are more likely to have chronic health conditions. The struggle to discharge patients comes amid a growing preference for home-based care.

House Leaves Town with Only One Appropriations Bill Approved

The House of Representatives approved their Fiscal Year 2024 Military Construction, Veterans Affairs, and Related Agencies spending bill 219-211 on Thursday before departing for August recess. House lawmakers initially planned to vote for the Agriculture and the Food and Drug Administration (FDA) appropriations bill on Thursday before punting the vote to September after House GOP leaders failed to address concerns over funding levels. Meanwhile, the Senate made further progress on its appropriations bill on Thursday, with the Appropriations Committee passing its four remaining spending bills with support from both parties. The gulf between funding levels in the House and Senate appropriations bills is a significant factor in how Congress will handle their September 30th deadline to fund the government in the next fiscal year.

Black Fetal Mortality Rate Dips Slightly

The fetal mortality rate for Black infants has declined by 4% in 2020, according to data from the Centers for Disease Control and Prevention (CDC). However, the Black fetal mortality is two times higher than the national average. Only 1% of pregnancies in the US end in fetal death, which is defined by death within 20 of gestation or later. While the study does not identify the causes of fetal death, the findings are consistent with lower health outcomes among Black Americans. For example, Black maternal deaths are higher than White maternal deaths due to a lack of diversity among medical professionals and higher comorbidities.

ICYMI: Senators Jump into Barbie, Oppenheimer Meme Debate

The social media debate over whether to identify with Barbie or Oppenheimer has reached the halls of Congress. Over the past two weeks, Senators from both parties have shared which one of the two films they’ve seen first or preferred. Sens. Ben Cardin (D-MD) and Chris Van Hollen (D-MD) have made Maryland’s Senate delegation a part of Team Barbie, while current and former presidential candidates Sens. Tim Scott (D-SC) and Bernie Sanders (I-VT) have sided with Team Oppenheimer. Meanwhile, Sens. Mitt Romney (R-UT) and Kyrsten Sinema (I-AZ) are picking both by joining “Team Barbenheimer.”

Administration Proposes New Medicare Drug Pricing Reforms 

On Tuesday, the Centers for Medicare and Medicaid Services (CMS) announced a trio of drug pricing proposals that would standardize how much Medicare beneficiaries pay for certain generic drugs, explore new ways for Medicaid to pay for expensive cell and gene therapies, and test ways to pay for drugs approved without a proven clinical benefit.  The proposals stem from an executive order President Biden signed last year directing the administration to develop demonstrations that would complement the drug pricing provisions of the Inflation Reduction Act. Beyond the three proposals, CMS also called for more research to encourage adoption of biosimilars, data access to support price transparency, and access to cell and gene therapies under Medicare. 

Administration Proposes Nursing Homes Disclose Connections to Private Equity 

Nursing homes would have to disclose whether private equity firms or real estate investment trusts own or help operate facilities under a proposed CMS rule released on Monday.  The rule would require nursing homes to report such relationships during the Medicare and Medicaid enrollment process, which would enable government agencies and the public to more easily determine whether nursing home owners are private equity investors or real estate investment trusts.  In response, the American Health Care Association and National Center for Assisted Living (ACHA/NCAL) called the rule a “distraction from the real issues” facing nursing homes, like the underfunding of Medicaid and workforce shortages. 

Feinstein Announces Retirement 

Sen. Dianne Feinstein (D-CA), the Senate’s oldest member, announced her retirement on Tuesday.  A former mayor of San Francisco, Feinstein announcement came amid concerns regarding her age and mental acuity.  She is the first woman to have chaired the Senate Rules Committee and the only woman to have chaired the Select Committee on Intelligence. Since the announcement, Reps. Katie Porter (D-CA) and Adam Schiff (D-CA) have both announced their plans to run for Feinstein’s Senate seat, and Rep. Barbara Lee (D-CA) is widely expected to announce her own Senate run.   

FDA Issues New Warnings on Aduhelm 

The Food and Drug Administration (FDA) recently updated the label of Biogen’s Alzheimer’s drug Aduhelm following the death of a 75-year-old woman who experienced brain bleeding and swelling while taking the drug.  The new label calls on physicians to “inform patients that events of intracerebral hemorrhage” can happen infrequently when taking Aduhelm.  According to clinical trial data, 41% of Aduhelm-treated patients experienced brain bleeding and/or swelling, compared to 10% of patients on placebo.  Aduhelm received a controversial accelerated approval from the FDA in June 2021, despite mixed data on the drug’s clinical benefit for Alzheimer’s patients.  Aduhelm sales have remained low due to the drug’s high price tag and a decision from some major university hospital systems to not prescribe the drug. 

ICYMI: UFO Fever Hits Washington…Again 

Members of Congress and the general public has once again become enamored with unidentified flying objects (UFOs) after the Pentagon admitted to shooting down three such UFOs last weekend.  Details about the recent incidents remain sparse as earlier this week, Sen. Jim Risch (R-ID) said the craft was “smaller than a car,” and that one carried “a payload.”  However, other senators have been quick to clarify that the objects are not extraterrestrial in origin.  In recent years, UFO fascination in Congress has centered around reports of unidentified ariel phenomena (UAP) from US Navy personnel. 

Biden Administration to End PHE in May 

The White House announced on Monday that the COVID-19 public health emergency (PHE) will officially come to an end on May 11.  Since it was first declared on January 31, 2020, the PHE has been renewed 12 times at 90-day intervals, with the most recent renewal being January 11, 2023. The end of the PHE will kick off a gradual unwinding of emergency measures and flexibilities related to the use of telehealth and a continuous coverage requirement for Medicaid. The PHE’s termination will also mean the end of free COVID-19 vaccines, tests, and treatments. By announcing the end of the PHE 101 days before May 11, the administration is honoring its commitment to provide 60 days’ notice prior to termination of the PHE. 

Surprise Bill Faces Lawsuit over IDR Process 

The Texas Medical Association (TMA) filed another lawsuit against the No Surprises Act – this time, over a 600% increase in administrative fees for parties seeking to enter the independent dispute resolution (IDR) process to resolve payment disagreements between health plans and out-of-network providers.  The Biden administration increased the $50 initial administrative fee to $350 to account for “increasing expenditures in carrying out the Federal IDR process,” likely due to the fact that more billing disputes have been directed to the IDR process than initially anticipated.  According to the TMA, the jump in administrative fees will disincentivize physicians’ ability to seek arbitration and disproportionally impact specialties with small-dollar claims, like radiology.  The TMA has filed three lawsuits against the No Surprises Act, and a district court ruling from one lawsuit compelled the administration to change its rules pertaining to the IDR process.  

Study: US Health Outcomes Worse Despite Higher Spending 

The US has some of the worst health outcomes among high-income countries despite having the highest health spending per person, according to a study from the Commonwealth Fund.  For example, the study found that the US had the lowest life expectancy at birth, the highest maternal and infant mortality rates, the highest suicide rates, and the highest death rates for avoidable or treatable conditions.  Some of the possible reasons for the poor health outcomes described in the study could be the lack of guaranteed health coverage in the US and the fact that the US has the lowest rate of practicing physicians and hospital beds per 1,000 population.  The study also noted that Americans see physicians less often than residents of other wealthy nations.  

Lawmakers Call for Drug Czar to Be Cabinet-Level Position 

55 bicameral, bipartisan lawmakers sent a letter to President Joe Biden on Thursday calling for the Director of the Office of National Drug Control Policy (ONDCP) to be elevated to a Cabinet-level position to better address the nation’s drug overdose epidemic.  Colloquially known as the “drug czar,” the position of ONDCP director was a Cabinet-level position until 2009 when then-President Barack Obama downgraded it.  Established under former President Ronald Reagan in 1988, the ONDCP coordinates with 19 federal agencies to lead US drug policy.  In the letter, the lawmakers urged President Biden to announce the reinstatement of the position to the Cabinet in the upcoming State of the Union address on February 7 due to a 60% increase in overdose deaths since 2019. 

ICYMI: Modernization Committee Lives On in 118^th Congress 

Despite being dissolved at the end of 2022, the House Select Committee on the Modernization of Congress will live on in the 118^th Congress as a subcommittee within the House Administration Committee as the the fate of the panel up until this week was in limbo due to a change in control of the House.  Like its predecessor, the new subcommittee consists of four members, equally divided between Republicans and Democrats.  Subcommittee leaders plan on building on the success of the select committee, which includes raising the pay ceiling for staff above what members earn and reviving a more transparent version of the earmarks process. 

Administration to Crack Down on Antipsychotics in Nursing Homes 

The Biden administration is getting ready to target the inappropriate use of antipsychotic medications in nursing homes, according to an announcement from the Centers for Medicare and Medicaid Services (CMS). The announcement is part of a larger initiative announced in October to strengthen oversight of the nation’s poorest performing nursing homes.  Starting this month, CMS will conduct targeted audits to determine whether nursing homes are accurately assessing and coding individuals with a schizophrenia diagnosis.  Nursing homes found to be regularly misdiagnosing residents will see changes to their rating in CMS’ nursing home rating system.  CMS will also start to make nursing home citations under dispute available to the public. 

Top White House COVID Official Steps Down 

Dr. David Kessler stepped down this week from his role as Chief Science Officer for the administration’s Covid-19 response.  His departure marks the end of a two-year stint at the White House that included oversight of the federal effort to develop and distribute COVID-19 vaccines and treatments.  In his role, Kessler was responsible for negotiating with drug companies to ensure that vaccines were available to anyone who wanted one.  Kessler is no stranger to public service, having served as Commissioner of Food and Drugs from 1990 to 1997.  The announcement of Kessler’s exit from the administration comes at a time when the federal government is working to shift COVID-19 vaccination from a government-run effort to one that will be managed by the private sector. 

Gallup: Most Americans Have Negative View of Health Care 

48% of Americans rate US health care quality as excellent or good, according to a new poll from Gallup.  The findings represent that for the first time since 2001, which was when Gallup began polling the public’s opinion on health care, that most Americans view health care quality as fair or poor.  The poll found that one of the key reasons that attitudes toward health care have declined is that Republicans’ faith in the health care system has deteriorated since former President Trump left office.  Another major reason respondents cited that health care quality declined was due to the high price of obtaining health care.  Views on health care in the US have gradually declined since their peak in 2012, when 62% of respondents viewed the health care system positively. 

Moderna’s Experimental RSV Vaccine Shows Promise 

Moderna’s experimental RSV vaccine was 83.7% effective at respiratory syncytial virus (RSV) in people ages 60 and older, according to data posted by the company on Monday.  No safety concerns were identified during the clinical trial of the vaccine, which uses the same mRNA technology as the company’s COVID-19 vaccine. The US is currently on the tail-end of a severe surge in RSV infections, which typically kill between 6,000 and 10,000 older adults every year and result in 60,000 to 120,000 hospitalizations.  A 37,000-person Phase III clinical trial is still ongoing, and the company plans on asking the Food and Drug Administration (FDA) to approve the vaccine by mid-year. 

Study Points to Benefits of Hybrid Immunity 

Hybrid immunity is more effective at protecting against severe COVID-19 cases and preventing hospitalization than immunity from infection alone, according to a study published in the Lancet.  The World Health Organization (WHO) defines hybrid immunity as protection in people who’ve been vaccinated for COVID-19 and have been infected with the virus either before or after vaccination.  The study found those with hybrid immunity were 42% less likely to get reinfected a year after their first two COVID-19 vaccine doses and 46% less likely six months after their first booster. While participants who had only been infected were 25% less likely to be reinfected with COVID-19.  The study’s authors recommended that mass vaccination should happen before case surges in the winter because immunity remains effective a year later. 

ICYMI: March for Life Rally Returns Today 

The March for Life returns to Washington, DC today, marking the first such rally of anti-abortion and pro-life advocates since the Supreme Court overturned Roe v. Wade last June.  Unlike previous years, this year’s march will partially go around the US Capitol instead of heading straight to the Supreme Court in order to send a message to lawmakers.  Organizers expect up 50,000 people to show up for the rally, which is similar to previous years.  Washington, DC area residents should be aware of road closures near the National Mall throughout the day.    

White House Revives Free COVID-19 Test Program 

The White House restarted a program to provide free COVID-19 tests to Americans via the US Postal Service, ahead of a possible winter surge as new cases and hospitalizations tick up.  The Biden administration initially began supplying COVID-19 tests by mail in January to address the Omicron surge, but the program was suspended in September due to a lack of funding.  The move is part of a broader COVID-⁠19 Winter Preparedness Plan that includes offering resources and assistance to states to get more Americans vaccinated and boosted, releasing a “winter playbook” for nursing homes and long-term care facilities, and monitoring for new variants.  Households can now order four tests at covidtests.gov, with shipments beginning next week. 

NBPP Proposes to Address Generic Drug Prices, Offer New Special Enrollment Period (SEP) 

The Department of Health and Human Services (HHS) proposed a number of new policies in its proposed 2024 Notice of Benefit and Payment Parameters (NBPP) rule, including one to require Affordable Care Act (ACA) marketplace plans to cover all generic drugs on a new, dedicated generic drug tier with lower cost-sharing.  According to HHS, the new policy would help prevent discriminatory benefit designs, improve access for prescription drugs, and reduce the risk of confusion for ACA plan enrollees.  Additionally, HHS proposed allowing ACA marketplaces to create a new special enrollment period (SEP) for people who lose Medicaid/CHIP benefits.  The proposed policy is likely a preemptive move to address coverage losses from Medicaid redeterminations once the COVID-19 public health emergency (PHE) comes to an end.  Stakeholders have until January 28 to comment on the proposed NBPP rule. 

Initial Data on Moderna’s Cancer Vaccine Show Promise 

Moderna’s mRNA cancer vaccine has resulted in a “clinically meaningful reduction” in the risk of death when used alongside an immunotherapy, according to early-stage clinical trial data released by the company on Tuesday.  Moderna stated in a press release the results amount to a “paradigm shift” in treating cancer by offering a new therapeutic that has significantly fewer side effects than existing treatments like chemotherapy and radiation therapy.  If approved, however, the cost of mRNA vaccines would be a major obstacle, as each treatment would be personalized to each patient. 

SAMHSA Proposes Buprenorphine Prescriptions via Telehealth 

In a notice of proposed rulemaking (NPRM) issued on Tuesday, the Substance Abuse and Mental Health Services Administration (SAMHSA) proposed nixing the in-person requirement to receive a buprenorphine prescription to treat opioid use disorder and allow the treatment to be prescribed via telehealth.  The change is likely intended to address a spike in opioid overdose deaths that began with the COVID-19 pandemic.  Since the start of the COVID-19 PHE, people suffering from opioid abuse have been able to get prescriptions for buprenorphine over audio-only or video telehealth via a temporary waiver.  According to a recent HHS study, people who took advantage of receiving a prescription over telehealth to treat opioid abuse experienced overall positive outcomes.   

ICYMI: Pelosi’s Portrait Unveiled at US Capitol 

An official portrait of Speaker Nancy Pelosi (D-CA) was unveiled in Statuary Hall of the US Capitol on Wednesday.  The portrait depicts the day she was first elected speaker on January 4, 2007.  Senate Majority Leader Chuck Schumer (D-NY) and former House Speaker John Boehner (R-OH) spoke at the unveiling ceremony, and former President Barack Obama delivered remarks via video.  The ceremony also included brief remarks in memory to the artist responsible for Pelosi’s and Boehner’s portraits, Ronald Scherr, who died last week at age 70.   

New White House Plan Aims to Increase Booster Numbers  

President Joe Biden got his updated bivalent COVID-19 booster shot on Tuesday to underscore the administration’s latest push to get more Americans boosted ahead of what’s expected to be a rise in the  case numbers over the coming weeks.  Since the bivalent boosters became available last month, only 8% of eligible Americans have received a shot so far.  Key components of the new plan include education and outreach to seniors and other high-risk Americans, which includes a media campaign and a #VaxUpAmerica Family Vaccine Tour.  The plan also calls for engagement with employers, pharmacies, and schools to urge members of their respective communities to get boosted.   The Biden administration is also urging Americans to get their annual flu shot alongside their COVID-19 vaccine booster. 

Administration Announces New Penalties for Underperforming Nursing Homes 

Some of the nation’s worst nursing homes will soon see stiffer penalties, according to new enforcement measures laid out by the Biden administration last Friday.  The enforcement actions are part of a broader plan to boost nursing home quality that President Biden first announced in his State of the Union Address earlier this year.  Some of the new steps the administration is taking is increasing penalties for nursing homes that fail to address their violations and increasing safety standards. The administration also announced several actions to help nursing homes improve, such as $93 million in grant funding to support workforce development, education, and training.  Nursing homes have come under increased scrutiny over the past few years as the COVID-19 pandemic has exacerbated workforce shortages and resulted in subpar conditions for residents.   

KFF: Employers May Face Higher Insurance Premiums Next Year 

While premiums in employer-sponsored health plans remained stable in 2022, employers could face higher premiums in 2023, according to an annual employer benefits survey from the Kaiser Family Foundation (KFF).  That’s because insurance plans finalized premiums for 2022 before fall 2021, which precedes the surge in inflation observed this year.  While employers have largely absorbed higher premiums thus far amid a tight labor market, KFF notes that a spike in premiums next year could mean employers may have to reconcile between the difficultly of passing higher premiums on to employees while managing their own inflation-driven financial pressures.  The survey also found that nearly a third of large employers say their insurance networks don’t have sufficient access to behavioral health care providers, despite a growing demand among employees for mental health care services.   

NCI: Cancer Death Rate Continues to Decline 

The number of Americans who died from cancer between 2015 and 2019 declined by 2.1%, according to the latest annual report from the National Cancer Institute (NCI).  The biggest decline in cancer deaths was observed in two cancer types:  melanoma and lung cancer.  The report also found modest improvements in the survival rate for pancreatic cancer, which is notable given its association as one of the most lethal types of cancer.  However, the report found that the incidence of new cancers has remained largely unchanged, and that racial and ethnic minorities are more likely to die from certain types of cancer.  

Hill Staffer Unions Ponder Future in GOP-Controlled House 

Ever since Speaker Nancy Pelosi (D-CA) endorsed unions for congressional staff back in February, six Democratic congressional offices have voted to form unions, while another five offices have filed petitions to hold elections on forming their own unions.  As Republicans are likely to control the House in the next Congress, some are worried that staff unions in the House could be short-lived, given House Republican Leader Kevin McCarthy’s (R-CA) opposition to staff unions.  However, some union experts say Republicans may not bother to disband unions because such a move would require statutory changes (as opposed to a simple resolution), as well as the fact that no GOP offices have yet to unionize.  

ICYMI: Marine Corps Marathon Returns to DC 

After a two-year pandemic hiatus, the Marine Corps Marathon is back in action in Washington, DC this Sunday.  The marathon route starts in Arlington National Cemetery and continue across the Key Bridge into Georgetown and Rock Creek Park before heading over to the National Mall and crossing the river back into Virginia.  Up to 30,000 people are scheduled to attend, making it one of the most popular marathons in the world.   

Administration Finalizes Rule to Fix “Family Glitch”  

On Tuesday, the Biden administration issued a final rule to close the “family glitch,” a loophole that blocked family members from receiving Affordable Care Act (ACA) tax credits if a member of their household had access to another source of minimum essential coverage, including employer-sponsored plans. According to the White House, 1 million Americans will gain coverage or see their insurance become more affordable as the result of the rule.  While stakeholders have been largely supportive over the rule, some questioned whether the administration had the authority to make the changes.  The final rule goes into effect in November.   

Walmart Steps into Health Care Research 

Retail giant Walmart launched the Walmart Healthcare Research Institute (WHRI) on Tuesday to add more medical services to its stores and address health disparities.  The new institute will be developing new interventions and medications that can impact underrepresented communities like seniors, rural residents, women, and minority populations.  To enhance clinical trial diversity, the WHRI will initially focus on including members of underserved communities in its studies on treatments for chronic conditions.  According to Walmart, about 4,000 of its stores are located in underserved communities.  The announcement comes amid a Food and Drug Administration (FDA) effort to increase racial and ethnic diversity in clinical trials. 

FDA, CDC Approve Bivalent Booster for Kids 5-11 

Both the FDA and the Centers for Disease Control and Prevention (CDC) signed off on the bivalent COVID-19 vaccine booster doses from Pfizer and Moderna for children ages five to 11 earlier this week.  The bivalent boosters, which target both the original iteration of COVID-19 and the Omicron BA.4/BA.5 subvariants, were made available to all US adults last month.  Only 40% of US children ages five to 11, who have already gotten their two primary doses, are eligible for the booster.  While children are far less likely than adults to face severe consequences from COVID-19, hospitalization rates in children have increased during previous surges, and federal health officials are urging patents to get their kids vaccinated or boosted ahead of a potential new COVID-19 surge in the late fall or winter. 

March of Dimes: Maternity Care “Deserts” Are Increasing 

The March of Dimes painted a sobering picture of the state of maternal health care in the US in a new report that found nearly seven million women of childbearing age and half-a-million babies live in maternity care “deserts,” meaning they lack obstetric hospitals or birth centers.  More so, the report found the number of maternity care deserts has grown 2% since the release of the last report in 2020.  The report also found that racial and ethnic minorities are more likely to live in maternity care deserts.  For example, about a quarter of Native American babies and 17% of Black babes are born in areas with limited or no maternity care services.  As policy solutions, the March of Dimes recommends that Congress passes legislation that will extend Medicaid postpartum coverage from 60 days to a year and expand telehealth services to bridge gaps in health care. 

ICYMI: Library of Congress Kicks Off Fall Concert Series 

If you’re in DC and you’re bummed about missing Jazz in the Garden this summer, don’t worry there are still plenty of opportunities to catch free live music at the Library of Congress Fall Concert Series, which officially starts tonight at the Thomas Jefferson Building.  The inaugural concert will feature Greek, English, Italian, Portuguese, French, and Japanese folk songs.  Piano and opera performances will also be on deck throughout the fall.