Insights

Week Ahead: Ready or Not Here It Comes – For Testing

The first presidential debate for the 2024 electionis upon us, with President Biden and former President Trump set to take the stage in Atlanta on June 27. As the candidates and the country prepare, we at Chamber Hill Strategies are also watching for the release of two proposed Medicare rules, a possible Ways and Means markup, and more. So, let’s get into it, welcome to the Week Ahead!

The Administration

Summers in Washington bring blazing heat and crowds of tourists. Summer is also when we start seeingthe arrival of more Medicare payment proposed rules. So as the temperature climbs,we are hearing these 2 rules could be released as early as June 28:

  • Proposed CY 2025 Physician Fee Schedule Rule: The PFS is how the Centers for Medicare and Medicaid Services (CMS) pays for physician services, incidental services, non-clinical laboratory diagnostic tests, and radiology services.
  • Proposed CY 2025 Outpatient Prospective Payment System. The OPPS is how CMS generally pays for hospital outpatient department services.

We are eagerly anticipating the rules governing the Home Health Prospective Payment System and the End-Stage Renal Disease Prospective Payment System, but those are still under review at the Office of Management and Budget.

These proposed rules are vitally important to health care providers and the Medicare beneficiaries they serve. They also provide an opportunity for the Administration to advance health care priorities with a Republican-controlled House and a Senate that lacks a filibuster-proof majority for Democrats. For example, we could see the Administration try to advance payment policies in the PFS that require inclusion of data on social determinants of health. We might also see the Administration include provisions in the OPPS rule designed to encourage hospitals to adopt stronger cybersecurity protections. We will be watching closely for the release of these rules and diving into the details as soon as they come out.

The Senate

The Senate is out of session until after the 4th of July Holiday. We will provide updates when they return the week of July 8.

The House

Ways and Means Looks at Innovative Products

Rumor is that that the House Ways and Means Committee could meet this week to mark up legislation that would extend Medicare coverage for new and innovative technologies and products.  While the markup has yet to be noticed, the Committee’s interest in advancing coverage for newly developed treatments and devices is not a secret in health policy circles. One possible candidate for consideration is H.R. 1691, the Ensuring Patients Access to Critical Breakthrough Products Act, which was introduced last year by Ways and Means member Rep. Brad Wenstrup (R-OH) and fellow committee members, Reps. Suzan DelBene (D-WA), Blake Moore (R-UT), and Rep. Terrie Sewell (D-AL); the bill would extend temporary Medicare coverage to devices approved under the Food and Drug Administration’s Breakthrough Devices Program.  Also, rumored for possible consideration is H.R.5389, National Coverage Determination Transparency Act, which counts committee member Rep. Mike Kelly (R-KY) among its lead cosponsors. The legislation which was introduced by Energy and Commerce Health Subcommittee Chair Rep. Brett Guthrie (R-KY) was approved by the Energy and Commerce Committee in December.

These bills both become prime contenders for a House vote during a possible “health care week” in July.

Other Health Care Hearings on the Radar

  • June 26: House Ways and Means Health Subcommittee hearing on Value-Based Care
  • June 26: House Veterans Affairs’ Oversight Subcommittee hearing on the VA’s Healthcare Network
  • June 27: House Education and the Workforce Health, Employment, Labor, and Pensions Subcommittee hearing on the Employee Benefits Security Administration
  • June 27: House Appropriations Labor, Health and Human Services, Education Subcommittee Markup

There You Have It

Did you know that the first televised debate about a presidential election featured two women? That’s right,in 1956, former First Lady Eleanor Roosevelt, acting as a surrogate for Democratic candidate Adlai Stevenson, debated Sen. Margret Chase Smith, acting as a surrogate for Republican President Dwight Eisenhower. Do you know any other fun facts about presidential debate history? If so, let us know! Make it a great week!

House Ways and Means Hearing on Rural Health access 3.12.24

On March 12, 2024, the House Ways and Means Committee held a hearing titled “Enhancing Access to Care at Home in Rural and Underserved Communities.” Though initially previewed to focus on the Hospital at Home model, the hearing centered entirely on telehealth. Chairman Jason Smith (R-MO) highlighted the benefits of telehealth in his opening statement, while Ranking Member Richard Neal (D-MA) discussed the healthcare achievements of the Biden administration over the past four years. Witnesses included patients, healthcare providers, and policy experts who emphasized telehealth’s potential in rural communities and addressed challenges such as internet access, alternative sites for telehealth, and ensuring patient adherence to treatment regimens.

The hearing also covered Medicare and private plan payments and regulations for telehealth, suggesting payment parity with urban settings and financial incentives for telehealth clinicians. Discussions highlighted the need for changes in Medicare policies requiring a nurse’s presence for at-home infusion services and streamlining multi-state credentialing for care providers. The bipartisan nature of the hearing underscored a shared commitment to revisiting the topic and enhancing healthcare access in rural and underserved communities.

Navigating Healthcare Transparency: Administration's Push for Medicare Advantage Clarity

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