What Will Congress Tackle in 2022?


2022 is shaping up to be a busy year for Congress, with potential implications for health care policy.  Lawmakers’ challenging agenda is partly due to unfinished business from 2021, including spending for Fiscal Year (FY) 2022 and the Democrats’ $1.7 trillion social and climate spending package, the Build Back Better Act.

At the top of the 2022 agenda are must-pass items tied to specific deadlines.  Here’s an overview of what Congress must take care of in the new year, no matter what.

  • FY 2022 Appropriations.  The short-term spending bill that’s keeping the federal government running is set to expire on February 18, 2022.    The House has already passed most of its FY 2022 spending bills, including a bill that provides a nearly 20% increase in funding for the Department of Health and Human Services (HHS) compared to the FY 2021 level.  However, the Senate Appropriations Committee has only approved three spending bills for FY 2022.  Going forward, lawmakers are hoping a bicameral and bipartisan deal comes together quickly to avoid passing another Continuing Resolution and can finalize FY 2022 appropriations.
  • MACRA.  A 5% bonus for providers participating in an Advanced Alternative Payment Model (A-APM) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is set to expire at the end of 2022. To circumvent the provisions in MACRA from expiring, the Senate Finance Committee is expected to hold hearings to review implementation of MACRA in 2022, and health care providers have been pushing for the bonuses to be extended.  On a related note, legislators are also planning to hold hearings on how MACRA has affected the Physician Fee Schedule.
  • Medicare Cuts.  In December, President Joe Biden signed into law a bill to extend the moratorium on 2% Medicare sequester cuts until April 1, 2022 and reduce the cuts to 1% from April 1 to June 30, 2022.  Providers will likely advocate for an extension of the moratorium due to continued stress from the COVID-19 public health emergency but are also looking to work with Congress to find a longer-term solution regarding the Medicare pay system.
  • PDUFA VII.  The current Prescription Drug User Fee Act (PDUFA VI) expires at the end of September 2022.  Regulators and industry stakeholders spent 2021 negotiating the details of PDUFA VII, which will determine drug user fees in FY 2023-2027.  It will be up to Congress to reauthorize the next iteration of PDUFA by October 1, 2022, and lawmakers are expected to hold hearings on PDUFA VII in spring 2022.

Other items on the 2022 legislative agenda are top policy and political priorities, particularly for Democrats, who will be fighting to retain their majority in Congress in the upcoming midterm election.  Additionally, health care stakeholders are urging legislators to make progress on pressing health care issues that saw little movement in 2021.

  • Build Back Better.  The White House and congressional Democrats had initially hoped to pass a $1.7 trillion social and climate spending package know as Build Back Better before the end of 2021, but progress halted after Sen. Joe Manchin (D-VW) rejected the measure due to concerns over its cost.  However, Democrats are hoping to pass a scaled-down version of Build Back Better that Manchin can support, with the hope that a revised measure will retain some of the original proposal’s health care provisions, including expanded eligibility for Affordable Care Act (ACA) subsidies and expanded Medicaid coverage in 12 states.
  • Cures 2.0.  In November 2021, bipartisan members of the House Energy and Commerce Committee introduced the Cures 2.0 Act, which would build on the success of the 21st Century Cures Act that passed in 2016. CURES 2.0 would authorize the Advanced Research Projects Agency-Health (ARPA-H), streamline the Food and Drug Administration (FDA) review process, enhance Medicare and Medicaid coverage of new technologies, and expand access to telehealth.  Lawmakers initially hoped to advance Cures 2.0 by the end of 2021, but a busy congressional agenda pushed work on the measure into the new year.  Since legislators expect 2022 to be just as busy, it’s possible elements of Cures 2.0 may find their way into PDUFA VII.
  • Behavioral Health Care.  In September 2021, bipartisan leaders of the Senate Finance Committee issued a request for information (RFI) on policy proposals to boost access to mental health care services.  Some of the reforms mentioned in the RFI include strengthening the health care workforce, improving parity laws, and increasing the use of telehealth.  Underscoring the need for behavioral health care reform is the upsurge in demand for mental health care during the COVID-19 public health emergency.  The Finance Committee may incorporate responses to the RFI in a potential bipartisan bill in the new year.
  • Prior Authorization.  In a bipartisan fashion, 246 House members cosponsored legislation to streamline prior authorization in Medicare Advantage and require rapid determination of the services that plans generally approve.  The Trump administration proposed to streamline prior authorization requirements in Medicaid (but not Medicare Advantage), but the Biden administration has since paused the initiative. Provider groups are advocating for new rulemaking or legislation to include Medicare Advantage in any push to improve prior authorization.

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