What Happened, What You Missed: April 4-8


Administration Proposes Fix to ACA “Family Glitch”

On Tuesday, the Treasury Department (USDT) and the Internal Revenue Service (IRS) issued a proposed rule to create a minimum value for family member of employees who are eligible for premium tax credits under the Affordable Care Act (ACA).  The rule aims to fix the “family glitch,” an ACA loophole that provides premium tax credits to individuals but not their family members.  According to the Kaiser Family Foundation, the family glitch has impacted about 5.1 million Americans.

CMS Limits Aduhelm Coverage to Clinical Trial Enrollees

On Thursday, the Centers for Medicare and Medicaid Services (CMS) issued a final coverage determination for Alzheimer’s drug Aduhelm that limits Medicare coverage of the drug to patients currently enrolled in clinical trials.  Aduhelm has been the subject of controversy since it was granted accelerated approval last summer due to its high out-of-pocket cost of $28,000 and mixed data on its efficacy.  In the coverage determination memo, CMS also outlined conditions of coverage for future drugs like Aduhelm that also target amyloid proteins.  For example, if the drugs were to go through the traditional approval process as opposed to accelerated approval, patients would not need to be enrolled in clinical trials to receive Medicare coverage.

CMS Proposes to Indefinitely Delay RO Model

On Wednesday, CMS issued a proposed rule that would indefinitely delay the implementation of the Radiation Oncology (RO) model, with no specific date for relaunching the model.  The proposed rule carries out legislation passed in December 2021 that required the RO model to be delayed until January 1, 2023.   The RO model was initially set to begin on January 1, 2021 but has been delayed multiple times.  The model, which would provide bundled payments for a 90-day episode of care to certain radiotherapy providers and suppliers, attracted controversy from radiology stakeholders over its mandatory status and reimbursement cuts.  In the proposed rule, CMS raised concerns over the costs of continually delaying the model’s implementation.

Republican Congressman Fred Upton to Retire

Rep. Fred Upton (R-MI) announced in a speech on the House floor Tuesday that he will not seek reelection in 2022.  Upton, who is among the 10 House Republicans who voted to impeach then-President Donald Trump in January 2021, cited Michigan’s new congressional map as a main reason for his decision to retire.  First elected to Congress in 1986, Upton forged a bipartisan reputation as chairman of the House Energy and Commerce Committee, where he was instrumental in advancing the 21st Century Cures Act.

ICYMI: Lawmakers Defeat Lobbyists in Congressional Hockey Game

On Thursday night, the first Congressional Hockey Challenge in two years ended with the Lawmakers defeating the Lobbyists by a score of 4-2.  The Congressional Hockey Challenge began nearly a decade ago from a weekly pickup match consisting of congressional staff and lobbyists, and like all congressional sporting events, the game raises funds for a variety of charities.  Three members of Congress played for the Lawmakers this year: Reps. Tom Emmer (R-MN), Mike Quigley (D-IL), and Larry Bucshon (R-IN).  A prominent former member of Congress, who once laced up for the Lawmakers, is Sen. John Kerry (D-MA), who played on Yale’s varsity hockey team.

Leave a Reply

Your email address will not be published. Required fields are marked *

Connect With Us

Ready to connect? Let’s talk