The Senate adopts a short-term CR, the CMS reconsiders its contract model

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THIS WEEK’S DOSE

The Senate passed a short-term continuing resolution (CR) this week, preventing the government shutdown and extending federal funding through March 11. The chamber also confirmed that Robert Califf would be the next commissioner of the Food and Drug Administration (FDA).

CONGRESS

The Senate passes CR in the short term. On February 17, the Senate approved (65-27) a Continuing Resolution (CR) to provide short-term funding for federal programs through March 11. The CR was passed by the House of Representatives on February 7 and now heads to President Biden for his Signature. The Senate also voted on three amendments, all of which failed: (1) Amendment No. 4929 proposed by Senator Lee which sought to remove funding for all federal COVID-19 vaccine mandates (vote 46- 47); (2) Amendment No. 4927 proposed by Senator Cruz on stopping federal funding for schools and daycares that require COVID-19 vaccines (44-49); and (3) amendment #4930 proposed by Senator Braun demanding a balanced federal budget (47-45), which would have required 60 affirmative votes to pass.

The interim funding bill will avoid a government shutdown when the current continuing resolution expires today, February 18. Owners will now have three more weeks to reach bipartisan agreement on fiscal year 2022 spending bills. Republicans and Democrats are on the verge of bipartisan agreement and remain optimistic about the production of comprehensive funding action by the deadline.

Conversations around additional COVID-19 relief are ongoing. This week, the Department of Health and Human Services (HHS) presented Congress with a $30 billion funding request focused primarily on testing and vaccine supply and development.

This request included:

  • $17.9 billion – Purchase of oral antivirals, monoclonal antibodies and vaccines

  • $4.9 billion – Maintain testing capacity, continue community testing sites, continue accelerated development of home testing

  • $3 billion – Maintenance of the uninsured fund

  • $3.7 billion – Development of vaccines that protect against future variants

  • $0.5 billion – CDC surveillance and operations around detection of emerging variants and other infectious disease threats

The administration’s request did not include funding for international vaccine distribution or the administration’s potential broader needs beyond HHS. It also did not include additional direct support for healthcare providers despite urgent calls from hospitals and other healthcare providers for increased support for the Provider Relief Fund. Members of Congress from both parties have questioned whether HHS needs additional funding on top of previously allocated dollars, leaving questions about whether Congress will provide additional COVID funding.

The Senate confirms Robert Califf as FDA commissioner. After more than a year without a Senate-confirmed FDA leader, the Senate narrowly endorsed Dr. Robert Califf to be the next FDA commissioner. Dr. Califf briefly served as commissioner of the FDA at the end of the Obama administration. However, his ties to the pharmaceutical industry since then have brought new scrutiny. Commissioner Califf faces a heavy workload in his new role, including working to successfully negotiate and deliver User Fee Agreements (UFAs) to Congress for full consideration and adoption. Current UFAs are set to expire on September 30, 2022, at which time the FDA would face significant furloughs and program funding shortages.

The Senate Finance Committee holds a second hearing on youth mental health. On February 15, the Senate Finance Committee held a hearing on “Protecting Youth Mental Health: Part II – Identifying and Removing Barriers to Care”. The audience discussed the role that telehealth can play in rural health and in schools by improving access to specialist providers, working to de-stigmatize mental health, fostering formal partnerships with community behavioral health providers and by training clinicians who do not specialize in mental health. There was also a discussion of challenges associated with telehealth, such as reimbursement, broadband access, and state licensing requirements. The conversation also touched on the mental health workforce, particularly around adequate reimbursement in Medicaid.

This hearing follows the committee hearing last week, Feb. 8, which focused on an opinion from the US Surgeon General and a call to action regarding the youth mental health crisis. Leading committee members are drafting comprehensive mental health legislation for consideration later this year. The House Energy and Commerce Committee also held a hearing on mental health on February 17, titled “American’s in Need: Responding to the National Mental Health Crisis.”

ADMINISTRATION

CMS is reconsidering the direct contract model. Under pressure from progressive Democratic members, the Biden administration evaluated changes to the direct contract model. Direct contract models, including global, professional and geographic models, were created under the Trump administration. Global and professional direct contracting models build on 10 years of Responsible Care Organization (ACO) policy and represent the next step in the evolution of the Pioneer and Next Generation ACO models, at the Centers for Medicare & Medicaid Services Innovation Center. A third option, the direct geographic contract model, seems to cause the most concern among lawmakers, as it would have allowed for random allocation of beneficiaries and participation of a wider range of entity types. Notably, the Biden administration put the geographic model on hold and to date it has not been implemented.

Direct contracts came under fire during the February 2 Senate Finance Committee hearing, titled “The Hospital Insurance Trust Fund and the Future of Medicare Funding,” during which President Elizabeth Warren (D-MA) called on the Biden administration to end the model immediately. . However, this week the tenor of the debate seemed to change, as Don Berwick, a former Obama-era CMS administrator, was quoted in the press as saying it would be disruptive if the model was simply stopped short and more than 200 Provider organizations have urged the administration to modify the model rather than end it. An announcement on the future of the model, and possible changes, is expected soon.

Uncertain future for public health emergency. The current national public health emergency (PHE) runs until April 16, 2022, and the Biden administration has indicated that it will provide 60 days notice before allowing the PHE to expire. This week we passed the 60-day mark, leaving many stakeholders to expect a renewal. Calls to end the PHE are growing, especially from Republicans. Some 70 House Republicans, led by Republican Energy and Commerce Committee leader Cathy McMorris Rodgers (R-WA), sent a letter to President Biden on Feb. 10 calling on the administration to submit a plan to end the PHE. This week, the Federation of American Hospitals, among others, weighed in with a letter to the Department of Health and Human Services expressing support for another PHE expansion. Many health policy flexibilities are tied to the PHE, including telehealth flexibilities, state and federal regulatory changes, and additional waivers for health care providers. Without congressional or agency action to expand or modify these flexibilities, stakeholders noted that there could be negative impacts on the entire health care system.

QUICK KEYS

  • The House Judiciary Committee’s Subcommittee on Immigration and Citizenship held a hearing titled “Is There a Doctor in the House?” The Role of Immigrant Physicians in the American Health System” to examine issues associated with the ability of immigrant physicians to practice medicine in the United States.

  • Medicaid Health Plans of America sent a letter to congressional lawmakers this week, detailing concerns about the impact a sudden end to the public health emergency would have on states’ federal Medicaid matching funds.

  • CMS released its quarterly Health Equity Bulletin, which provided numerous research updates, including those on trends in inequities under Medicare Advantage, disparities in flu vaccination rates, and trends in hospital readmission rates.

  • Senators Jeanne Shaheen (D-NH) and Susan Collins (R-ME) introduced a bill that would extend the vendor relief fund (PRF) spending deadline and allow vendors to use PRF funds while along the PHE. It would also require HHS to release any outstanding COVID-19 relief by March 31, 2022. It does not include any new funding.

  • On February 17, the Department of Homeland Security (DHS) released a proposed rule to amend the actions of the previous administration to expand the so-called “public charge” rule. This rule is a measure used in the immigration application process to determine if someone is likely to have to rely on the federal government. This proposed rule revises the definition to ensure that the public charge rule does not penalize individuals who choose to access public health benefits and other government services available to them.

NEXT WEEK’S DIAGNOSIS

Next week, the House and Senate will be on recess, giving lawmakers a brief week back in their districts before returning to Washington, D.C. to negotiate the FY22 appropriations package. Funding for additional COVID-19 relief and the expiration of PHE-related health policies will likely attract congressional attention. Preparations are also underway for the State of the Union on March 1, 2022.

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