Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


House Committees Begin Markup of $3.5T Reconciliation Bill

Committees of jurisdiction in the House of Representatives have made progress in recent days to advance major components of the $3.5 trillion reconciliation package. The Education and Labor Committee reported out its portion of the Build Back Better plan last week, focusing on early child care and pro-worker measures, including for direct care workers. The package was advanced by a 28-22 vote along party lines.

Over a two-day markup last week, the Ways and Means Committee approved the largest expansion of the Medicare program in nearly two decades. The provision to add dental, vision, and hearing benefits to Medicare was approved in a 24-19 vote. Vision and hearing benefits would begin in 2022 and 2023 respectively, while coverage for dental benefits would begin in 2028. Rep. Stephanie Murphy (D-Fla.) was the only Democrat to vote with panel Republicans against the proposal, after having noted that the deadline was “too rushed” and “driven by politics rather than policy.” The Ways and Means portion of the tax and spending legislation would make permanent the recent two-year expansion of Affordable Care Act (ACA) premium subsidies and would provide $425 million for the Health Profession Opportunity Grant program. The panel also voted to include elder justice legislation that would create ombudsman programs to target elder abuse and neglect, as well as a nursing home oversight measure. In addition, $400 million in grants would be made available for three years to increase pay and staffing retention for employees of nursing homes and long-care facilities. The federal government would also be empowered to reduce payments to certain understaffed facilities. Ways and Means will reconvene on Tuesday to resume debate on the bill and to consider language related to drug pricing. Additional details on proposed tax increases and the revenue- raising portions of the bill are expected in the coming days.

The Energy and Commerce Committee is scheduled to begin marking up its portion of the social spending package today. The panel is proposing to include Democrats’ signature drug pricing legislation in the reconciliation bill. The measure would allow the Medicare program to negotiate the prices of certain medications – and extend those prices to employer-sponsored insurance – while penalizing manufacturers that raise the price of a drug above inflation. The bill would also cap out-of-pocket costs in Medicare Part D and permanently repeal the Trump-era rebate regulation. The drug pricing changes would help pay for an extension of the Affordable Care Act’s (ACA) tax credits to individuals that make too much money to qualify for Medicaid in states that have opted to not expand their program until a federally-run Medicaid program is established in 2025. The proposal would also fund reinsurance programs to lower ACA marketplace premiums by 7%. The E&C package provides $190 billion to home and community- based services (HCBS), meets the President’s request for $15 billion for pandemic preparedness programs, and provides $3 billion to establish the Advanced Research Projects Agency for Health (ARPA-H).

The Budget Committee will combine the health care measures with various education, housing, climate, and transportation provisions ahead of the September 15 deadline set by the fiscal year (FY) 2022 budget resolution. House Speaker Nancy Pelosi (D-Calif.) aims to hold a vote on the reconciliation package this month, ahead of a vote on the $550 billion bipartisan infrastructure framework, which is slated to have a vote by September 27. The Senate is not expected to meet the September 15 deadline, with certain Senate Democrats already stating that they wish to pare back the total size of the package, and Sen. Joe Manchin (D-W.Va.) calling on a pause in the development of the bill. Democrats will have to be unified in their support for the reconciliation bill in the evenly divided Senate, and Speaker Pelosi can only afford to lose three votes from her caucus when the bill comes to the House floor.

President Biden Announces New US Vaccine Mandates

During a speech on Thursday, President Joe Biden unveiled his Path Out of the Pandemic action plan to fight the COVID-19 pandemic and require more Americans to be vaccinated. The President’s COVID-19 Action Plan has six main components:

  • Vaccinating the Unvaccinated
  • Furthering Protection for the Vaccinated
  • Keeping Schools Safely Open
  • Increasing Testing and Requiring Masking
  • Protecting Our Economic Recovery
  • Improving Care for Those with COVID-19
The Department of Labor through the Occupational Safety and Health Administration (OSHA) is tasked with issuing an Emergency Temporary Standard (ETS) to implement a requirement that all employers with 100 or more employees ensure that their workplace is fully vaccinated or that unvaccinated workers produce a negative test result at least on a weekly basis. The OSHA ETS is expected to be released in the coming weeks. Absent more details, already, key questions about the proposal include who would pay for the COVID-19 testing, how employers would verify workers’ vaccination status, and its intersection with religious exemptions.

In a related announcement last week, the Centers for Medicare and Medicaid Services (CMS) will begin requiring COVID-19 vaccination of staff within all Medicare and Medicaid-certified facilities, an expansion of previously- announced emergency regulations requiring vaccinations for nursing home workers. The Administration also stated that this requirement would apply to “clinical staff, individuals providing services under arrangements, volunteers, and staff who are not involved in direct patient, resident, or client care.” CMS is currently developing an interim final rule with comment period that will be issued in October, but is encouraging facilities to begin complying with the new vaccination requirements immediately. Health professionals and clinical practices are likely affected under this provision if they work or provide services under arrangements at one of the above-listed facilities, including as part of a provider-based department; operate a CLIA-certified lab; serve as a DME supplier; or operate an ambulatory surgical center. Additional health professional offices may be further affected due to fee-for-service payments through Medicare, but the specifics of that would need to better defined in the upcoming CMS rule.

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