At a glance
- Unresolved issues range from reauthorizing expired programs and extending existing policies to more complex legislation addressing politically popular issues such as lowering the cost of prescription drugs.
- Transparency and reform for pharmacy benefit managers are politically popular, but the key question is what the final package will look like and, assuming an agreement can be reached, whether this The question is when the bill will be enacted.
- What needs to be addressed to maintain telemedicine policies is Medicare coverage of telemedicine with no location restrictions, and the ability of high-deductible health plans with health savings accounts to offer up-front deductibles for telemedicine. , allowing ERISA employers to offer telemedicine on a standalone basis. advantage.
Health care officials will once again be left waiting to resolve several priorities as Congress once again postpones action on the full fiscal year 2024 (FY24) federal spending law, now until at least early March.
On the other hand, this delay creates an additional six-week grace period during which Congress can work to address at least some of these issues. Conversely, the same overarching challenge that has so far prevented Congress from completing work on the FY24 spending bill, namely the spending cap negotiated as part of the debt ceiling agreement reached last June, The standards ultimately cost Rep. Kevin McCarthy (R). CA) His speakership remains in place, along with some socially conservative policies as well as divisions over foreign aid and border security funding. Current Speaker Mike Johnson (R-Louisiana) will also continue to grapple with the differences between House conservatives and Senate Republicans.
The unresolved health care issues that Congress must address are large and diverse. This includes reauthorizing expired programs and extending existing policies that are generally easier to resolve into more complex legislation that addresses politically popular issues, such as reducing the cost of prescription drugs. . It also includes aggressively encouraging doctors to reverse or at least ease Medicare payment cuts, and to reinstate and eventually eliminate the old Sustainable Growth Rate (SGR). A flashback to the long-term efforts to achieve this goal.
With this framework in mind, below we take a closer look at the health policy legislative landscape.
Re-authentication and extenders
This category includes a mix of laws that have expired or are scheduled to expire, as well as laws that require Congress to act. Some of these have been addressed in previously enacted continuing resolution packages, but only in the short term. This category includes:
- Several public health delivery and workforce programs, including Community Health Centers, the National Health Service Corps, and the Education and Health Center Graduate Medical Education Program.
- The nation's core biological control law, the Pandemic and All-Hazards Preparedness Act (PHPA), is fully reauthorized. Generally a bipartisan issue, the Senate Health, Education, Labor, and Pensions (HELP) Committee passed an iteration of the reauthorization bill last summer, but the bill has passed in the House of Representatives over the Centers for Disease Control and Prevention (CDC). It faces several challenges, including conflicts. ) funding, and whether it is an appropriate means to address concerns about drug shortages.
- Reauthorizing the Assistance Act and policies to address the ongoing substance use disorder crisis. Currently, illegal fentanyl is the main cause.
- It would once again delay the burden on hospitals from planned cuts in Medicaid Disproportionate Hospital (DSH) funding.
- Reauthorization of the Pediatric Priority Examination Voucher, which was created by Congress over a decade ago and has since been reauthorized several times. It is intended to encourage the development of rare disease treatments by providing transferable vouchers for FDA priority review to manufacturers of therapeutics that achieve this designation. Companies can use the vouchers to speed up FDA review time for another product or sell the vouchers to another entity. The current voucher program is authorized until the end of September, meaning Congress would have to act again if it chooses to continue the program.
Another emerging issue of increasing importance is legislation that took effect in January to address cuts in Medicare payments to physicians. The lack of action in January could make easing the cuts even more difficult, but physician advocates are sure to weigh in on the issue, especially as providers begin to feel Medicare reimbursement cuts. It will continue to be a focus.
Beyond these issues, the committee has been working on more targeted legislation to reauthorize specific programs and policies. These are measures that could be incorporated into a larger legislative instrument, given the challenges associated with enacting standalone legislation in the current circumstances.
new problem or new problem
Over the past year, more than six legislative committees have been working on legislation to reform the work of pharmacy benefit managers (PBMs). In December, the House of Representatives passed the Cutting Costs, Improving Transparency Act, which was developed by three committees. This bill would codify and expand health care price transparency requirements, as well as require more transparency into PBM practices.
On the Senate side, the HELP, Finance, and Commerce committees all passed various bills related to PBM transparency, including the HELP measure, which prohibits PBMs from using drug spread pricing. Transparency and PBM reform are politically popular, but the main question now is what the final package will look like, and when, assuming an agreement can be reached, this bill will be released. The question is whether it will be enacted.
telemedicine
The COVID-19 pandemic has given healthcare providers extensive flexibility to offer telehealth to their patients. There are three main policies that Congress must address to sustain.
- Medicare Covers Telemedicine with No Origin Site Restrictions
- Ability for high-deductible health plans (HDHPs) with health savings accounts to provide up-front deductibles for telehealth.
- ERISA Employers may offer telehealth as a separate benefit
The first two policy flexibilities, Medicare and HDHP, were extended by Congress through the end of 2024, so we must act this year to decide whether to extend these policies further or make them permanent.
Pandemic policies that allow employers with ERISA plans to offer telehealth as a standalone benefit to workers (part-time, contract, seasonal workers) who are not eligible to purchase health insurance through their employer , which expired at the end of 2023. Congress remains a possibility. Either repeal it or make the policy permanent, employers and telehealth advocates are asking Congress to consider doing so in the next administration's funding package.
Advocates would certainly also welcome Congress to address Medicare and HDHP policies in future packages, but Congress is typically pressed by deadlines and these policies will be taken up at the end of 2024, before they expire. I am aware that this is highly possible. Questions also remain about whether Congress will continue to extend flexibility or make many policies permanent. Although permanence enjoys broad support, challenges are bound to arise in the form of Congressional Budget Office (CBO) scores and cost estimates.
Another major federal telehealth policy that must be addressed by the end of 2024 is remote prescribing for controlled substances (CS) regulations. Congress gave the Drug Enforcement Administration (DEA) authority to regulate this issue under the Ryan-Haight Act in 2008, and has since directed the Drug Enforcement Administration (DEA) to create a special registry for telemedicine. We have repeatedly considered the matter, including requesting new support methods. 2018. There is bipartisan legislation, the TREATS Act, to expand access to telemedicine prescribing of buprenorphine treatment for opioid use disorder (OUD), but so far Congress has blocked DEA rulemaking from addressing this issue. I hope it will be postponed.After retention Stakeholder hearing session in SeptemberThe DEA plans to release new proposed rules early this year for providers to implement by the end of 2024.
There are many other telehealth-related policies that do not have specific deadlines or expiration dates. For example, Congress is interested in ensuring that CMS keeps home addresses private and secure for health care providers who conduct telemedicine from their homes, and this policy has been approved by the Committee on Energy and Commerce. This will be accomplished through the Medicare Telehealth Privacy Act, which was passed.
final thoughts
It remains to be seen whether Punxsutawney Phil will see his shadow, but we do know there are six weeks left on the 24th Continuing Resolution.
A new short-term spending patch will give health officials more time to resolve outstanding bills, but it will reduce the focus on federal spending and the challenges that remain. All things considered, it remains unlikely that many measures will be completed by St. Patrick's Day. The full resolution of the 2024 funding decision gives this story some character in motion. marmot day.
Ultimately, the most likely scenario in many areas is a continuation of the trend of large post-election conventions, with a resolution likely to be passed as part of a very active November and December lame-duck Congress. there is.
