This week in Washington: House passes reconciliation package.

House

House Passes Reconciliation Package

On Nov. 19, the House passed the $1.7 trillion reconciliation package with a vote of 220-213. Votes came the morning after the Congressional Budget Office (CBO) published a complete cost estimate of the reconciliation package, also called the Build Back Better (BBB) Act. Healthcare provisions in the reconciliation package include an extension of the Affordable Care Act (ACA) tax credits, a short-term policy to address the Medicaid coverage gap, the addition of hearing benefits to Medicare, a cap for seniors’ out-of-pocket drug costs and authority for Medicare to negotiate some drug prices. The reconciliation package now goes to the Senate, where it is expected to be modified to meet reconciliation restrictions. The bill will then return to the House for another vote.

The Congressional Budget Office (CBO) estimates extending the American Rescue Plan’s higher ACA tax credits and allowing people in states that did not expand Medicaid to access the subsidies from 2022 to 2025, as well as the BBB’s other coverage provisions, would decrease the number of uninsured Americans by an average of 3.4 million over that period. The provisions together would cost about $130 billion.

The predicted drop in the number of uninsured includes 4.9 million people with individual market coverage and 100,000 additional Medicaid enrollees, net 1.6 million people with employer-sponsored coverage. CBO attributes a third of losses in employer coverage to firms no longer offering insurance and two-thirds from workers who choose not to enroll.

The American Rescue Plan (ARP) lowered the premium contribution requirements for people earning up to 400% of the poverty level and limited the contribution to 8.5% of income for others, and the BBB would extend both policies through 2025. The BBB also would lower the contribution threshold for an employer-sponsored plan to be considered affordable from 9.5% of income to 8.5%, in alignment with the individual market. CBO assumes those policies would increase spending by $43.5 billion and would reduce revenue by $30 billion over 10 years.

Extending the subsidies would result in 1.2 million fewer uninsured people during the years they are in effect, CBO and the Joint Committee on Taxation predict.

Medicaid GAP

The BBB would fix the Medicaid gap by extending the ACA tax credits to people earning 100% of the poverty level in states that did not expand Medicaid. This measure would increase spending by about $43.8 billion and reduce revenue by $13 billion over 10 years, CBO predicts. CBO and JCT say the gap fix policy would result in 1.7 million fewer uninsured.

After 2025, the extended credits and gap fix policy would have much smaller effects on sources of coverage and no net effect on the number of people without health insurance.

The ARP also offered maximum ACA tax credits to anyone on unemployment in 2021, and the Build Back Better Act would extend that policy by one year. CBO says that provision would increase expenditures by $804 and lower revenue by about $1 billion over 10 years.

The coverage provisions are part of the House Ways & Means section of the BBB that also includes a provision capping cost-sharing for insulin products at $35 (or 25% of the negotiated price, whichever is cheaper). The policy would cost a total $5.1 billion including $529 million in expenditures and $4.6 billion in lower revenues.

PBM Oversight/Transparency

A provision requiring oversight of PBMs would raise revenue by $1.7 billion (CBO and Joint Tax estimate).

Medicaid/CHIP Provisions

Requiring one-year continuous enrollment for kids in Medicaid or CHIP will save nearly $3.7 billion over 10 years while making CHIP permanent will save about $1 billion. Meanwhile, it will cost $2.21 billion to extend coverage for postpartum women from 60 days after giving birth to one year.

And CBO estimates it will cost $954 million to provide a maternal health home for pregnant and postpartum women.

Drug Pricing

Overall, the drug pricing measures, including savings and new revenues, would reduce the deficit by $297 billion and would result in 10 fewer drug inventions out of the 1,300 drugs expected to be introduced in the next 30 years.

Medicare price negotiation would contribute to $79 billion in savings, which is far less than the other drug pricing measures. The current version eventually applies to 20 of the most expensive drugs, including insulin, does not use international reference pricing and delays the risk of negotiation until biologics have been on the market for 13 years and until drugs have been on the market for nine years

The drug cost controls would save $262 billion, and the rebates that drug companies would pay when they raise prices faster than inflation would generate $34 billion in new revenue.

Repealing the Trump-era drug rebate rule saves $143 billion. The rule would have been a bigger offset had the separate bipartisan infrastructure bill not eaten into about $50 billion of those savings by delaying the rule.

Inflation rebates would save the government $49 billion by discouraging drug companies from raising prices. That’s separate from the $34 billion that inflation rebates would generate when companies raise prices faster than inflation.

The Part D redesign would save the government $1.6 billion. The bill would cap beneficiaries’ annual out-of-pocket costs, which would cost $130 million, but it would also shift a greater share of liability onto insurers. The bill would make plans pay 65% of beneficiary’s brand drug costs, including for biosimilars, and 75% of generic drug costs during the initial stage of Part D. Once beneficiaries hit the catastrophic phase, plans would pay 60% of all drug costs. Brand and biosimilar drug makers would have 10% liability during the initial phase and 20% liability during the catastrophic phase. Medicare would cover 20% of the cost of brands and biosimilars during catastrophic and 40% of the cost of generics. Generics would pay nothing throughout the phases

The CBO cost estimate can be found here.

Energy and Commerce Committee Passes Healthcare Bills Out of Committee

On Nov. 17, the House Energy and Commerce Committee passed 12 bills out of committee, 9 of them pertaining to healthcare and the healthcare workforce. The bills, which can be found listed below, now go to the House floor.

  • R. 5561, the Early Hearing Detection and Intervention Act
  • R. 5487, the Stillbirth Health Improvement and Education (SHINE) for Autumn Act of 2021
  • R. 1193, the Cardiovascular Advances in Research and Opportunities Legacy Act
  • R. 1667, the Dr. Lorna Breen Health Care Provider Protection Act
  • R. 3320, the Allied Health Workforce Diversity Act of 2021
  • R. 4555, the Oral Health Literacy and Awareness Act of 2021
  • R. 5551, the Improving the Health of Children Act
  • R. 3537, the Accelerating Access to Critical Therapies for ALS Act
  • R. 1218, the Data Mapping to Save Moms’ Lives Act

Reps. DeGette and Upton Introduce the Cures 2.0 Act

On Nov. 16, Reps. Diana DeGette (D-CO) and Fred Upton (R-MI) introduced the Cures 2.0 Act, which is intended to be a follow-up bill to the 21st Century Cures Act. The bill would establish the Advanced Research Projects Agency for Health (ARPA-H), fund Food and Drug Administration (FDA) programs and create a Medicare coverage pathway for innovative device coverage. The bill would also direct the FDA commissioner to establish incentives to increase the use of decentralized trials.

A press release on the bill can be found here. A summary of the bill can be found here. The bill text can be found here.

Rep. DeLauro and Sen. Markey Introduce Bill to Fund Research for a Universal Flu Vaccine

On Nov. 19, Rep. Rosa DeLauro (D-CT) and Sen. Ed Markey (D-MA) reintroduced the Flu Vaccine Act, which would allocate $1 billion to the National Institutes of Health to research and develop a universal influenza vaccine or prevention that protects against multiple strains of the virus.

The bill text can be found here.

Senate

Senators Introduce Bill to Strengthen the Infectious Disease and Public Health Workforce

On Nov. 18, Sens. Tammy Baldwin (D-WI), Susan Collins (R-ME), Jacky Rosen (D-NV) and Lisa Murkowski (R-AK) introduced the Bolstering Infectious Outbreak (BIO) Preparedness Workforce Act. The bill aims to address retention and recruitment issues by establishing a student loan repayment program for professionals who focus on infectious diseases (ID) and public health preparedness and response.

The bill text can be found here.

House and Senate Members Request Investigation into Nurse Staffing Agencies Pricing

On Nov. 15, Sens. Bill Cassidy (R-LA) and Mark Kelly (D-AZ) along with Reps. David McKinley (R-WV) and Doris Matsui (D-CA) wrote to White House COVID-19 Response Team Coordinator Jeffrey Zients requesting an investigation into reports of nurse staffing agencies inflating prices during the COVID-19 pandemic.

The letter can be found here.

Read more on healthcare policy in McGuireWoods Consulting’s Washington Healthcare Update.

This week in Washington: CBO Scores Reconciliation Package While House Waits.

House

Reconciliation Update 

In a Nov. 9 post, Congressional Budget Committee (CBO) Director Phillip Swagel said the CBO is in the process of preparing a cost estimate for the $1.75 trillion social spending reconciliation package. Swagel stated that the CBO will release estimates for some of the bill’s titles within the week, while other titles will take longer. Moderate House Democrats previously stated they would not vote for the reconciliation package until seeing the CBO scores.

House Speaker Nancy Pelosi (D-CA) has committed to holding votes on the $1.75 trillion social spending reconciliation package before Thanksgiving.

150 Members of Congress Request the Surprise Billing Final Rule be Amended

On Nov. 5, a group of 150 members of Congress, led by Reps. Brad Wenstrup (R-OH) and Tom Suozzi (D-NY), wrote to the Secretaries of the Health and Human Services, Treasury and Labor Departments. In the letter, the members requested that the recent Interim Final Rule for Surprise Billing be amended to align with the No Surprises Act, which was passed by Congress in 2020. Specifically, the letter states that the independent dispute resolution (IDR) process in the final rule does not align with the process laid out in the No Surprises Act and represents an unbalanced approach.

The letter can be found here.

Read more on healthcare policy in McGuireWoods Consulting’s Washington Healthcare Update.

Stethoscope on laptop keyboard

On Nov. 2, 2021, the Centers for Medicare and Medicaid Services (CMS) released a final rule to update the Physician Fee Schedule (PFS) and address other Medicare Part B issues for Calendar Year (CY) 2022. The rule, which goes into effect Jan. 1, 2022, retains proposed changes concerning telehealth and important updates to the Medicare Diabetes Prevention Program (MDPP).

Telehealth Policies Update

Because of the COVID-19 Public Health Emergency (PHE), CMS temporarily expanded the number of Medicare telehealth services from 101 to 238. Temporary additions to the Medicare telehealth service list include cardiac rehabilitation, eye exams and speech therapy, among other things. The final rule retains this expanded list through Dec. 31, 2023. This will allow more time for CMS to evaluate whether the services should be permanently added.

The rule also updates restrictions relating to furnishing mental health telehealth service to reflect the amendments of Section 123 of the Consolidated Appropriations Act of 2021. A beneficiary’s home may now be an originating site for tele-mental health services. A patient receiving tele-mental health services must have an in-person visit with a practitioner within six months of the first telehealth appointment, with at least one in-person visit required every year. The rule allows exemptions to the in-person visit requirement based on beneficiaries’ situations.

In addition, the rule updates the definition of interactive telecommunications system to specify that telehealth services can include audio-only communications for mental health services under the following conditions: The patient is located in the patient’s home at the time of service, the provider has video telecommunications capability, and the patient is not capable of using video technology or does not consent to its use. The rule also includes a new modifier requirement for audio-only communications to verify that audio was used because of beneficiary choice or limitation and not due to a lack of provider capability.

CMS also finalized its proposal to revise the current regulatory language for Rural Health Clinic (RHC) or Federally Qualified Health Center (FQHC) mental health visits to include visits furnished using interactive, real-time telecommunications technology. This change will allow RHCs and FQHCs to report and receive payment for mental health visits furnished via real-time telecommunication technology in the same way they currently do for in-person visits, including audio-only visits when the beneficiary does not consent or cannot use video technology.

For additional details, view the CMS press release announcing the physician fee schedule or the final rule.

Medicare Diabetes Prevention Program Update

The final rule waives the provider enrollment Medicare application fee for suppliers that apply to MDPP after Jan. 1, 2022. CMS believes that waiving the application fee beyond the COVID-19 Public Health Emergency (PHE) will lead to higher MDPP supplier enrollment.

In addition, CMS is eliminating the Ongoing Maintenance Session phase which will change the MDPP service period to one year. This change will align the MDPP services time frame with the Centers for Disease Control and Prevention’s (CDC) National Diabetes Prevention Program. The Ongoing Maintenance sessions phase performance payments will then be redistributed to certain Core and Core Maintenance Session performance payments. Payment amounts for attendance-only achievement goals will also be increased beginning in 2022.

For more information, see the CMS press release on the final rule’s MDPP policies or the final rule.

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This week in Washington: Congressional Democrats reach drug pricing agreement; bipartisan infrastructure bill goes to President Biden’s desk with budget reconciliation bill delayed.

House

House Passes Bipartisan Infrastructure Bill, Delays Social Budget Reconciliation Package Bill
On Nov. 6, the House voted 228-206 to pass the $1.2 trillion bipartisan infrastructure bill. The bill now goes to President Biden’s desk for his signature. House Speaker Nancy Pelosi (D-CA) delayed voting on the $1.75 trillion budget reconciliation package until the Congressional Budget Office (CBO) report on the bill’s spending and revenue is finished. Speaker Pelosi stated that the House will vote on the bill before Thanksgiving.

Drug Pricing Reform Agreement Reached
On Nov. 2, Democratic members in the House and Senate agreed on a prescription drug pricing framework. The plan would allow Medicare to negotiate high-cost prescription drugs, impose a tax penalty for pharmaceutical companies that increase prices faster than inflation and cap Medicare Part D drugs out-of-pocket costs for seniors and people with disabilities at $2,000 a year. The proposal would also cap insulin prices at $35 a month. The Congressional Budget Office (CBO) scores show that the Medicare drug price controls will save $100 billion and repealing the rebate rule will save $150 billion. The framework can be found here.

Speaker Pelosi Says the Build Back Better Act is Paid For
On Nov. 4, House Speaker Nancy Pelosi (D-CA) wrote a Dear Colleague letter stating that the Joint Committee on Taxation (JCT) issued a report showing that the Build Back Better Act is paid for. She said that the bill would raise $1.5 trillion over 10 years. Speaker Pelosi also stated that the Rules Committee is preparing the Manager’s Amendment to include privilege fixes received from the Senate. The JCT report can be found here. The Dear Colleague letter can be found here.

Reps. Rodgers and Guthrie Release Statement on CMS Vaccine Mandate
On Nov. 4, House Energy and Commerce Ranking Member Cathy McMorris Rodgers (R-WA) and Health Subcommittee Chair Brett Guthrie (R-KY) released a statement in opposition to the Centers for Medicare and Medicaid Services (CMS) vaccine mandate for Medicare and Medicaid providers. The representatives are considering using the Congressional Review Act as a way to negate the rule. The statement can be found here.

Senate

Sens. Baldwin and Braun Introduce Bill to Reduce Anti-Competitive Practices in Healthcare
On Nov. 3, Sens. Tammy Baldwin (D-WI) and Mike Braun (R-IN) introduced the Healthy Competition for Better Care Act, which aims to reduce anti-competitive practices in healthcare. The legislation would prohibit health systems from requiring a payer or employer to contract with an affiliated provider or hospital as a condition of entering into a contract with the healthcare system. The press release with additional information on the bill can be found here.

Read more on healthcare policy in McGuireWoods Consulting’s Washington Healthcare Update.

This week in Washington: The budget reconciliation saga continues.

House

Build Back Better Activity

On Oct. 27, House Speaker Nancy Pelosi (D-CA) wrote a “Dear Colleague” letter stating that the House was close to agreement on the priorities and budget of the Build Back Better Act.

The letter can be found here.

On Oct. 28, President Biden announced the updated Build Back Better framework. The framework includes $1.85 trillion in spending, a considerable decrease from the earlier $3.5 trillion proposed.

Healthcare measures in the framework include $150 billion for home- and community-based services, a decrease from the $400 billion originally support by President Biden. The bill includes an expansion of Affordable Care Act (ACA) tax credits through 2025. In addition, the bill would expand tax credits for people in Medicaid non-expansion states through 2025.

Healthcare provisions notably missing from the new framework include a $500 billion federal paid family and medical leave benefit. In addition, the proposed expansion of Medicare to cover vision, dental and hearing services has been limited to just hearing. The expanded child tax credit would be extended until 2023 and not made permanent. The outline also leaves out a proposal to lower prescription drugs by allowing Medicare to negotiate directly with pharmaceutical companies.

The Build Back Better framework can be found here.

The House Rules Committee met on Oct. 29 to determine the rules by which the Build Back Better Act would be debated on the House floor.

The bill text can be found here.

Senate

Senators Request Update on CMS Efforts to Streamline Prior Authorization Processes

On Oct. 28, a group of 29 senators led by Sens. Sherrod Brown (D-OH) and John Thune (R-SD) wrote to the Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure requesting an update on CMS efforts to streamline prior authorization protocols across programs, including Medicare Advantage (MA) plans. The letter cites the Improving Seniors’ Timely Access to Care Act as a balanced approach to prior authorization in the MA program that could be adopted by CMS.

The letter can be found here.

Read more on healthcare policy in McGuireWoods Consulting’s Washington Healthcare Update.

For local governments, higher education institutions, development authorities and other public entities the final months of 2021 is the right time to best position yourself to receive future federal funding. McGuireWoods Consulting is uniquely positioned to help you create and implement a strategy to secure federal funds for 2022 and beyond.

Earmarks are Back in Congress

In 2021, Congressional leaders announced the return of earmarks after a decade-long moratorium. Consequentially, a diverse set of public entities were granted license to petition individual lawmakers for government funding, in amounts ranging from $50k to as high as the tens of millions. This year’s combined earmarks totaled $3.7 billion.

Examples of Entities Receiving Earmarks in 2021

  • County Commissions
  • Hospitals
  • Local Transportation Departments
  • City Governments
  • Housing Authorities
  • Community Colleges
  • Fire, EMS Departments
  • Aquariums
  • Sheriffs’ Offices
  • School Districts
  • Community Centers
  • Rehabilitation Centers
  • Landscape Restoration Projects
  • State Universities
  • Health Centers
  • Family Services Providers

Additional Funding Opportunities

Public entities may also access government funds via two forthcoming legislative packages, the Bipartisan Infrastructure Bill and the budget reconciliation bill, also called the Build Back Better Act. Though negotiations remain ongoing, conservative estimates place the combined spending value of these bills above $3 trillion.

This funding will undergo a significant rule- and distribution-making process within federal agencies following Congressional approval. As with earmarks, public entities most likely to receive funding are those with early and sustained engagement with federal agencies.

Yet another opportunity for public entities to receive government funding is the $1.9 billion American Rescue Plan Act (ARPA), passed in March 2021. Large amounts of this funding remain unspent and allocation rules were altered as recently as Oct. 19, 2021 to expand the number of qualifying entities. Further federal engagement from stakeholders may yield additional funding opportunities for public entities.

Process

To receive an earmark, an entity must submit funding requests to individual Congressional offices during the January – March timeframe. Each office will have its own unique process and strategy for soliciting, approving, and submitting the Congressional Member’s “wish list” of projects. This is a competitive process and Congressional offices receive hundreds of requests. Funding requests most likely to succeed are those submitted early, strategically crafted to fit the political and policy landscape, and accentuated through sustained Congressional engagement.

Contacts

Scott Binkley
Vice President
202 857 2921

Clayton Cox
Vice President
202 857 2926

This week in Washington: Reconciliation negotiations continue.

House

House Passes Four Public Health Bills

On Oct. 20, the House voted to pass four public health bills. The first, the Strengthening America’s Strategic National Stockpile Act (H.R. 3635), aims to secure medical supply chains and would allow the Department of Health and Human Services (HHS) to transfer supplies from the strategic national stockpile to other federal agencies or departments under specific conditions. In addition, the bill would require HHS to maintain reserves of certain critical supplies.

The second bill, the National Centers of Excellence in Advanced and Continuous Pharmaceutical Manufacturing Act (H.R. 4369), would allow the Food and Drug Administration (FDA) to designate educational institutions as National Centers of Excellence in Continuous Pharmaceutical Manufacturing.

The third bill, the Drug-Free Communities Pandemic Relief Act (H.R. 654), would waive a federal grantee’s matching requirements for grantees that cannot meet the Drug-Free Communities Support Program match during the COVID-19 pandemic.

The fourth bill, the State Opioid Response Grant Authorization Act (H.R. 2378), would authorize the State Opioid Response (SOR) Grant Authorization Program and align the program’s grants with Substance Abuse and Mental Health Services Administration (SAMHSA) funding.

House Energy and Commerce Committee’s Subcommittee on Health to Discuss Legislation

On Oct. 26, the House Energy and Commerce Committee’s Subcommittee on Health will hold a hearing titled “Caring for America: Legislation to Support Patients, Caregivers, and Providers” to discuss legislation. The bills to be discussed are listed below.

  • H.R. 1474, the Alzheimer’s Caregiver Support Act
  • H.R. 1667, the Dr. Lorna Breen Health Care Provider Protection Act
  • H.R. 3297, the Public Health Workforce Loan Repayment Act of 2021
  • H.R. 3320, the Allied Health Workforce Diversity Act of 2021
  • H.R. 5583, the Helping Enable Access to Lifesaving Services Act or the HEALS Act
  • H.R. 5594, the Enhancing the Community Health Workforce Act
  • H.R. 5602, the Bolstering Infectious Outbreaks Preparedness Workforce Act of 2021 or the BIO Preparedness Workforce Act of 2021

CBO Releases Score of Healthcare Provisions of the House Reconciliation Bill

On Oct. 19, the Congressional Budget Office (CBO) wrote to Rep. Jason Smith (R-MO) providing additional information and cost estimates on the health provisions in the House reconciliation legislation. While the CBO has not scored the Build Back Better Act in its entirety, it did study the potential impact of increasing the premium tax credits and cost-sharing reductions established under the Affordable Care Act (ACA).

The letter, with more detailed information and cost estimates, can be found here.

Senate

Senate Appropriations Labor-H Released

On Oct. 18, the Senate Appropriations Committee released the nine remaining fiscal year 2022 appropriations bills. The Labor, Health and Human Services (HHS), and Education and related agencies bill text can be found here, the explanatory statement here and the bill summary here.

Sen. Wyden Requests Review of Pharmacy Closures

On Oct. 20, Sen. Ron Wyden (D-OR) wrote to Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure requesting that the agency review pharmacy closures. Specifically, Sen. Wyden voiced his concern that Medicare Part D plan fees and pharmacy benefit managers are contributing to pharmacy closures, many of which have occurred in rural areas.

The letter can be found here.

Read more on healthcare policy in McGuireWoods Consulting’s Washington Healthcare Update.

This week in Washington: Debt ceiling measure signed by President Biden; default averted for at least a month. Discussions about budget reconciliation continue.

House

House Passes Debt Ceiling Extension
On Oct. 12, the House voted to pass legislation to raise the U.S. debt ceiling through Dec. 3. The bill passed the Senate the previous week. The measure was signed by President Biden on Oct. 14. With this action, a default is avoided for at least a month.

Speaker Pelosi Says Congress Will Fund Reconciliation Measures for Shorter Time Frame
On Oct. 12, House Speaker Nancy Pelosi (D-CA) stated that Congress will likely vote on a smaller reconciliation package that funds policy priorities for a shorter period of time than was previously planned. The time frame will be decreased in order to reduce the overall cost of the bill while maintaining the original programs.

Energy and Commerce Committee Health Subcommittee to Discuss Public Health Legislation
On Oct. 20, the Energy and Commerce Committee’s Subcommittee on Health will meet to discuss public health legislation. The bills under consideration can be found below.

  • H. R. 623, the “Gabriella Miller Kids First Research Act 2.0”
  • H. R. 1193, the “Cardiovascular Advances in Research and Opportunities Legacy Act”
  • H. R. 1956, the “Increasing Access to Quality Cardiac Rehabilitation Care Act of 2021”
  • H. R. 2161, the “Children and Media Research Advancement Act” or the “CAMRA Act”
  • H. R. 3749, the “Katherine’s Law for Lung Cancer Early Detection and Survival Act of 2021”
  • H. R. 4555, the “Oral Health Literacy and Awareness Act of 2021”
  • H. R. 4612, the “Protecting Access to Lifesaving Screenings Act of 2021” or the “PALS Act”
  • H. R. 5487, the “Stillbirth Health Improvement and Education for Autumn Act of 2021” or the “SHINE for Autumn Act of 2021”
  • H. R. 5551, the “Improving the Health of Children Act”
  • H. R. 5552, the “Lead Poisoning Prevention Act”
  • H. R. 5558, the “Prostate Cancer Prevention Act”
  • H. R. 5561, the “Early Hearing Detection and Intervention Act”

95 House Members Ask CMS to Finalize Durable Medical Equipment Proposed Rule
In an Oct. 12 letter, 95 House members asked the Centers for Medicare and Medicaid Services (CMS) to finalize the Durable Medical Equipment (DME), Prosthetics, Orthotics and Supplies Proposed Rule. The proposed rule was issued on Oct. 27, 2020 and included a provision to extend the Medicare “50/50” blended rate for DME in rural areas. The letter requested that CMS consider policies to ensure that Medicare beneficiaries have access to DME.

Rep. Golden Raises Concern About “Critical Errors” in Reconciliation Medicare Proposal
On Oct. 14, Rep. Jared Golden (D-ME) wrote a letter to Rep. Richard Neal (D-MA), Chair of the House Ways and Means Committee, and Rep. Frank Pallone (D-NJ), Chair of the House Energy and Commerce Committee, stating that the current budget reconciliation proposal to add dental, vision and hearing benefits to Medicare is insufficient. In the letter, Rep. Golden said that the flaws in the reconciliation proposal, especially in the dental benefit, should be fixed, even if this results in removing the proposal from the reconciliation package. Rep. Golden stated that while he supports budget reconciliation measures such as adding dental, vision and hearing benefits to Medicare and letting Medicare negotiate lower drug prices, it is important that these measures are done in a responsible manner that strengthens Medicare in the long term. The letter comes as Democrats are facing pressure to reduce the cost of the reconciliation package. The full letter can be found here.

Senate

Senate Finance Committee Hearing to Discuss Medicare Drug Price Negotiations
On Oct. 20, the Senate Finance Committee will hold a hearing titled “Health Insurance Coverage in America: Current and Future Role of Federal Programs.” The hearing will include discussions on allowing Medicare to negotiate drug prices. The witness list includes Linda Blumberg, Fellow at the Urban Institute; Sara Collins, Vice President for Health Care Coverage and Access at The Commonwealth Fund; Douglas Holtz-Eakin, President of the American Action Forum; and Frederick Isasi, Executive Director of Families USA. For more information on the hearing, click here.

Sens. Warren and Grassley Request the Release of Over-the-Counter Hearing Aid Proposed Rule
On Oct. 12, Sens. Elizabeth Warren (D-MA) and Chuck Grassley (R-IA) wrote to Acting Food and Drug Administrator (FDA) Janet Woodcock calling on the agency to issue the over-the-counter hearing aid proposed rule before Nov. 6, 2021. The letter notes that in July, President Biden directed the Department of Health and Human Services (HHS) to publish a proposed rule on over-the-counter hearing aids within 120 days of the Executive Order on Promoting Competition in the American Economy. The letter can be found here.

Read more on healthcare policy in McGuireWoods Consulting’s Washington Healthcare Update.

This week in Washington: Reconciliation delayed; short-term debt ceiling fix passed.

Congress

Reconciliation Update
Votes on both the reconciliation package and the infrastructure bill were delayed last week after Democratic party divisions threatened the needed consensus. Sen. Joe Manchin (D-WV) stated the most he would support spending on a reconciliation package is $1.5 trillion. The reconciliation package is currently $3.5 trillion. Sen. Kyrsten Sinema (D-AZ) has also opposed the reconciliation package. It is possible that healthcare measures included in the earlier version of the bill would be cut or otherwise impacted to reduce overall cost.

Debt Ceiling
On Oct. 7, Senate Republicans and Democrats reached a deal to vote on a short-term extension of the debt ceiling. The full Senate passed the debt ceiling measure on Oct. 7. The House is disrupting its scheduled recess to return on Tuesday to vote on the measure. This short-term measure will raise the debt ceiling until early December.

House

House Committee Leadership Write to Agencies Regarding ACA Contraceptive Coverage
On Oct.7, four Democratic House committee chairs wrote to the Departments of Health and Human Services (HHS), Labor (DOL) and Treasury to stress that the full range of contraceptives approved by the Food and Drug Administration (FDA) continue to be enforced by the Affordable Care Act. The letter expressed concern that health plans are not fully complying with the requirements, citing cases of coverage denials and extensive requirements that limited access to some FDA-approved contraceptives. The letter can be found here.

Senate

Sens. Cassidy and Murphy Request Stakeholder Input on Mental Health and Substance Use Disorder Programs
On Oct. 5, Sens. Bill Cassidy (R-LA) and Chris Murphy (D-CT) wrote a letter requesting feedback from stakeholders, including patients, families, providers, advocacy organizations and state and local governments, on the effectiveness of certain mental health and substance use disorder programs. The letter notes that many of the mental health and substance use disorder programs included in the 21st Century Cures Act will have their authorization periods end in fiscal year 2022. The letter requests feedback be directed to the congressional offices no later than Nov. 5, 2021. The letter can be found here.

Sen. Mike Crapo and Rep. Kevin Brady Request GAO Look into Potential ACA Premium Tax Credit Fraud
On Oct. 5, Sen. Mike Crapo (R-ID) and Rep. Kevin Brady (R-TX) wrote to the Comptroller General, of the Government Accountability Office (GAO), Gene Dodaro requesting that the agency look into potential fraud occurring with the Affordable Care Act’s (ACA) premium tax credit program. The letter can be found here.

Read more on healthcare policy in McGuireWoods Consulting’s Washington Healthcare Update.

Mike Andrews, former staff director and chief counsel to the Senate Committee on Indian Affairs, joins McGuireWoods as partner and McGuireWoods Consulting’s federal public affairs team as a senior vice president, and will lead the firm’s Native American public policy efforts. After a successful career on Capitol Hill and recent experience working for Sens. John Barrasso, John Hoeven and Lisa Murkowski, Andrews brings extensive knowledge in federal Indian law, as well as agriculture, housing, land use and congressional oversight issues.

“Mike has a wealth of experience implementing legislative strategies in Congress, and has mastered bipartisan negotiations while working under different administrations,” said Paul Reagan, senior vice president and director of McGuireWoods Consulting’s federal public affairs team. “He will deliver results for our clients.”

During his time on Capitol Hill, Andrews was instrumental in passing over 50 bills signed into law by Presidents Obama, Trump and Biden. He also assisted with over 90 bills passed out of the Senate by unanimous consent and helped steer more than 140 bills through of the Senate Indian Affairs Committee with strong bipartisan support. Additionally, Andrews played important roles in confirming over 10 presidential nominees spanning three administrations, and worked on some of the largest appropriations funding programs in American history.

“Mike’s knowledge of Native American affairs and congressional oversight experience in education, energy, healthcare and law enforcement will bring a new service line to our clients,” said McGuireWoods Consulting’s president and former South Carolina Gov. Jim Hodges. “He is a great asset to our team.”

Prior to Capitol Hill, Andrews served as a state, federal and tribal prosecutor in Arizona and was the chief prosecutor and counsel for the Pascua Yaqui Indian Nation in Tucson, Arizona. He also served as a senior executive at the U.S. Department of Housing and Urban Development, where he focused on Native American housing, as well as the U.S. Department of Homeland Security, where he focused on border security matters.

“Mike brings legislative and legal experience to the firm, with a working knowledge of navigating congressional committees,” McGuireWoods Consulting’s chairman Mark Bowles said. “His expertise will be invaluable to our clients on the federal level.”

Andrews serves as an adjunct professor at the University of Maryland Global Campus and is a Flotilla Commander in the United States Coast Guard Auxiliary, where he concentrates on boater education and marine safety for the National Capitol Region.