This Week in Washington: The House and Senate return to face funding the government and other issues; the administration reverses for good the Trump-era “public charge” rule.



Funding the Government

Current funding for the federal government runs out on Oct. 1; Congress will need to do a short-term Continuing Resolution (CR). Currently being discussed in the House is a CR to run through Dec. 16. What is unclear is whether the CR will have anything attached to it.

The White House has asked that COVID and monkeypox funding be attached. They have requested $22.4 billion in COVID money and $4.5 billion for monkeypox funding. Republican senators state that there is already unspent money that could be used for these purposes. The administration also released a list of programs that should be included or programs they would not object to being included on the CR.

Meanwhile, Senate Budget Committee Chairman Bernie Sanders (I-VT) announced that he will vote against the CR if it includes a package of energy provisions meant to satisfy Sen. Joe Manchin (D-WVA). Sanders says that “at least” 59 House Democrats will be releasing a letter opposing the energy provisions as well.

Bipartisan Group of Members Ask for Input on How to Revamp the Medicare Access and CHIP Reauthorization Act (MACRA)

Eight House members led by Reps. Ami Bera (D-CA) and Larry Bucshon (R-IN) are asking stakeholders for feedback concerning how to fix MACRA without dramatically increasing Medicare spending.

Members Push for Audio-Only Telehealth Coverage

Reps. Ann McLane Kuster (D-NH), Lori Trahan (D-MA) and Peter Welch (D-VT) wrote CMS Administrator Chiquita Brooks-LaSure to urge Medicare coverage of audio-only telehealth continue beyond the pandemic, raising concerns that ending reimbursement would add to health disparities. However, CMS has said it cannot do so without congressional action. CMS proposed to extend audio-only coverage for mental healthcare but said legislative restrictions prevent it from doing so for other telehealth services.

The letter asks CMS to answer several questions, including how the agency is measuring the effectiveness of audio-only telehealth and what data it has about the factors that impact audio-only usage as opposed to other kinds of telehealth. It also asks what CMS believes the impact of ending audio-only telehealth coverage would be on rural beneficiaries and on other groups that are more likely to use the modality, including Black patients.


FDA User Fee Bill Drama Continues

Congress has until Sept. 29 to reauthorize the FDA User Fee program. FDA Commissioner Robert Califf has said the agency could fund the programs into early November using carryover user fees. Some believe that reauthorization should be added to the short-term CR in order to give more time for members to negotiate an agreement.

Senators Ask AHIP about HIV Prevention Medication Coverage

On Sept. 8, a letter lead by Sens. Jeff Merkley (D-OR) and Tina Smith (D-MN) asked the America’s Health Insurance Plans (AHIP) about reports that some insurers are not providing cost-free coverage of HIV prevention medication and related services as required under the Affordable Care Act.

The letter comes after a federal district judge ruled that the pre-exposure prophylaxis (PrEP) mandate violates rights of a Texas employer under the Religious Freedom Restoration Act (RFRA) and that the ACA violates the appointments clause of the Constitution by deferring decisions on coverage requirements to the U.S. Preventive Services Task Force (USPSTF).

Under the ACA, insurers must cover all preventive services rated “A” or “B” by the USPSTF without cost-sharing. In June 2019, the task force gave PrEP an “A” rating, and plans were required to cover the drug as of Jan. 1, 2021. CMS issued additional guidance to clarify that ancillary services, like testing fees and adherence consultations, must also be covered without cost-sharing.

The judge has yet to issue any remedies related to the decision, so it’s unclear whether it will apply only to the plaintiffs, or nationwide.

In their letter, the senators stressed it is an insurer’s responsibility to ensure the cost-free coverage is provided.

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