This Week in Washington: Congress passes Continuing Resolution to keep the government funded until Nov. 17; CMS announces premium increase for Medicare Advantage plans in FY 2024; HHS releases shutdown contingency plan



House Passes 45-Day Continuing Resolution

On Sept. 30, the House of Representatives passed a Continuing Resolution that keeps the government open until Nov. 17. It was passed with the support of Democratic members. The CR is a “clean” CR which contains no funding cuts, and includes funding for disaster relief. It also extended the FAA authority until Dec. 31. It is likely that Ukraine funding will be considered with border security issues in the coming days. The Senate also passed the CR in a vote of 88 to 9 with no debate. 

House Passes Three Appropriations Bills

On Sept. 28, House Republicans passed the Defense, State-Foreign Ops and Homeland Security appropriations bills.

Debate began on Sept. 26 and included the Agriculture-Food and Drug Administration (FDA) appropriations bill as well. However, the Agriculture-Food and Drug Administration (FDA) failed to pass because of issues related to the abortion pill and other funding matters.

House Republican leaders had hoped that by allowing debate and amendments on the appropriations bills, they would be able to convince holdouts among their conference to support a short-term continuing resolution that Speaker McCarthy brought to the floor on Friday in the hopes of averting a government shutdown. However, the House rejected the CR in a 198-232 vote.

House Energy and Commerce Committee Chairmen Warn NIH and HHS Over Possible Subpoenas

On Sept. 28, House Energy and Commerce Committee Chairman Cathy McMorris Rodgers (R-WA), Subcommittee on Health Chairman Brett Guthrie (R-KY) and Subcommittee on Oversight and Investigations Chairman Morgan Griffith (R-VA) sent letters to National Institutes of Health (NIH) Acting Director Lawrence Tabak and Secretary of the Department of Health and Human Services (HHS) Xavier Becerra stating that the committee would be forced to issue subpoenas against the agencies if they fail to comply with previously issued requests for documents and information.

The chairmen are seeking information on the NIH’s involvement in virus mutation and manipulation research and the appointment and reappointment of NIH institute and center directors.

For more information, click here.


Senate Finance Committee Chairman to Investigate MCO-Prior Authorization Denials

On Sept. 28, Senate Finance Committee Chairman Ron Wyden (D-OR) and House Energy and Commerce Committee Ranking Member Frank Pallone (D-NJ) launched a bicameral investigation into Medicaid managed care organization (MCO) prior authorization practices and sent letters to large MCOs, requesting that they submit information on their rate of prior authorization approvals, partial denials and full denials. They are also requesting information on the rate of appeals and on the prior authorization algorithms used by insurers.

The Chairman and Ranking Member are concerned about findings of a recent Department of Health and Human Services (HHS) Office of Inspector General (OIG) report that revealed MCOs are denying Medicaid prior authorizations at nearly twice the rate of Medicare Advantage prior authorizations.

Senate HELP Committee Ranking Member Requests Information on CDC Reform and 340B Drug Program Revenue

On Sept. 26, Senate Health, Education, Labor and Pensions (HELP) Committee Ranking Member Bill Cassidy (R-LA) sent a letter to stakeholders requesting information regarding how the Centers for Disease Control and Prevention (CDC) can be modernized. The Ranking Member is seeking input on how data-sharing and transparency partnerships between the CDC, federal agencies and the private sector can be broadened and how innovation and collaboration can be strengthened. Public comments will be accepted until Oct. 20.

In addition, the Ranking Member sent letters to two 340B-eligible hospitals on Sept. 28, requesting that they provide information on the revenue they generate from the 340B program. The Ranking Member is concerned over reports that entities are not passing on the revenue they generate from the 340B program to improve healthcare services for low-income patients.

For more information on the request for information on CDC reform, click here.

For more information on the request for information on 340B program revenue, click here.

Senators Oppose In-Person Visit Requirement in Expected DEA Telehealth Final Rule

On Sept. 12 and 13, Drug Enforcement Administration (DEA) leaders met with a number of stakeholder groups to discuss a DEA flexibility that allows providers to prescribe controlled substances via telehealth to patients who have not conducted a prior in-person visit. The flexibility, originally issued during the COVID-19 pandemic, is set to expire on Nov. 11. The DEA has announced that it will release a final rule addressing the flexibility this fall.

Following the listening sessions, a group of senators including Sens. Cassidy (R-LA), Thune (R-SD), Feinstein (D-CA), Markey (D-MA) and Warren (D-MA) met with telehealth stakeholders and announced that they will apply pressure and oversight on the DEA if the agency’s final rule requires providers to conduct an in-person visit with a patient before they are able to prescribe controlled substances via telehealth.

Sen. Markey Expresses Concern Over Prohibition of Facility Fees for Telehealth Providers

On Sept. 21, the Senate Health, Education, Labor and Pensions (HELP) Committee marked up the Primary Care and Health Workforce Act, which would reauthorize community health and medical education programs and address primary care and health workforce challenges. The legislation contains a provision that would prohibit hospitals from billing facility fees for telehealth and evaluation and management services.

During the markup, Sen. Markey (D-MA) expressed his concern over the provision, noting that it would create barriers for individuals who rely on telehealth services to receive care, particularly disabled, elderly and low-income patients. Many hospital stakeholders also expressed their concerns and noted that it would be detrimental to telehealth.

Modernizing and Ensuring PBM Accountability Act Introduced

On Sept. 28, Senate Finance Committee Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) introduced the Modernizing and Ensuring PBM Accountability Act. The legislation aims to increase the accountability and transparency of pharmacy benefit manager (PBM) practices. It would:

  • Prohibit PBM compensation in Medicare Part D from being tied to the price of a drug;
  • Allow Part D plan sponsors to audit their PBM for compliance with contract requirements;
  • Require the Secretary of the Department of Health and Human Services (HHS) to implement standard Part D measures to assess the performance of network pharmacies;
  • Ban PBM spread pricing in Medicaid;
  • Require retail community pharmacies to participate in the National Average Drug Acquisition Cost (NADAC) Survey; and
  • Implement stricter PBM reporting requirements.

For more information, click here.

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