– Strong support for extending telehealth flexibilities
With uncertainty around when the Biden administration will end the Public Health Emergency declaration, members of Congress and stakeholders are seeking a temporary extension of the Medicare telehealth waivers implemented during the pandemic. To that end, Senators Catherine Cortez Masto (D-NV) and Todd Young (R-IN) have introduced the Telehealth Extension and Evaluation Act (S.3593) and Representative Lloyd Doggett (D-TX) has introduced the Telehealth Extension Act (H.R. 6202) that both include an extension of the telehealth waivers for two years. In addition, more than 300 health groups sent a letter to House and Senate leadership urging a temporary extension before taking up permanent comprehensive telehealth legislation.
– FY2022 annual spending bills under negotiation
Federal government spending is operating under a continuing resolution through March 11, five months after the start of fiscal year 2022. This will allow time for negotiations on the 12 annual spending bills. A deal was recently reached on the top-line spending amount for the bills as well as the allocations for the 12 bills. Negotiations center around both funding levels and policy issues to be addressed in the bills. In addition to the annual appropriations bills, the White House is expected to ask Congress for emergency supplemental funding to address the COVID pandemic as well as prepare for future pandemics.
– President to address a joint session of Congress on March 1
The President will make his State of the Union address on March 1 to lay out his priorities for the nation. The President’s FY2023 budget request is expected to be released in late March or early April. The delay in the release of the President’s budget will likely impact Congress’ timeline for receiving input and developing the FY2023 annual spending bills.
– Congressional focus mental health and substance use
Committees in the House and Senate have been holding hearings on mental health and substance use to inform the development of legislation to be released in a spring/summer timeframe. The COVID-19 pandemic has exacerbated the need for services and highlighted the workforce challenges and disjointed systems of care. In addition, there are a wide range of Substance Abuse and Mental Health Services Administration programs that expire in September.
The Senate Finance Committee announced five areas of focus for their legislation:
- strengthening the workforce
- increasing integration, coordination, and access to care
- ensuring parity between behavioral and physical health care
- furthering the use of telehealth
- improving access for children and young people
The Senate Health, Education, Labor, and Pensions Committee and the House Energy and Commerce Committee are also developing legislation.
– CMS maintains the previous administration’s position on co-pay accumulators in exchange plans
In January, CMS issued the proposed rule Notice of Benefit and Payment Parameters for 2023 for qualified health plans offered through federal and state Affordable Care Act insurance exchanges. CMS is proposing to strengthen plan offerings by reinstating standardized benefits plans with flat dollar co-pays for specialty medication and strong non-discrimination protections.
However, the rule does not include any reference to co-pay accumulator adjustment policies and therefore does not reverse the Trump administration’s decision to allow insurers and pharmacy benefit managers to include co-pay accumulator adjustment policies in their plans. PAN submitted comments requesting CMS reinstate the agency’s original rule requiring issuers to count all payments made by or on behalf of the beneficiary, including patient co-pay assistance, toward patients’ annual deductible and out-of-pocket limit.
– MedPAC discusses prescription drugs telehealth
The Medicare Payment Advisory Commission (MedPAC) held a meeting in January in which the commissioners reviewed the status of the Medicare Part D program in preparation for their report to Congress in March. One notable trend in Part D is that a small share of enrollees who reach the catastrophic phase drive overall spending. At future meetings, commissioners will review MedPAC’s previous recommendations to strengthen Medicare Part D.