Health Care Policy Update – Weekly Wrap-up and What’s Ahead – July 15, 2024


When is Congress in session? House 2024 Calendar Senate 2024 Calendar

What’s Ahead: This Week

Hearings and Markups – No notable hearings this week. Congress is not in session.

Notable Policy Events –
  • Monday, July 15
    • Resources for Integrated Care (RIC), “Supporting Dental Health Care Coordination for Individuals Dually Eligible for Medicare and Medicaid.” Free, Virtual. Additional Information
  • Tuesday, July 16
    • American Medical Association (AMA), “Revolutionizing Behavioral Health Services with the CPT Code Set.” Free, Virtual. Additional Information
    • CMS, “Accountable Care Organization Primary Care Flex Model (ACO PC Flex Model) Office Hour.” Free, Virtual. Additional Information
    • Health Resources and Services Administration (HRSA), “National Telehealth Conference.” Free, Virtual. Additional Information
    • Office of the National Coordinator for Health Information Technology (ONC), “2024 TEFCA RCE Monthly Informational Call.” Free, Virtual. Additional Information
  • Wednesday, July 17
    • Office of the National Coordinator for Health Information Technology (ONC), “ONC HTI-2 Proposed Rule: Overview Information Session.” Free, Virtual. Additional Information
    • Paragon Health Institute, “Follow the Money: How Tax Policy Shapes Health Care.” Free, Virtual. Additional Information
  • Thursday, July 18
    • Center for American Progress (CAP), “State Policy Efforts to Avert and Alleviate Medical Debt.” Free, Virtual. Additional Information
    • Peterson Health Technology Institute (PHTI), “Assessing Musculoskeletal Solutions with PHTI.” Free, Virtual. Additional Information

New Client Resources – On July 10, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2025 Physician Fee Schedule proposed rule. Please visit the Sirona Strategies website to find a summary of the proposed rule. Password is Sirona2024Resources.

Weekly Wrap-Up: Notable Health Care Developments from Last Week

Medicare & Medicaid

  • On July 8, CMS announced that Utah submitted a request to amend its section 1115 demonstration waiver, which would provide health-related social services to additional qualifying Medicaid-eligible groups and change the age eligibility for fertility preservation treatment for Medicaid-eligible individuals diagnosed with cancer. Comments are due August 7, 2024. Pending Application Comments
  • Also on July 8, the HHS Office of Inspector General (OIG) published an impact brief identifying risk and fraudulent payments in Medicare Advantage Organizations (MAOs). Impact Brief
  • On July 10, CMS issued the Calendar Year (CY) 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) proposed rule. The rule proposes payment rates and policy changes effective January 1, 2025. Comments are due September 9, 2024. Fact Sheet Press Release Proposed Rule
  • Also on July 10, CMS issued the CY 2025 Physician Fee Schedule (PFS) proposed rule. The rule proposes payment rates and policy changes effective January 1, 2025. Comments are due September 9, 2024. Fact Sheet MSSP Fact Sheet Medicare Prescription Drug Inflation Rebate Program Fact Sheet Press Release Proposed Rule
  • Also on July 10, CMS published the Open Payments Program Year 2023 data, along with updated payment records for Program Years 2017 – 2022. Open Payments Data
  • On July 11, CMS released the 2024 Medicaid and CHIP Beneficiaries at a Glance: Autism Infographic as part of its data products series. Data Products Infographics
  • On July 12, CMS announced that Iowa submitted a request to extend its section 1115 demonstration, which would provide coverage to a new adult group and continue demonstration elements including premiums, healthy behaviors, a waiver of non-emergency medical transportation, and a waiver of retroactive eligibility for certain beneficiaries. Comments are due August 11, 2024. Announcement Pending Application Comments
  • Also on July 12, CMS released a companion guide to the fee-for-service (FFS) financial provisions of the Ensuring Access to Medicaid Services final rule. Companion Guide Final Rule

Marketplaces – On July 10, CMS released its first No Surprises Act audit, listing a number of errors in how the audited company calculated reimbursement rates for air ambulance services. Audit No Surprises Act

Payment & Delivery System Models – 

  • On July 8, CMS launched the Guiding an Improved Dementia Experience (GUIDE) Model, which aims to support people with dementia and their unpaid caregivers. CMS Blog GUIDE Model GUIDE Model Participants
  • On July 10, CMS announced participants in the Making Care Primary (MCP) model. There are 133 participants, representing 772 practices across Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington. MCP Model Participant List
  • Also on July 10, CMS released the second evaluation report for the Global and Professional Direct Contracting (GPDC) Model. Evaluation Report Summary

Health IT, Privacy, & Digital Health – 

  • On July 10, ONC released the Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) proposed rule, which aims to improve patient engagement, information sharing, and public health interoperability. The rule has not yet been published in the Federal Register; comments will be due 60 days after publication. Fact Sheet Press Release Proposed Rule
  • Also on July 10, Senate HELP Committee Ranking Member Cassidy (R-LA) sent a letter to HHS OIG and ONC requesting clarity regarding its delays in implementing and enforcing regulations to prevent health information blocking. Letter Press Release
Mental Health & Substance Use Disorder – 
  • On July 8, the Government Accountability Office (GAO) issued a report on the Department of Defense’s (DOD) oversight of TRICARE behavioral health provider directories. Highlights Report
  • Also on July 8, GAO issued a report on federal guidance to address work arrangements for individuals living in residential facilities. Highlights Report
  • Also on July 8, HHS announced $27.5 million in funding opportunities aimed at improving women’s behavioral health across the United States. Applications are due August 26, 2024 for the Community-Based Maternal Behavioral Health Services Program and August 20, 2024 for the Women’s Behavioral Health Technical Assistance Center. Community-Based Maternal Behavioral Health Services Program Press Release Women’s Behavioral Health Technical Assistance Center
Prescription Drugs & Health Innovation – 
  • On July 8, HHS issued a report on the impacts of a nonprofit membership-based pharmaceutical company on the volume of drugs sold and drug prices. Report
  • Also on July 8, HHS issued a report on the potential role of the nonprofit pharmaceutical industry in addressing shortages and increasing access to essential and low-cost medicines. Report
  • On July 9, the Federal Trade Commission (FTC) issued an interim report on pharmacy benefit managers (PBMs), part of an ongoing study of PBMs and their impact on access to and affordability of medicines. Interim Report Press Release
SDOH & Health Equity – 
  • On July 11, the United States Department of Agriculture (USDA) announced $4.5 million in funding, which would establish three additional USDA Nutrition Hubs in communities across the country. Applications are due October 3, 2024. Application Information Press Release
  • Also on July 11, Sen. Cortez Masto (D-NV) and 16 colleagues released a report on the impact of the Supreme Court’s decision of Roe v. Wade. Report Press Release

Misc. – 

  • On July 10, House Oversight and Accountability Committee Chairman Comer (R-KY) sent letters to the Federal Acquisition Regulatory Council, General Services Administration (GSA), Office of Personnel Management (OPM), and several other agencies requesting information about their interpretations of their statutory authority to provide congressional oversight of compliance with the Supreme Court’s Loper Bright decision. Letter to the Federal Acquisition Regulatory Council Letter to GSA Letter to OPM Press Release

Legislative Activity –

Votes and Committee Activity  –

  • On July 9, the House Appropriations Committee advanced the Fiscal Year (FY) 2025 Commerce, Justice, Science, and Related Agencies Appropriations Act by a vote of 31-26. The bill would make appropriations for the Departments of Commerce, Justice, Science, and related agencies for FY 2025. Bill Report Bill Summary Bill Text Press Release
  • On July 10, the House Appropriations Committee advanced the FY 2025 Labor, Health and Human Services, Education, and Related Agencies Appropriations Act by a vote of 31-25. The bill would make appropriations for the Departments of Labor, Health and Human Services, Education, and related agencies for FY 2025. Bill Report Bill Summary Bill Text Press Release
  • Also on July 10, the House Appropriations Committee advanced the FY 2025 Agriculture, Rural Development, FDA, and Related Agencies Appropriations Act by a vote of 29-26. The bill would make appropriations for the Departments of Agriculture, Rural Development, FDA, and related agencies for FY 2025. Bill Report Bill Summary Bill Text Press Release
  • On July 11, the Senate passed the Affordable Prescriptions for Patients Act of 2023 (S. 150) by unanimous consent. The bill would prohibit product hopping. The bill heads to the House for consideration. Bill Text Press Release

Introduced Legislation  –

  • On July 9, Reps. Newhouse (R-WA) and Johnson (R-SD) introduced the Uniform Credentials for IHS Providers Act (H.R. 8956), which would develop and implement a centralized system to credential licensed health professionals who seek to provide health care services at any Indian Health Service unit. Bill Text Press Release
  • Also on July 9, Reps. Foster (D-IL), Grijalva (D-AZ), Meeks (D-NY), and Beatty (D-OH) introduced the Medical Records Access Fairness Act (H.R. 8964), which would allow an individual to obtain a copy of such individual’s protected health information at no cost unless certain circumstances apply. Bill Text Press Release
  • Also on July 9, Rep. Johnson (R-SD) introduced the Restoring Accountability in the Indian Health Service Act of 2024 (H.R. 8966), which would improve the recruitment and retention of employees in the Indian Health Service, restore accountability in the Indian Health Service, and improve health services. Press Release Bill Text
  • On July 10, Reps. Carey (R-OH), Doggett (D-TX), Miller (R-WV), Dingell (D-MI), and Ryan (D-NY) introduced the Improving Access to Emergency Medical Services for Seniors Act (H.R. 8977), which would require the Center for Medicare and Medicaid Innovation (CMMI) to test an emergency medical services treatment-in-place model under the Medicare program. Bill Text Press Release
  • Also on July 10, Reps. Porter (D-CA), DeLauro (D-CT), Grijalva (D-AZ), Cohen (D-TN), and Omar (D-MN) introduced the Lowest Price for Patients Act (H.R. 8987), which would ensure cost sharing for a drug does not exceed the nationwide average of consumer purchase prices for such drug. Press Release
  • On July 11, Reps. Burgess (R-TX), Cárdenas (D-CA), Griffith (R-VA), and Gonzalez (D-TX) introduced the Physician Led and Rural Access to Quality Care Act (H.R. 9001), which would allow certain exemptions to rules for physician owned hospitals in rural areas and remove a ban that prevents existing physician owned hospitals from expanding. Press Release
  • Also on July 11, Reps. Garcia (D-CA) and Bacon (R-NE) introduced the Surveilling Effluent Water for Epidemic Response (SEWER) Act (H.R. 9008), which would establish, maintain, or improve activities related to the detection and monitoring of infectious diseases through wastewater for public health emergency preparedness and response purposes. Press Release
  • Also on July 11, Rep. Schakowsky (D-IL) and six cosponsors introduced the Consumer Health Options and Insurance Competition Enhancement (CHOICE) Act (H.R. 9020), which would establish a public health insurance option. Sens. Whitehouse (D-RI) and Brown (D-OH) introduced companion legislation (S. 4682) in the Senate. Bill Text Press Release
  • Also on July 11, Reps. Slotkin (D-MI), Craig (D-MN), and Trone (D-MD) introduced the No Tax Breaks for Drug Ads Act (H.R. 9021), which would deny the deduction for advertising and promotional expenses for prescription drugs. Press Release
  • Also on July 11, Rep. Stefanik (R-NY) introduced the Military Moms Act (H.R. 9022), which would include pregnancy and loss of pregnancy as qualifying life events under the TRICARE program and require a study on maternal health in the military health system. Sens. Rubio (R-FL) and Risch (R-ID) introduced companion legislation in the Senate. Press Release
  • Also on July 11, Sen. Casey (D-PA) and nine cosponsors introduced the Capping Prescription Costs Act (S. 4671), which would limit cost sharing for prescription drugs. Press Release
  • Also on July 11, Sens. Warnock (D-GA), Baldwin (D-WI), Casey (D-PA), Warren (D-MA), and Ossoff (D-GA) introduced the Bridge to Medicaid Act (S. 4684), which would ensure affordable health insurance coverage for low-income individuals in states that have not expanded Medicaid. Press Release
  • Also on July 11, Sens. Rosen (D-NV), Young (R-IN), and King (I-ME) introduced the Healthcare Cybersecurity Act (S. 4697), which would enhance the cybersecurity of the Healthcare and Public Health Sector. Press Release