This week the Senate Finance Committee held a hearing titled “Bolstering Chronic Care through Medicare Physician Payment” which discussed a variety of Medicare payment policy reforms. Lawmakers and witnesses evaluated the current state of Medicare physician payments through the Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs). Committee members emphasized concerns that physician payments have not kept up with costs and that coding complexities and prior authorization requirements exacerbate administrative burden. The discussion on opportunities to reform chronic care reimbursement included revising the budget neutrality threshold for physician fee schedule adjustments, supporting primary care providers with monthly prospective payments, and testing physician-focused payment models recommended by the Physician-Focused Payment Model Technical Advisory Committee (PTAC).

Additionally, the House Committee on Energy and Commerce’s Health Subcommittee held a hearing to explore “Legislative Proposals to Support Patient Access to Telehealth Services.” The hearing discussed bills that would make permanent temporary Medicare telehealth coverage policies that expire after 2024. There is strong bipartisan support in Congress for making these popular policies permanent. Committee Members from both parties showed support for legislation that invests in telehealth but remained conscious of concerns like maintaining quality of care, clarifying licensure requirements, and lowering healthcare costs.

Lastly, Senate Commerce Committee Chair Maria Cantwell (D-WA) and House Energy and Commerce Committee Chair Cathy McMorris (R-WA-05) introduced bicameral, bipartisan data privacy legislation, called the “American Privacy Rights Act.” This 53-page legislation has been years in the making and a true landmark privacy bill introduction that would give Americans more control of what data is collected on them and how that data is shared. It especially could have a significant impact on how the privacy of health data is maintained, especially health related data that falls outside the scope of existing federal health privacy laws such as HIPAA.

At the end of March, the Biden Administration issued the “Short-Term, Limited-Duration Insurance and Independent, Non-coordinated Expected Benefits Coverage” Final Rule that limits the sale of short-term limited-duration insurance plans. The availability of these types of insurance plans tends to go in and out, based on which party is in the White House.

Short-term, Limited-Duration Insurance (STLDI) plans are intended to serve as an option for people to maintain health coverage when experiencing gaps in coverage (such as when between transitioning jobs). Republicans contend that these plans can serve as a lower-cost alternative Affordable Care Act (ACA) plans. While this is true, Democrats tend to oppose these sorts of plans since STLDIs are not subject to the same coverage requirements as ACA plans. For example, they do not cover pre-existing conditions and have very high out of pocket payments. Additionally, the deductibles reset when the plans renew, which can subject enrollees to perpetually high out-of-pocket costs. For this reason, President Biden has criticized these health insurance plans as “junk insurance.”

President Trump expanded STLDIs by increasing their duration from only a few months to a full year. The new Final Rule issued by the Biden Administration limits the amount of time Americans are able to enroll in them from 36 months to now four months.

The Final rule also requires plans be accompanied with a “clear, easy-to-understand consumer notice on marketing, application, enrollment, and reenrollment materials, so that consumers can make informed coverage purchasing decisions”. This will increase transparency surrounding the insurance, and help people better understand the health plan they are purchasing.

This Final Rule correlates with the Biden Administration’s efforts to encourage ACA enrollment. For example, legislation passed by Congress eliminated the income threshold for ACA premium assistance subsidies. This policy makes these subsidies available to anyone, regardless of income. However, this policy ends after 2025.

The Final Rule goes into effect later this year on September 1^st.

The 2025 Medicare Advantage and Part D released by the Center for Medicare and Medicaid Services last week allows Medicare Part D sponsors to substitute biosimilars as “maintenance changes” to formularies without approval by CMS. This change should address delays in timely access to affordable prescriptions.

The National Institute of Allergy and Infectious Diseases (NIAID) has awarded 11 cooperative agreements to the Consortium for Food Allergy Research (CoFAR) in its most recent renewal. NIAID plans to award at least $11 million annually for seven years to the selected institutions.

A Mayo Clinic study published in Open Forum Infectious Diseases this week found that COVID-19 mortality was 22% higher for rural patients compared to urban patients, after hospitalization. The study population included patients in Arizona, Minnesota, and Wisconsin who were hospitalized between March 2020 and July 2022.

In an analysis conducted by Lokker, one-third of healthcare websites used Meta Pixel tracking code. Concerns about tracking codes on healthcare websites are based on recent data breaches, the potential for lawsuits, and compliance with HIPAA guidelines.

The Centers for Medicare and Medicaid Innovation (CMMI) proposed a new Episode Payment Model for conditions such as lower extremity joint replacement, surgical hip and femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure. The proposed Transforming Episode Accountability Model (TEAM) is a five-year mandatory model that is intended to incentivize coordination between care providers during a surgery as well as the services provided during the 30 days that follow.

Department of Health and Human Services Secretary Xavier Becerra may consider leaving his role in the Biden administration to run for governor in California in 2026. Secretary Becerra has played an important role in highlighting high-priority health issues for the Biden re-election campaign.

The Arizona Supreme Court upheld a law from 1864 that enforces a near-total abortion ban. The decision by the state supreme court reverses the ruling of a lower court which said that a 15-week ban from 2022 would replace the 1864 law.

The Center for Medicare and Medicaid Services released a proposed rule on the Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LICH PPS) for 2025. The proposed rule includes a 2.6% increase to IPPS payment rates.

A Government Accountability Office (GAO) report released on Monday found that revenue for community health centers (CHCs) increased from $26 billion in 2017 to $42.9 billion in 2022. This significant increase is the first data published on CHC revenue since 2017.