Following the August recess, Congress returned to session for just under three weeks this month. Now they adjourn again until after the November 5^th election. Despite the short time frame, it was a busy period with legislation advancing in both chambers and several healthcare-related committee hearings. The typical “What Happened in Congress this Week?” section of the newsletter will serve as this issue’s featured topic.

Government Shutdown Averted

To start things off with arguably the most important news, Congress averted a government shutdown by passing a Continuing Resolution (CR) to fund the government through December 20 under FY 2024 figures. As noted in the September 6^th edition of Capitol Insights, a shutdown just before the election could have been politically damaging for both parties. This move pushes the larger task of finalizing government funding into the post-election “lame duck” period. Alternatively, Congress could ultimately pass another CR in December and hold off on fully funding the government into the next Congress that will begin in January.

House of Representatives

In addition to preventing a shutdown, several healthcare-related bills passed out of the House over the past two weeks. Here’s a list of some of the notable legislation:

• R. 3800: Expands types of preventative care that can be covered under high-deductible health plans (HDHP) without a deductible.
• R. 7858: Creates a modifier code for incident-to mental health services furnished by telehealth.
• R. 3433: Reauthorizes the FDA’s priority review voucher program which incentivizes drug manufacturers to develop drugs for pediatric cancer by five years.
• R. 2706: Bans discrimination on the grounds of mental or physical disabilities during the organ transplant process.
• R. 5526: Indefinitely allows independent physicians to send Medicare beneficiaries their prescriptions via mail.

In committee actions, the House Energy & Commerce Committee advanced the Telehealth Modernization Act which would expand pandemic-era Medicare telehealth rules by two years (notably, the bill has yet to receive a CBO score). There is also a separate telehealth extension bill being considered by the House Ways and Means Committee. Although the two committees have yet to reconcile their approaches, the bipartisan popularity of telehealth makes it likely that some form of extension will pass before the end of the year.

Senate

Turning to the Senate, drug pricing was in the spotlight. On Tuesday, Novo Nordisk CEO Lars Fruergaard Jørgensen testified before the Senate Health, Education, Labor, and Pensions (HELP) Committee regarding the high prices of Novo Nordisk’s blockbuster drugs Wegovy and Ozempic. Jørgensen defended the pricing, but Committee Chairman Bernie Sanders (I-VT) revealed that major pharmacy benefit managers—OptumRx, Express Scripts, and Caremark—pledged to keep these drugs on their preferred drug lists, even if Novo Nordisk reduced its prices. Jørgensen was extremely skeptical of how this could play out in practice.

The Senate HELP Committee also voted to hold the CEO of Steward Health in criminal contempt for failing to comply with a subpoena to testify about Steward Health’s financial collapse. This resolution will now move to the full Senate for further consideration.

Both Chambers of Congress

The Congressional Budget Office (CBO) Data Access Act was passed with bipartisan support in both chambers. This legislation is designed to speed up data sharing between the CBO and federal agencies. If signed into law, it will allow the CBO faster access to Medicare and Medicaid data, helping to streamline the process of obtaining CBO scores for legislation. Delays in obtaining these scores can slow down legislative progress, but this bill aims to address that issue through improved data sharing.

Meanwhile, Democrats in both chambers have introduced bills to permanently extend the Affordable Care Act’s advance premium tax credit. This policy, previously discussed in the September 13 edition of Capitol Insights, is expected to remain a partisan issue, sparking further debate in the weeks to come.

Importantly to note, this overview is non-exhaustive. The actions taken (or in many instances, not taken) will set the scene for what could be a busy congressional session after the election.

The National Committee for Quality Assurance (NCQA) released its annual ratings of commercial, Medicare, and Medicaid plans based on quality of care, patient experience, and patient outcomes. Of the 1,019 plans health plans that received ratings, five plans received 5-star ratings (comprised of three commercial plans and two Medicare Advantage plans).

CMS released its public-facing resources for the Medicare Prescription Payment Plan (MPPP). Part of the Inflation Reduction Act (IRA). MPPP is designed to help Medicare Part D beneficiaries manage the monthly costs of their prescription drugs by allowing them to spread their payments across the calendar year. The new resources explain the program and advise beneficiaries on when it makes the most financial sense to participate in the MPPP.

 CMS and the state of Oklahoma announced a pilot program for a National Provider Directory. A “first-of-its-kind” project, the stated goal of the pilot program is to “develop an automated, single, statewide centralized directory for Qualified Health Plans (QHPs) and providers in Oklahoma to improve data accuracy, lessen burdens on providers and payers, lower administrative costs, support interoperable data exchange, and ultimately improve patient and provider experiences.” If successful, CMS may aim to implement a provider directory at the national level. 

This week, Particle Health, a health data start-up that leverages Application Programming Interfaces (APIs) to aggregate data from digital health companies, filed an 81-page lawsuit against Epic Systems, alleging antitrust violations. In the suit, Particle Health accuses Epic of exploiting its dominance in the Electronic Health Records (EHR) market to stifle competition and limit access to critical patient data.

Cigna Group’s Express Scripts has filed a lawsuit against the Federal Trade Commission (FTC), claiming that July’s interim report on pharmacy benefit managers (PBMs) is biased and includes unsupported conclusions. While the FTC maintains its position on the report, Scripts argues that the FTC ignored substantial evidence submitted by PBMs and instead relied on select public sources to support its narrative regarding PBM’s role in the high prices Americans pay for prescription drugs.

 Days after the Cigna lawsuit was filed, the Federal Trade Commission (FTC) officially filed a lawsuit against the three largest Pharmacy Benefit Managers (PBMs)—CVS’s Caremark, UnitedHealth’s OptumRx, and Cigna’s Express Scripts—for anti-competitive practices, inflating their prices (specifically for insulin), and denying patients affordable access to life-saving treatments.

Last week, the Federal Reserve announced its first rate cut since 2020, reducing its benchmark rate by 0.5 percentage points. This reduction could prompt health systems to issue bonds at more favorable rates and also enhance investments for biotech firms that depend on lower interest rates to fund their more innovative projects.

MIPS Value Pathway (MVP) Registration is open for the 2024 Performance Year. The deadline for those who wish to report an MVP is December 2, 2024, at 8 pm EST.

In April 2023, states began the Medicaid redetermination process. A KFF analysis of publicly available data published by CMS found that over 25 million Americans lost their healthcare coverage during the unwinding process. However, the total number of Americans covered by Medicaid has increased by 10 million since the beginning of the pandemic.

The FDA has approved AstraZeneca’s FluMist, a nasal influenza vaccine, aiming to increase convenience and accessibility. The vaccine is for self-administration or caregiver administration, making it the first flu vaccine available for home use.

Here is a list of the drugs that many expect to be included in the 2025 Medicare Drug Price Negotiation Program.

A recent report from CDC’s National Center for Health Statistics indicates that while obesity rates among U.S. adults have seen a slight decline, they remain higher than a decade ago, with significant disparities based on age and education. The findings highlight the ongoing public health challenge of obesity and the need to promote healthier lifestyles and accessibility to resources across communities.

 CMS announced that states must fully comply with Medicaid renewal requirements by December 31, 2026. This gives states a little more than two years to be fully compliant—CMS that agency action would be taken against states who were non-compliant at the deadline.

HHS’ Office of the Inspector General (OIG) released a report that found a drastic increase in spending for remote patient monitoring devices. The report called for additional oversight to prevent Medicare fraud and abuse.

On Thursday CMS released new guidance on Medicaid Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements. Notably, the guidance reiterated to states that they must provide comprehensive services to children covered by Medicaid, including transportation to doctor’s appointments.

The Pentagon announced a new $500 million commitment to advance women’s health research, reflecting the growing prioritization of women’s health within the Department of Defense (DoD). This initiative builds on a legacy of groundbreaking efforts in women’s health.

Relatedly, we encourage you to read about Fran Visco, a trailblazer and president of the National Breast Cancer Coalition, who was instrumental in forging the once-unlikely partnership between the DoD and breast cancer research, setting the stage for initiatives like the Pentagon’s women’s health research commitment.