United States: Washington Healthcare Update | July 17, 2023

This Week in Washington: Appropriation bills move forward but remain incomplete; House Energy and Commerce Committee markup includes 17 healthcare bills; Senate Finance Committee schedules PBM markup

Congress

House

House Appropriators Continue Work on Funding Bills

On July 14, the House Appropriations Committee Subcommittee on Labor, Health and Human Services, and Education subcommittee held a markup of the FY 2024 Labor, Health and Human Services and Education appropriations bill and moved it out of the subcommittee.

The proposed House Republican funding levels for the Labor-HHS bill are below the spending caps agreed to in the debt-ceiling agreement.

The proposed bill would:

• Authorize $147 billion in overall funding to labor and health programs, a 29 percent reduction from FY 2023 funding levels;
• Cap funding for the Department of Health and Human Services (HHS) at $103.3 billion, $14 billion less than in FY 2023;
• Reduce funding for the Centers for Disease Control and Prevention (CDC) by $1.6 billion;
• Reduce funding for the National Institutes of Health (NIH) by $3.8 billion; and
• Eliminate funding for various healthcare programs, including the Agency for Healthcare Research and Quality and the CDC Center for Forecasting and Outbreak Analytics.

For more information, click here.

House Energy and Commerce Health Subcommittee Marks Up 17 Healthcare Bills

On July 13, the House Energy and Commerce Subcommittee on Health marked up and voted out of committee 17 healthcare bills. The bills that were considered include:

H.R. 824, Telehealth Benefit Expansion for Workers Act of 2023
This legislation would expand COVID-19 telehealth flexibilities issued by the Departments of Health and Human Services (HHS), Labor, and the Treasury, and allow employers to offer stand-alone coverage of telehealth-only services to employees.

H.R. 3226, Prematurity Research Expansion and Education for Mothers who deliver Infants Early (PREEMIE) Reauthorization Act of 2023
This legislation would reauthorization the Prematurity Research Expansion and Education for Mother who deliver Infants Early (PREEMIE) Act for fiscal years (FYs) 2024 to 2028. It would direct the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) to strengthen efforts to reduce preterm births and infant mortality and would authorize a new study to analyze the financial costs of premature births on society.

H.R. 3838, Preventing Maternal Deaths Reauthorization Act of 2023
This legislation would reauthorize federal support of state efforts to address disparities that exist in maternal health outcomes. It would require the CDC to work with HRSA to inform hospitals and healthcare providers of maternal mortality prevention strategies.

H.R. 3843, Action for Dental Health Act of 2023
This legislation would reauthorize Section 340G of the Public Health Service Act to address dental workforce needs.

H.R. 3884, Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act of 2023
This legislation would reauthorize Section 1106 of the Public Health Service Act for FYs 2024 to 2028 to continue research and treatment services.

H.R. 3821, Firefighter Cancer Registry Reauthorization Act of 2023
This legislation would reauthorize funding for FYs 2024 to 2028, for a voluntary CDC registry used to report firefighter cancer incidents.

H.R. 2365, National Plan to End Parkinson's Act
This legislation would direct the HHS Secretary to coordinate and improve federal prevention, treatment and cure strategies for Parkinson's disease. It would also require HHS to form an advisory council to assess current national Parkinson's disease recommendations and strategies.

H.R. 3391, Gabriella Miller Kids First Research Act 2.0
This legislation would reauthorize funding through FY 2028 for the National Institutes of Health (NIH) Gabriella Miller Kids First Pediatric Research Program. It would also enhance the coordination of federal pediatric cancer research efforts and require HHS to report on federally funded pediatric cancer research programs and initiatives.

H.R. 4421, Preparing for All Hazards and Pathogens Reauthorization Act
This legislation would reauthorize federal programs supporting public health security and all-hazards response, the Biomedical Advanced Research and Development Authority (BARDA), the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) and the Strategic National Stockpile (SNS). It would also contain provisions aimed at streamlining emergency response authorities and medical countermeasure research and enhancing transparency across federal agencies.

H.R. 4420, Preparedness and Response Reauthorization Act
This legislation would reauthorize CDC programs that support the distribution of medical countermeasures and the control of biological agents and mosquito-borne diseases. It would also strengthen epidemiological monitoring.

H.R. 4529, Public Health Guidance Transparency and Accountability Act of 2023
This legislation would require the CDC to implement public participation requirements prior to finalizing and implementing guidance. It would also clarify that CDC guidance is nonbinding.

H.R. 4381, Public Health Emergency Congressional Review Act
This legislation would establish a congressional review process for a public health emergency (PHE) and would allow Congress to consider and vote on terminating a PHE six months after it was declared.

H.R. 3813, CDC Leadership Accountability Act of 2023
This legislation would require any director of the CDC appointed by the president on or after June 1, 2023, to be confirmed by the Senate.

H.R. 3836, Medicaid Primary Care Improvement Act
This legislation would clarify that current Medicaid law does not prohibit state Medicaid programs from using direct primary care to provide services to Medicaid beneficiaries. It would also require the Centers for Medicare and Medicaid Services (CMS) to report to Congress on existing Medicaid primary care contracting arrangements.

H.R. 4531, Support for Patients and Communities Reauthorization Act
This legislation would reauthorize portions of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act. It would reauthorize public health programs related to substance use disorder prevention, treatment and recovery and the permanent extension of Medicaid's required coverage of medication-assisted treatments.

H.R. 4056, Ensuring Medicaid Continuity for Foster Care Act
This legislation would lift Medicaid's institutions for mental diseases (IMD) exclusion pertaining to qualified residential treatment programs (QRTPs) for foster youth. It would limit the lifting of the IMD Exclusion to QRTPs that are in compliance with existing QRTP guardrails outlined in the Family First Prevention Services Act of 2018.

H.R. 3887, Children's Hospital GME Support Reauthorization Act
This legislation would reauthorize payments to children's hospitals that have Graduate Medical Education programs for FYs 2024 to 2028. It would also prohibit payments to children's hospitals that furnish specified procedures or drugs for minors.

For more information, click here.

House Education and Workforce Committee Marks Up Four Healthcare Bills

On July 11, the House Education and Workforce Committee marked up and voted out of committee four healthcare bills. The bills that were considered include:

H.R. 4509, Transparency in Billing Act
This legislation would prohibit group health plans from paying a hospital for providing services at an off-campus location unless they provide a separate health identifier. It would also authorize the Department of Health and Human Services (HHS) to charge hospitals for noncompliance. Hospitals with more than 30 beds would be charged up to $5500 per day and hospitals with less than 30 beds would be charged up to $300 per day.

H.R. 4507, Transparency in Coverage Act
This legislation would codify the October 2020 Centers for Medicare and Medicaid Services (CMS) Transparency in Coverage Final Rule, which would require health plans to publicly disclose price and cost-sharing information to consumers. In addition, it would require pharmacy benefit managers (PBMs) to disclose spending and compensation data to their plan administrator.

H.R. 4527, Health DATA Act
This legislation would allow health plan fiduciaries to access and review de-identified cost and quality information of their plan.

H.R. 4508, Hidden Fee Disclosure Act
This legislation would strengthen requirements for pharmacy benefit managers (PBMs) and third-party administrators and require them to disclose fees and compensation data to plan sponsors.

For more information, click here.

House Energy and Commerce Committee Chairman Announces Plans to Circulate Drug Shortage Discussion Draft

On July 12, House Energy and Commerce Chairman Cathy McMorris Rodgers (R-WA) announced that the committee will circulate a drug shortage discussion draft following the completion of a recent request for information (RFI) that the chairman led alongside Senate Finance Committee Ranking Member Mike Crapo (R-ID).

For more information, click here.

Senate

Senate Majority Leader Outlines Work Priorities in Dear Colleague Letter

On July 9, Senate Majority Leader Chuck Schumer (D-NY) sent out a Dear Colleague letter outlining his plan for the July congressional work period. The leader is urging his colleagues to work on a bipartisan basis and advance legislation relating to an array of policy areas, among them health bills that seek to address the ongoing fentanyl crisis and the cost of insulin and prescription drugs. The leader is also encouraging the Senate to build upon his previously released artificial intelligence (AI) framework and to continue confirming judicial nominees.

For more information, click here.

Senate Continues Work on Appropriations Bills

The Senate Appropriations Committee is continuing its work on appropriations for fiscal year 2024, including commerce, science, financial services, the legislative branch and general government. Before going on recess, the Senate Appropriations Committee passed two bills: the FY 2024 Agriculture-FDA and the Military Construction and Veterans Affairs funding bills. Senate appropriators are setting funding levels close to spending caps that were agreed to in the debt-ceiling agreement. This is in contrast to House appropriators who are setting funding levels below those agreed upon.

Senate HELP Committee Ranking Member Unveils Legislation

On July 13, Senate Health, Education, Labor and Pensions (HELP) Committee Ranking Member Bill Cassidy (R-LA) introduced the Community Health Care Reauthorization Act. The bill would increase funding for the Community Health Center Fund (CHCF) to $4.2 billion and increase funding for the National Health Service Corps to $350 million over the next two years. It would also increase funding for the Teaching Health Center Graduate Medical Education (THCGME) program to $275 million over the next six years.

In addition, the ranking member noted that his decision to introduce the bill came after negotiations regarding the reauthorization of community health center funding between his office and committee Chairman Bernie Sanders (I-VT) stalled. The chairman and ranking member are in disagreement over the total amount of funding that should be allocated.

For more information, click here.

Senate Finance Committee Continues Work on PBMs

On July 12, the Senate Finance Committee unveiled a draft bill that would increase pharmacy benefit manager (PBM) disclosure requirements. The committee has been developing legislation since April, when committee Chairman Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) released a bipartisan framework outlining legislative solutions.

In addition, the chair and ranking member announced that they will mark up PBM and federal prescription drug program proposals on July 26.

For more information on the draft PBM bill, click here.

For more information on the upcoming markup, click here.