Holland & Knight Health Dose: November 22, 2022 – Healthcare

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legislative update

midterm election update

Democrats would retain control of the Senate in the 118th Congress, after key races in Arizona and Nevada were called in their favor. The Georgia runoff between incumbent Sen. Raphael Warnock (D) and challenger Herschel Walker (R) on Dec. 6, 2022, will determine whether Democrats have a 51- or 50-seat majority in the Senate next year (with Vice President Kamala Harris ) to cast the tie-breaking vote). After some pending House races were called last week, Republicans will take narrow control of the House.

congress leadership update

Congressional Republicans held their party’s leadership elections last week. Minority Leader Mitch McConnell (Ky.) fended off a challenge from Sen. Rick Scott (Fla.) to remain leader of the Republican Party in the Senate. Senate Republicans selected Sen. John Thune (SD) as Senate Minority Whip, Sen. John Barrasso (Wyo) as Senate Republican Conference Chairman, Sen. Joni Ernst (Iowa) to run the Senate Republican Policy Committee, Sen. Moore Capito (W. Va.) to serve as vice chairman of the Senate Republican Conference, and Sen. Steve Daines (Mont.) to replace Scott at the helm of the National Republican Senatorial Committee.

In the House of Representatives, incumbent Minority Leader Kevin McCarthy (Calif.) was elected the Republican nominee for Speaker of the House. McCarthy received only 188 votes—less than 218 during the formal House speaker vote in January. Many conservative members of the Freedom Caucus supported Rep. Andy Biggs (Ariz.), who received 31 votes. Rep. Steve Scalise (La.) was also reelected as the Republican Party’s No. 2 leader. Rep. Tom Emmer was elected whip of the House Republican Conference. Rep. Alice Stefanik (NY) was reelected as convention chair and Rep. Richard Hudson (NC) will serve as chairman of the National Republican Congressional Committee.

Senate Democrats will hold their leadership election the week of December 5, and the House Democratic leadership election is expected on November 30. The current House Speaker is Nancy Pelosi (Calif.), who has served as leader of the Democratic House for nearly two years. Decades and the only woman to serve as speaker, announced her exit from the Congress leadership last week. She will retain her seat in the House. Majority Leader Steny Hoyer (Mo.) announced he would be stepping down from his leadership role. Representative Jim Clyburn (SC), who serves as the Democrats’ No. 3 position in the leadership, is expected to continue as assistant leader. Rep. Hakeem Jefferies (NY) is widely considered the favorite to become the new Democratic leader. Rep. Katherine Clark (Mass.) is running to become Democratic whip, and Rep. Pete Aguilar (Calif.) is running for caucus chair.

In committee leadership news, Sen. Rand Paul (R-Ky.) said he will not seek the top Republican spot on the Senate Health, Education, Labor and Pensions (HELP) Committee, opting instead for the top Republican spot. Senate Homeland Security and Governmental Affairs Committee. Paul’s decision cleared the way for Sen. Bill Cassidy (R-La.) to be the ranking Republican on the HELP committee in the 118th Congress.

Sen. Patty Murray (D-Wash.) officially announced she would step down as chairman of the Appropriations Committee to seek the gavel on the Appropriations Committee following the retirement of Sen. Patrick Leahy (D-Vt.). As a result, Sen. Bernie Sanders (I-Vt.) would seek to chair the Aid Committee next year. Whereas, Sen. Susan Collins (R-Maine) is expected to replace retiring Sen. Richard Shelby (R-Ala.) as the top Republican on the appropriations panel.

Healthcare Professionals at the 118th Congress

  • Retiring health care professionals: Rep. Karen Bass, PA, MSW (D-Calif.) – Los Angeles Mayor-elect; Representative Eddie Bernice Johnson, RN (D-Texas) – Retd.; Representative Alan Lowenthal, PhD, psychologist (D-Calif.) – Retd.; Rep. Kurt Schrader, DVM (D-Ore.) – Lost in primary.
  • Health care professionals attending the 118th Congress: Rep.-Elect Jane Kigans, RN, AGNP (R-Va.) – Geriatric Nurse Practitioner; Rep.-elect Rich McCormick, MD (R-Ga.) – Emergency physician; and Rep.-elect Yadira Caravio, MD (D-Colo.) — pediatrician.
  • NOT CALLED YET: (Though Lean Republican): Kermit Jones, MD, JD, MPH (D-Calif.) – Family physician.

regulatory update

Bumpy billing implementation continues

House Ways and Means Committee Chairman Richard Neal (D-Mass.) and Ranking Member Kevin Brady (R-Texas) recently sent a letter to the Biden administration addressing the issue of the most recent rule implementing the No Surprises Act. has been raised. In the letter, they argue that the latest August rule “follows neither the letter nor the intent of the law” and raise specific concerns with the administration’s terminology around “double counting” certain criteria. Meanwhile, several insurer, consumer and employer groups filed amicus briefs supporting the administration’s interpretation of the rule in response to the Texas Medical Association’s lawsuit, which was also supported by the American Medical Association and the American Hospital Association.

In hopes of reducing the backlog due to the high volume of cases, the US Department of Health and Human Services (HHS) announced that it would increase the maximum allowable certified unit fee for 2023 from $700 ($938 for batched claims) to $500 will do it. (and $670) for 2022. The administrative fee will remain at $50. Independent Dispute Resolution (IDR) entities have until November 18 to notify HHS of any changes to their fees, which will be effective January 1, 2023. The Centers for Medicare and Medicaid Services (CMS) also added three new approved entities. Its approved list of certified IDR entities.

HHS Evaluating Medicare Advantage Reforms as Plans Face Scrutiny

US Department of Health and Human Services (HHS) Secretary Xavier Becerra made public comments last week saying the department is currently evaluating future policy changes to improve oversight of Medicare Advantage (MA) plans, which allegedly ” have come under scrutiny for “up-coding”. “Market consolidation has increased, and the use of prior authorization has increased. A recent American Medical Association survey found that increased consolidation hindered competition – 79 percent of metropolitan statistical areas, according to the survey had MA markets with low levels of competition in the U.S., and were ranked “highly concentrated” by federal standards. A recent American Hospital Association report found that prior authorization requirements caused delays in care, administrative burdens, and additional costs. Costs increased. The Improving Seniors Timely Access to Care Act aims to establish protections when prior authorization requirements are used by MA plans. The bill unanimously passed the House in September and is likely to be on the health care agenda later in the year. increasingly inclined to consider the rush. This follows as Senate Finance Committee Democrats sent a letter to HHS and CMS, saying the Centers for Medicare and Medicaid Take additional steps to enforce consumer protection in Services (CMS) MA.

Medicaid director calls for increased predictability/certainty for PHE wind down

In a recent letter to Congress, the National Association of Medicaid Directors said the US Department of Health and Human Services (HHS) lacks transparency about when the COVID-19 public health emergency (PHE) will end. The planning of state Medicaid programs was hampered. , which increases the risk of Medicaid beneficiaries unnecessarily losing coverage. The letter calls for 120 days of advance notice, double the 60 days the Joe Biden administration previously promised, as well as maintaining the current 6.2 percent federal Medicare aid percentage increase through the first quarter of the rescheduling. And increased certainty by gradually reducing growth. in a subsequent year, as well as a guarantee that the underlying Medicaid eligibility rules will not change during this time.

Senior HHS official anticipates value-based change after COVID-19

In recent comments, Secretary of the US Department of Health and Human Services (HHS) Javier Becerra and Director of the Center for Medicare and Medicaid Innovation (CMMI) Liz Fowler both acknowledged that the transition to value-based payment has been slowed by the COVID-19 pandemic. Was done and lawsuits. Still, both reiterated that it remains a priority and hoped that momentum would pick up. Fowler said the CMMI would consider mandatory demonstrations following a public health emergency (PHE).

Administration Improves Artificial Intelligence Strategy

The US Department of Health and Human Services (HHS) released a document outlining eight of the most common ways artificial intelligence (AI) is currently used, along with a detailed list of all uses. Uses include US Food and Drug Administration (FDA) counterfeit drug detection, fraud prevention, and responding to public assistance requests. The documents were released to increase transparency, encourage the use of AI by other federal agencies, and build on a recent White House blueprint for an AI Bill of Rights.

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