Latest Federal Healthcare Policy Changes: Opportunity or Stalemate?

Overview

• Key unresolved issues include reauthorizations of expiring programs and policies, and complex legislation addressing popular issues like reducing prescription drug costs.
• Pharmacy benefit managers’ transparency and reform are popular, but it’s unclear what the final package will look like and when it could be enacted.
• To continue, telehealth policies requiring attention are Medicare coverage of telehealth without originating site restrictions, the ability for high deductible health plans with health savings accounts to offer telehealth pre-deductible, and the ability for ERISA employers to offer telehealth as a standalone benefit.

As Congress delays resolution of fiscal year 2024 (FY24) federal spending legislation until early March, health care stakeholders continue to wait for resolution of key priority issues. This delay, on one hand, provides a six-week window for Congress to address some issues. However, the challenges that have hindered the completion of the FY24 appropriations bills remain. These challenges include top-line spending levels, foreign aid and border security funding, and divisions among House conservatives and Senate Republicans.

The range of unresolved health care matters is both extensive and diverse, spanning from simple reauthorizations or extensions of expiring policies to more complex legislation targeting popular issues such as reducing prescription drug costs. An aggressive push from physicians to reverse or at least mitigate cuts to their Medicare payments is also ongoing.

Reauthorizations & Extenders

This includes a variety of laws that have expired or will soon expire, requiring Congressional action. These have been addressed in earlier continuing resolution packages, but only short-term. This category includes:

• Several public health delivery and workforce programs including community health centers, the National Health Service Corps, and the Teaching Health Center Graduate Medical Education Program.
• Full reauthorization of the core bio-preparedness law, the Pandemic and All-Hazards Preparedness Act (PAHPA).
• Reauthorization of the SUPPORT Act addressing the ongoing substance-use disorder crisis.
• Delaying cuts to hospitals through planned reductions of Medicaid Disproportionate Share Hospitals (DSH) funding.
• Reauthorizing pediatric priority review vouchers to incentivize the development of rare-disease therapies.

Another rising concern is legislation addressing a reduction in Medicare payments to physicians effective in January. Additionally, more targeted legislative pieces to reauthorize specific programs or policies are also undergoing committee action.

The New or Emerging Issues

Several legislative committees have been working on reforming pharmacy benefit managers’ practices. The House passed the Lower Costs, More Transparency Act in December, requiring additional transparency into PBM practices. Senate committees have also passed various pieces of legislation on PBM transparency, though the final package and enactment timeline remain uncertain.

Telehealth

COVID-19 allowed providers to offer telehealth to patients. Three major policies that Congress must address to maintain this flexibility are:

1. Medicare coverage of telehealth without originating site restrictions
2. The ability for high deductible health plans with health savings accounts to offer telehealth pre-deductible
3. The ability for ERISA employers to offer telehealth as a standalone benefit

The first two policies have been extended by Congress through the end of 2024, and will need action this year to further extend or make them permanent. Congress could also reverse or make permanent the policy allowing ERISA employers to offer telehealth as a standalone benefit to certain workers. Furthermore, the remote prescribing of controlled substances rules needs addressing before the end of 2024. The DEA, given authority over this issue by Congress, held stakeholder listening sessions in September and is expected to release new proposed rules within this year.