Dose | Health Policy Week in Review; AHA Sues Over Surprise Bills; Sequester Delayed

Congress

Vaccine Mandate. In a rebuke of President Joe Biden’s vaccination mandate for private employers, the Senate passed a Congressional Review Act resolution 52-48 that would nullify the Occupational Safety and Health Administration’s rule. It is slower going on the House side. Although all 213 members of the House Republican Caucus have cosponsored the resolution, it needs five Democrats to crossover to assure passage. The president, however, has vowed veto.

It may not matter; the courts have halted implementation citing constitutional issues.

Sequester. The Senate approved a phase-out of the sequester, a moratorium for which was expected to expire in January. The new schedule is 1% to go into effect in March through the end of June, after which cuts would return to 2%. Most or all the publicly traded companies put a return of the sequester in their outlooks, so Congress delivered a little tail wind.

The bill delayed implementation to 2023 of an additional sequester needed to offset the costs associated with the American Rescue Plan Act.

Evaluation and Management Offsets. Also pushed off until 2023 are cuts to provider payments necessary to offset increases to the evaluation and management codes. Some providers faced cuts as steep as 8-10%.

PAMA. PAMA’s rate cuts will be delayed until 2023. Reporting for the next round of price setting would also be delayed until 2024.

Hearings Next Week.

The White House.

Surprise Billing. A group of health care’s biggest lobbies filed a lawsuit to stop implementation of the No Surprises Act. The lawsuit argues that the administration incorrectly directed arbitrators to primarily consider something called the Qualifying Payment Amount – which is, in effect, the median in-network rate – when deciding the winner of a payment dispute arbitration.

The implications of reliance on the median in-network rate are that certain physicians in a select group of practice areas like radiology, anesthesiology, etc., would be de-facto in network and be subject to imposed prices.

Pending Rules

Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Policy Issues and Level II of the Healthcare Common Procedure Coding System (HCPCS) (CMS-1738)

HHS Notice of Benefit and Payment Parameters for 2023 (CMS-9911)

Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals; the Long-Term Care Hospital Prospective Payment System; and FY 2022 Rates (CMS-1752)

Most Favored Nation (MFN) Model (CMS-5528)

Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (CMS-4192)

Advance Notice of Methodological Changes for Calendar Year (CY) 2023 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies

Other Stuff

 CPI. CPI is mostly a reflection of out-of-pocket costs for consumers and not a measure of health care inflation directly. One area we are watching and will discuss in the studio next week are drug prices. CPI has been ticking up at a rate not seen for several years. According to Pink Sheets, China has requested that drug manufacturers limit production in advance of the Olympics to limit pollution. If true, inflation in drugs could accelerate in the spring.

Upcoming Events.

Sequestration, More Sequestration and Medicare Reimbursement. – I am going to look at three names highly levered to Medicare reimbursement CHE, DVA and HCA to examine how they are going to be affected by Medicare reimbursement in 2023. Look for calendar invite tomorrow.

SPAC and S-1 Corner.

No time to update SPAC spreadsheet this week. Here is the one from last week. Be back on it on Friday.

Have a great weekend.

Emily Evans
Managing Director – Health Policy



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