As 2024 unfolds, Congress faces a narrowing timeframe to enact significant health initiatives. The fiscal year’s spending bills offer a crucial opportunity for legislation. The process faces two key deadlines: the first when four annual appropriations bills expire on March 1, and the second when the remaining eight, including those for the U.S. Department of Health and Human Services (HHS), expire on March 8. This period is crucial, not only for these appropriations but also for overdue reauthorizations from 2023, such as the Pandemic and All-Hazards Preparedness Act and the SUPPORT Act.

Late 2023 saw Congress making significant strides towards a substantial bipartisan package, notably with the House passing the Lower Costs, More Transparency (LCMT) Act (H.R. 5378), aimed at enhancing price transparency and standardizing Medicare payments. Senate committees also advanced bipartisan health bills focusing on mental health, substance use disorder services, and prescription drug costs. The Biden administration, meanwhile, is striving to advance its priorities, including reducing health costs and addressing the behavioral health crisis, through regulatory avenues and is under pressure to implement its agenda swiftly, given the potential for congressional shifts.

Key Areas of Focus:

Medicare:
Medicare reforms are imminent in 2024, particularly regarding telehealth coverage and payment policies, and Alternative Payment Models (APM) incentive payments. Congress must act before 2025 to maintain telehealth flexibilities introduced during the pandemic. Calls for broader payment reform are intensifying due to two key issues: the impending end of bonuses for physicians involved in Alternative Payment Models (APM) and a 3.4 percent reduction in the Medicare Physician Fee Schedule (MPFS) conversion factor. There’s bipartisan support for extending reduced-rate payments through 2026 and for potentially revising the MPFS payment methodology. Increased accountability in Medicare Advantage, with a focus on consumer protection and financial incentives, is also on the agenda.

Prescription Drugs:
Efforts to curb high prescription drug prices continue, with a focus on increasing transparency and reforming pharmacy benefit management. Congressional scrutiny of pharmacy benefit managers (PBMs) and proposals for increased transparency and restrictions on spread pricing are notable. The administration’s implementation of the Inflation Reduction Act, including Medicare drug price negotiation, is a key part of this focus.

Behavioral Health:
Strengthening the behavioral health workforce, addressing the opioid epidemic, and improving mental health and substance use outcomes remain priorities. Legislative efforts include the reauthorization of the SUPPORT Act to enhance state and Tribal responses to the opioid crisis and policies to ensure timely access to behavioral health care for Medicare, Medicaid, and CHIP beneficiaries. The administration is also working on strengthening parity requirements for mental health and substance use disorder benefits and considering making telemedicine flexibilities for controlled medication prescriptions permanent.

Access to Care:
Bipartisan efforts to improve healthcare affordability continue, addressing price-transparency regulations and reconciling differences between legislative proposals. Oversight of the administration’s implementation of the No Surprises Act is ongoing, as are efforts to resolve payment dispute processes for out-of-network services. The administration is also focused on expanding access to comprehensive coverage and strengthening consumer protections, including policies related to short-term plans, association health plans, and eligibility expansions for coverage. Discussions are expected to begin regarding the expiration of enhanced Advanced Premium Tax Credits for marketplace coverage at the end of 2025.

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