Washington Watch for July 2021

Carter L. Alleman, J.D.

White House Reaches Bipartisan Deal on Infrastructure
President Joe Biden announced last week that a bipartisan agreement had been reached on a pared-back infrastructure proposal. The bipartisan outline would total $973 billion over five years, or $1.2 trillion over eight years. In addition to investments in roads, highways, electric vehicles, and transit systems, the bill includes $65 billion for broadband and $47 billion to address climate change. While the full list of pay-fors has not been released, some spending will be offset by repurposing $125 billion in unspent coronavirus funding. The deal was struck by a bipartisan group led by Sens. Rob Portman (R-Ohio) and Kyrsten Sinema (D-Ariz.).

Latest Cures 2.0 Discussion Draft Unveiled
Representatives Diana DeGette (D-Colo.) and Fred Upton (R-Mich.) have released the latest version of their Cures 2.0 Act discussion draft, which aims to build upon 2015’s landmark 21st Century Cures Act. The bill would establish the Advanced Research Projects Agency for Health (ARPA-H), a medical research agency housed within the National Institutes of Health (NIH) responsible for accelerating new medical breakthroughs.

Lawmakers Look to Curb Vaccine Misinformation
Senators Bob Menendez (D-N.J.), Mark Warner (D-Va.), and Mazie Hirono (D-Hawaii) have sent a letter asking Facebook CEO Mark Zuckerberg for details about plans to remove COVID-19 vaccine misinformation from his social media platform. In related news, Senator Chris Murphy (D-Conn.) announced that he is working with the American Medical Association (AMA) to draft a bill to combat vaccine misinformation on social media. The legislation aims to use the U.S. Department of Health and Human Services (HHS) to track and evaluate medical misinformation online.

Democrats Call for CFPB Action on Medical Debt
Six Democratic senators have sent a letter to the Consumer Financial Protection Bureau (CFPB) urging the agency to place restrictions on medical debt collectors. The lawmakers outline a series of polices for consideration, including restrictions on the reporting of medical debt to credit agencies, a limit on how often debt collectors can call someone, requirements to inform debtors about financial assistance programs, and a ban on collecting from patients while they are appealing coverage denial, disputing charges, or seeking financial aid.

Statement on COVID Vaccine and Myocarditis
A statement co-signed by the U.S. Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), and organizations representing the nation’s doctors, nurses, and public health leaders was released last week following the Advisory Committee on Immunization Practices (ACIP) meeting to discuss the latest data on reports of mild cases of myocarditis and pericarditis following COVID-19 vaccination among younger people.

Supreme Court Rejects ACA Challenge
Supreme Court rejected the latest challenge to the Affordable Care Act (ACA) in a 7-2 ruling last week. The court held that the Republican- controlled states and two individuals who brought the lawsuit could not prove they were injured. Liberal Justice Stephen Breyer wrote the majority opinion, stating that the plaintiffs lacked legal standing to go to court. Justice Neil Gorsuch joined Justice Samuel Alito in the dissenting opinion, arguing that “no one can fail to be impressed by the lengths to which this court has been willing to go to defend the ACA against all threats.”

MedPAC June 2021 Report to Congress
The Medicare Payment Advisory Commission (MedPAC) released its June Report to Congress last week. The report also contains the commission’s summary of the impact of private equity investments on the Medicare program and an interim report on beneficiaries’ access to care in rural areas.

OSHA ETS Expected to Go into Effect
The Occupational Safety and Health Administration (OSHA) recently released a long-awaited emergency rule outlining workplace safety standards for the health care services and support industry for the duration of the coronavirus pandemic. The emergency temporary standard (ETS) details what health care employers must do to protect their workers from COVID-19. The rule requires social distancing protocols, proper patient screening, paid time off for vaccination, and encouraging employees to get the vaccine. To help employers assess whether the ETS is applicable to their worksites, OSHA has provided a flowchart, available here.

Surprise Billing Regulation Sent to OMB for Review
The first rule implementing the No Surprises Act, which prohibits the practice of surprise medical billing, is under review by the Office of Management and Budget (OMB) and due to be released on or before July 1. The regulation is expected to outline the methodology for determining the qualified payment amount (QPA) used to settle payment disputes between insurers and health care providers. It is also expected to contain guidance on informed consent. OMB is required to review the interim final rule -- “Requirements Related to Surprise Billing; Part 1” -- before it can be issued. Additional rules and regulations will be necessary to establish the law’s independent dispute resolution (IDR) process. The No Surprises Act takes effect on January 1, 2022.

AAMC Releases Latest Report on Physician Shortages
The Association of American Medical Colleges has released its annual report containing physician workforce shortage projections. The 2021 update of The Complexities of Physician Supply and Demand: Projections from 2019 to 2034 projects a shortfall of 37,800 to 124,000 physicians by 2034. That shortage includes shortfalls of 17,800 to 48,000 primary care physicians and 21,000 to 77,100 specialists. The report’s data was gathered before the COVID-19 pandemic, which AAMC states only exacerbated the challenges to the nation’s health care system.

Klobuchar, Grassley Push Implementation of Rural Emergency Hospital Designation
Senators Amy Klobuchar (D-Minn.) and Charles Grassley (R-Iowa) are urging the Centers for Medicare and Medicaid Services (CMS) to prioritize implementation of the new Rural Emergency Hospital designation to prevent more hospital closures. This provision, which was sponsored by Senator Grassley and included in the coronavirus stimulus package passed late last year, would provide increased funding to small rural hospitals that decide to close their in-patient operations and revamp as standalone emergency rooms that offer some outpatient services. Hospitals in rural areas with fewer than 50 beds can apply for the designation, which goes into effect in 2023. “