This week in Washington: House committees hold budget reconciliation markups for COVID-19.

Congress

House

• Ways & Means Finishes Markup of COVID-19 Relief Measures
• Education and Labor Finishes Markup of COVID-19 Relief Measures
• Energy and Commerce Finishes Markup of COVID-19 Relief Measures
• Adams, Booker, Underwood Release the Black Maternal Health Momnibus Act to Address America’s Maternal Health Crisis

Senate

• Grassley, Ernst Ask Biden Administration to Release Vaccine Allocation Statistics

Administration

• CMS Rolls Back Work Requirements
• CMS Reverses Procedures Requiring Existing Demos Continue for 9 Months before Being Rescinded
• 2021 Special Enrollment Period for Marketplace Coverage Starts on HealthCare.gov, Monday, Feb. 15

Proposed Rules

• CMS: Draft 2021 Call Letter Now on Public Comment Period

Courts

• DOJ Shifts Position in ACA Case
• SCOTUS Will Hear Oral Arguments for Section 1115 Waiver Case on March 29
• DOJ Requests Delay from District Court in Association Health Plans Case

Reports

• GAO: Electronic Health Records - VA Has Made Progress in Preparing for New System, But Subsequent Test Findings Will Need To Be Addressed
• GAO: Operation Warp Speed - Accelerated COVID-19 Vaccine Development Status and Efforts to Address Manufacturing Challenges

Congress

House

Ways & Means Finishes Markup of COVID-19 Relief Measures

On Feb. 11, the House Ways & Means Committee cleared its piece of the House’s $1.9 trillion COVID-19 package, which would increase Affordable Care Act (ACA) tax credits, provide maximum credits to anyone on unemployment in 2021, subsidize COBRA and offer tax relief to those who would otherwise have to return ACA subsidy overpayments. The bill was reported out of committee, 25-18, ahead of the Feb. 16, 2021, deadline.

Find more information and the full text here.

Education and Labor Finishes Markup of COVID-19 Relief Measures

On Feb. 8, the House Education and Labor committee cleared its piece of the House’s budget reconciliation, $1.9 trillion COVID-19 package. Among the committee’s additions is a provision that allows workers who are eligible for COBRA due to involuntary termination or reduction in hours to receive coverage under their employment-based health plan with a premium reduction of 85 percent. Premium assistance will be available to workers beginning the first month following the date of enactment and will remain available through Sept. 30, 2021.

The provision also permits for an extended election period to allow individuals who previously experienced a qualifying event to enroll in coverage. In addition, employers are required to provide clear and understandable written notices to workers and establishes an expedited review process for workers who are denied premium assistance. It also allows for a payroll tax credit to allow employers and plans to be reimbursed for the full amount of COBRA premiums not paid by workers.

Find more information and a section-by-section summary here.

Energy and Commerce Finishes Markup of COVID-19 Relief Measures

On Feb. 12, the House Energy and Commerce Committee cleared its piece of the House’s budget reconciliation package. The Energy and Commerce budget reconciliation package includes titles on public health Medicaid and the Children’s Health Insurance Program. The package includes provisions authorizing:

• $14 billion for vaccines;
• $46 billion for testing, contact tracing, and mitigation;
• $7.6 billion to hire 100,000 full time public health workers to support COVID-19 response;
• $25 billion to address health disparities and protect vulnerable populations;
• $4 billion for behavioral and mental health services;
• $5 billion to help families pay their energy and water bills; and
• $7.6 billion to expand internet connectivity for students and teachers without internet access.

No Republican amendments were accepted in the mark up. Find more information here.

Adams, Booker, Underwood Release the Black Maternal Health Momnibus Act to Address America’s Maternal Health Crisis

On Feb. 8, Reps. Alma Adams (D-NC) and Lauren Underwood (D-IL), Sen. Cory Booker (D-NJ) and members of the Black Maternal Health Caucus released the Black Maternal Health Momnibus Act of 2021. The legislation builds on existing maternal health legislation and the Black Maternal Health Momnibus of 2020 with 12 bills to address the drivers of the maternal health crisis. The legislation makes investments in addressing social determinants of health, funding community-based organizations, growing and diversifying the perinatal workforce and improving data collection processes. It also addresses the impacts of COVID-19 and climate change on maternal and infant health.

Find more information here.

Senate

Grassley, Ernst Ask Biden Administration to Release Vaccine Allocation Statistics

On Feb. 9, Sens. Chuck Grassley (R-IA) and Joni Ernst (R-IA) requested the Centers for Disease Control and Prevention (CDC) to publicly release its weekly formula for allocating vaccines to states and other jurisdictions. The purpose of the request is to ensure transparency in the vaccine distribution process. The request asks CDC to publish this information in a simple format for every week of allocated vaccines and each state’s weekly pro-rata share of vaccine allocations.

Find the letter here.

Administration

CMS Rolls Back Work Requirements

On Feb. 12, the Centers for Medicare and Medicaid Services (CMS) took initial steps to roll back states’ Medicaid work requirements that had been encouraged by the previous administration. CMS told states, it does not believe their programs’ work requirement and community engagement requirements promote Medicaid objectives. CMS is giving affected states 30 days to send information on why they disagree. In addition to Arkansas and New Hampshire, Utah, Arizona, Arkansas, Georgia, Indiana, Nebraska, New Hampshire, Ohio, South Carolina and Wisconsin received letters.

The agency also removed from its website the 2018 guidance that invited states to submit waivers to impose work requirements.

CMS Reverses Procedures Requiring Existing Demos Continue for 9 Months before Being Rescinded

On Feb. 12, CMS sent letters to various states reversing the Trump administration’s last minute insertion of additional procedures for withdrawing approvals of 1115 waivers that included a new requirement that existing demos continue for at least nine additional months before being rescinded.

CMS sent letters to a number of states, including: Alabama, Alaska, Arizona, Arkansas, California, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, New Jersey, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, Utah, Washington, West Virginia, Wisconsin and Wyoming, along with Washington, D.C.

Acting CMS Administrator Richter told states that the previous Administrator Verma’s letter didn’t consider CMS’ need for flexibility. The agency “needs to remain able to exercise its authority under the Act and implementing regulations to maintain continued oversight of demonstrations in order to ensure that they remain likely to achieve the statutory purposes.” CMS will not accept letters states signed agreeing to the procedures. Instead, CMS will follow the special terms and conditions that were part of state’s waiver approvals.

2021 Special Enrollment Period for Marketplace Coverage Starts on HealthCare.gov, Monday, Feb. 15

On Feb. 12, the Centers for Medicare and Medicaid Services (CMS) announced that the Special Enrollment Period (SEP) for the Health Insurance Marketplace will officially be available to consumers in the 36 states that use the HealthCare.gov platform on Monday, Feb. 15, 2021, and will continue through Saturday, May 15. At least 13 states plus the District of Columbia, which operate their own Marketplace platforms, have decided to offer a similar opportunity.

Find more information here.

Proposed Rules

CMS: Draft 2021 Call Letter Now on Public Comment Period

On Feb. 9, the Centers for Medicare and Medicaid Services (CMS) requested public comment on proposed refinements to the QRS and QHP Enrollee Survey included in the Draft 2021 Call Letter for the Quality Rating System and the Qualified Health Plan Enrollee Experience Survey.

Public comments should be submitted to Marketplace_Quality@cms.hhs.gov, by March 10, 2021.

Find more information here.

Courts

Find a comprehensive look at “The Courts and Healthcare Policy” here.

DOJ Shifts Position in ACA Case

On Feb. 10, the Department of Justice (DOJ) sent a letter to the Supreme Court reversing the position of former President Donald Trump’s administration that the entire Affordable Care Act (ACA) should be invalidated. The DOJ told the Court that it believes the ACA’s individual mandate, even though the penalty for not having insurance has been taken away, is still constitutional because individuals still have a choice of whether to heed the law or not.

SCOTUS Will Hear Oral Arguments for Section 1115 Waiver Case on March 29

On Feb. 10, the Supreme Court docket was updated to show the schedule for Cochran v. Gresham and Arkansas v. Gresham. The cases pertain to Section 1115 waivers and Medicaid work requirements. The Court will hear oral arguments on March 29, 2021.

Find more information here.

DOJ Requests Delay from District Court in Association Health Plans Case

On Feb. 8, 2021, the District Court for the District of Columbia agreed to the Department of Justice’s (DOJ) unopposed request to delay proceedings in order to give the Biden administration an opportunity to review the case. The parties are to update the court again on April 9, 2021, and every 60 days thereafter.

Reports

GAO: Electronic Health Records - VA Has Made Progress in Preparing for New System, But Subsequent Test Findings Will Need To Be Addressed

On Feb. 11, the Government Accountability Office (GAO) released a report on the Department of Veterans Affairs’s (VA) replacing its 30-year-old health records system. In May 2018, it contracted to acquire a commercial system for up to $10 billion over 10 years. According to the report, the VA has made progress implementing the new system. It deployed the new system in one location in October 2020 and has addressed many of the potential problems uncovered in testing. Additional testing will likely identify more issues. GAO recommended the VA postpone any more deployments until these issues are resolved.

Find GAO’s recommendations here, and full report here.

GAO: Operation Warp Speed - Accelerated COVID-19 Vaccine Development Status and Efforts to Address Manufacturing Challenges

On Feb. 11, the Government Accountability Office (GAO) released a report on Operation Warp Speed, the federal effort that supported multiple COVID-19 vaccine candidates to speed up development. GAO analyzed the program’s vaccine candidates and found that their development followed traditional practices, with some adaptations. For example, some clinical trial phases overlapped with each other and with animal studies to accelerate development. Two vaccines were authorized for emergency use and the GAO tracker shows all the candidates. GAO also found that agencies are working to help mitigate vaccine manufacturing challenges. For example, agencies have taken steps to require contractors to prioritize vaccine production supplies.

Find GAO’s the full report here.