On The Hill

Following civil unrest this week, House Speaker Nancy Pelosi (D-CA) has indicated she may bring back the chamber to begin formal impeachment proceedings. Senate Minority Leader Chuck Schumer (D-NY) has also called for President Trump to be impeached.

“If the President does not leave office imminently and willingly, the Congress will proceed with our action,” Pelosi said in a statement released Friday (Jan. 8).

Congress is not currently scheduled to return until inauguration on Jan. 20.

While impeachment and removal are possible, there are only 12 days left until inauguration (as of Friday, Jan. 8), Congress will be hard-pressed to move through proceedings on time.

Additionally, Democratic lawmakers and one House Republican called on Vice President Pence to invoke the 25th Amendment and remove President Trump from office. Despite this, the vice president has reportedly rejected these calls.

On Tuesday (Jan. 5), Reverend Raphael Warnock and Jon Ossoff defeated Republican incumbents Kelly Loeffler (R-GA) and David Perdue (R-GA) in the Georgia run-off election. Senators-elect Warnock and Ossoff will be sworn in later this month, leaving the Senate with a 50-50 party split for the first time since 2001. Vice President-elect Kamala Harris will have tie-breaking ability and Democrats will take the majority.

Senate leaders will need to reach an agreement on a powersharing arrangement. The Congressional Research Service has outlined the 2001-2003 powersharing agreement. Click here to view the report.

With Democrats in the majority, Sen. Ron Wyden (D-OR) will lead the Senate Finance Committee and Sen. Patty Murray (D-WA) will likely lead the Senate Health, Education, Labor and Pensions Committee.

While the push to eliminate the filibuster will be renewed, it is unlikely Democrats will have the votes to do so. However, Democrats may be able to use budget reconciliation to pass legislation in the Senate via simple majority. In 2017, Republicans passed the Tax Cuts and Jobs Act (TCJA) through this process.^[1]

This week, President-elect Joe Biden announced the following nominees and appointees:

Gina Raimondo, Secretary of Commerce

Marty Walsh, Secretary of Labor

Merrick Garland, Attorney General

Don Graves, Deputy Secretary of Commerce

Isabel Guzman, Small Business Administrator

To view a full list of nominees, appointees, and White House staff, click here.

On Friday (Jan. 8) the Small Business Administration (SBA) and Department of Treasury announced the PPP will reopen next week for certain existing PPP borrowers and new borrowers. Community financial institutions will be the only entity allowed access to the funds on Monday (Jan. 11) and Wednesday (Jan. 13). All other lenders will have access to PPP loans shortly after community financial institutions. The guidance also includes updates on what expenses the loans can cover, eligibility, and flexibility for seasonal workers.

To view new guidance on PPP loans, click here.

On Thursday (Jan. 7), CMS Administrator Seema Verma announced she has formally withdrawn the proposed Medicaid Fiscal Accountability Rule (MFAR) from the Federal Register.

“While we support its intent, further work is needed to ensure accountability for states while protecting critical safety-net care for vulnerable patients,” Verma said in a tweet on the announcement.

“While the proposed rule will be withdrawn, I thank Congress for recently enacting new payment transparency requirements which help accomplish our goals,” Verma continued.

On Wednesday (Jan. 6), Health and Human Services (HHS) Secretary Alex Azer, Dr. Moncef Slaoui, and General Gustave Perna held a briefing to provide updates on COVID-19 vaccine distribution. During the briefing, Azar highlighted Operation Warp Speed’s (OWS) plan to accelerate pharmacy involvement in vaccine administration by allowing pharmacies to administer vaccinations at drugstores earlier than originally anticipated.

“The plan had been to ramp up this partnership over time, because vaccine supply would not be sufficient to spread across all of the pharmacy partners right away,” Azar said during the briefing.

“But, to help give states as many options as possible for vaccine administration, we’re launching the program this week and states can choose particular partners to send vaccines to now,” the secretary continued.

The federal pharmacy partnership will eventually include over 40,000 locations and 19 major chains and associations. Pharmacies will be permitted to administer vaccinations first to members of specific populations, and eventually, to the general public.

To view Secretary Azar’s full remarks, click here.

As of Thursday (Jan. 7), around 5.9 million Americans had received a first dose of a COVID-19 vaccine. Approximately 21.4 million doses of COVID-19 vaccines have been distributed to states, territories, and federal agencies.

As part of the federal pharmacy partnership for LTCF distribution, over 600,000 LTCF residents and staff have received the initial dose of the COVID-19 as of Wednesday (Jan. 6). Approximately 3.7 million doses of COVID-19 vaccines have been distributed to LTCFs

To view the CDC COVID-19 vaccine tracker, click here.

As of Friday (Jan. 8), the U.S. has recorded 981,800 new cases, 4,164 new hospitalizations and 13,297 new deaths.

On Dec. 21, the House and Senate passed FY 2021 appropriations and COVID-19 stimulus. The President initially threatened to veto the legislation over the size of stimulus checks, however, under the threat of a government shutdown, he signed the bill into law on Dec. 27. The legislation included $69 billion for vaccines and testing, $20 billion to purchase vaccines and therapies, $8.75 billion for vaccine distribution, and $3 billion for the Strategic National Stockpile.

The spending/COVID-19 package also included a number of key healthcare provisions, including:

No Surprises Act: Following nearly two-years of lobbying and debate between provider groups and health plans, an agreement to end surprise billing was included in this year’s spending package. Surprise billing, also known as balance billing, results when a patient is treated by an out-of-network provider unexpectedly, often at an in-network facility.

The No Surprises Act aims to make this practice illegal by requiring health plans to hold patients harmless from surprise medical bills, leaving patients responsible only for their in-network cost-sharing amount. Instead, providers will work with health plans to ensure full payment of services, and can bring claims forward to the Independent Dispute Resolution (IDR). The IDR will be responsible for determining the amount owed to the provider based on costs of similar services provided elsewhere. Notably, air ambulance services are covered by the bill.

To view a section-by-section summary, click here.

Medicare/Medicaid Provisions: The year-end spending package extended expiring Medicare and Medicaid provisions related to quality management, low-income beneficiary assistance programs, and demonstration programs for three years, until December 31, 2023.

Additionally, the package includes a moratorium on payment under the Medicare physician fee schedule of the add on code for inherently complex evaluation and management (E/M) visits, prohibiting the Secretary of the Department of Health and Human Services (HHS) from making payments under the Physician Fee Schedule (PFS) for these services prior to January 1, 2024. The bill also provides an additional $3 billion to the FY 2021 PFS and delays the two percent sequester cuts, set to resume January 1, 2021, for an additional two months.

Graduate Medical Education (GME): The omnibus spending package supports expanded physician workforce development by providing for an additional 1,000 Medicare-funded GME residency positions. Additionally, the package provides greater flexibility for rural hospitals participating in the GME Rural Training Tracks (RTT) program.

^[1] Emma, Caitlin. “Georgia just delivered Democrats their most powerful weapon.” Politico Pro, 7 Jan. 2021.