HealthCare Roundtable e-News – May 13, 2024



Congressional Forum – June 5-6, 2024

Register NOW to attend the Roundtable’s 2024 Congressional Forum

The Phoenix Park Hotel, Washington, DC

Whether you actively advocate with the Administration or your Members of Congress or not, you should plan to participate in the Roundtable’s Congressional Forum. You’ll learn first hand from industry leaders, DC allies, and key friends in Congress about the issues which impact health care purchasers today.

The Forum will begin with a networking reception on Wednesday, June 5th and continue with a series of educational presentations on Thursday morning, June 6th. For those who are able, the Roundtable will provide information to support meetings on Capitol Hill as health plan representatives reach out to educate their Members of Congress on Roundtable priorities.

Register Here

We look forward to welcoming you to Washington!

The following are links to hotels that are convenient to our Welcome Reception at the Healthsperien Office and the Phoenix Park Hotel:

Top News

DOJ Launches Task Force Targeting Healthcare Monopolies and Collusion

The U.S. Department of Justice (DOJ) has introduced the Antitrust Division’s Task Force on Health Care Monopolies and Collusion (HCMC), aimed at shaping the division’s strategy and policies concerning healthcare. Led by Assistant Attorney General Jonathan Kanter, the task force, directed by Katrina Rouse, will focus on tackling monopolies and collusive practices that drive up costs and diminish quality in the healthcare industry. It will address various competition concerns, including payer-provider consolidation, labor issues, and the misuse of healthcare data, by bringing together a multidisciplinary team of experts. Rouse, a seasoned antitrust prosecutor, will lead the task force while concurrently serving as the division’s Deputy Director of Civil Enforcement and Special Counsel for Health Care. The division encourages input from the public, inviting practitioners, patients, and others to share their insights on competition concerns in healthcare through


HHS Releases Data on the Impact of the Inflation Reduction Act on Medicare Beneficiaries Access to Vaccines

The U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) recently published a report showing that more than 10 million people with Medicare Part D received a free vaccine in 2023 as a result of the implementation of the Inflation Reduction Act (IRA). In 2021, just 3.4 million people received vaccines under Part D, with annual out-of-pocket costs totaling to $234 million. At the beginning of 2023, the IRA eliminated cost-sharing for all adult vaccines that are covered under Part D, resulting in significantly lower out-of-pocket costs and a sharp increase in vaccine uptake. More specifically, the IRA’s elimination of cost-sharing showed that approximately 3.9 million Medicare enrollees received a shingles vaccine in 2023 compared to about 2.7 million in 2021, nearly 1.5 million Medicare enrollees received a Tdap vaccine in 2023 compared to about 700,000 enrollees in 2021, and 6.5 million Medicare Part D enrollees accessed an RSV vaccine free of charge in 2023.


House Committee on Ways & Means Advances Legislation on Medicare Telehealth Extension

The House Committee on Ways & Means held a markup on six bills to address pressing health care issues, particularly affecting rural communities. In his opening statement, Chairman Jason Smith (MO-08) highlighted the connection between health care access gaps and higher mortality rates in rural America. Legislation includes preserving telehealth and health-at-home access, preventing rural hospital closures, incentivizing ambulance services, and expanding the health care workforce in rural areas. Each bill addresses specific challenges such as telehealth access, ambulance coverage in mountainous areas, rural hospital financial stability, nursing workforce shortage, rural physician workforce, and reopening of closed rural hospitals. All six bills were approved by a vote of 41-0. Healthsperien covered the markup and will share full, comprehensive notes soon.

Administrative Action

  • The U.S. Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA), announced $46.8 million in funding opportunities to support behavioral health services. The funding opportunities aim to supplement initiatives in President Biden’s Unity Agenda, as taking on the mental health crisis and beating the opioid epidemic are key pillars within it. Some of the areas that the funds are being allocated to include promoting youth mental health, growing the behavioral health workforce, improving access to culturally competent behavioral care across the country, and strengthening peer recovery and recovery supports.


  • CMS recently released a resource that contains health equity-related data definitions, standards, and stratification practices. The resource is a technical guide that organizations and entities, including providers, states, community organizations, and others, can utilize to align with CMS when collecting, stratifying and/or analyzing data related to health equity. The document aims to clarify variations in outcomes that may occur due to the utilization of different data standards and definitions. It incorporates suggested definitions, standards, and stratification processes for a range of sociodemographic elements. CMS commented that standardized data collection and stratification allow for analyses that can be combined or compared across various programs or initiatives, thereby making progress towards enhancing population health. CMS noted it could update the resource in the future.

Regulatory Action

  • The U.S. Department of Health and Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS) recently announced the Increasing Organ Transplant Access (IOTA) Model (fact sheet/proposed rule) which aims to enhance kidney transplant access, care quality, and reduce disparities among end-stage renal disease (ESRD) patients. This initiative builds on the Biden-Harris Administration’s commitment to improving the kidney transplant system. The model focuses on accountability, performance incentives, and health equity plans for transplant hospitals. It complements existing efforts to modernize the organ transplant system and address racial and ethnic disparities. The proposed model aims to increase the number of transplants and improve patient outcomes. CMS has proposed the model be a 6-year mandatory model with a proposed start date of January 1, 2025. Model goals would include achieving a sufficient and representative national sample of participating kidney transplant hospitals that represent diverse geographic locations, familiarity with designing care focused on quality, provider performance, and the patient experience, and success with increasing transplants. Additional resources and support will be provided to ensure the success of participating hospitals. Comments on the proposed rule are due within 60 days of the publication of the rule.


  • The Administration for Community Living (ACL), announced a landmark final rule establishing the first federal regulations for Adult Protective Services (APS). These regulations aim to enhance the quality of APS and ensure consistency in service delivery across states, with the overarching goal of better addressing the needs of adults vulnerable to maltreatment and self-neglect. The final rule, a result of extensive stakeholder engagement, reflects detailed input received by ACL. Effective June 7 of the current year, regulated entities have until May 8, 2028, for full compliance. ACL pledges to collaborate with stakeholders to ensure effective implementation, offering substantial technical assistance and resources in the coming months.

Congressional Action

  • The Senate Finance Committee held a hearing on the United Health Group cyber-attack on its subsidiary, Change Healthcare. It commenced with Chairman Wyden (D-OR) highlighting the severity of the breach, emphasizing its potential to disrupt the nation’s healthcare system. He underscored the magnitude of United Health Group’s influence as a major player in the healthcare industry, with concerns raised about the vulnerability of patient data and the significant impact on providers. Ranking Member Crapo (R-ID) echoed these concerns, emphasizing the need for improved cybersecurity measures and federal response protocols. Andrew Witty, CEO of UnitedHealth Group, expressed regret for the breach’s impact and outlined the company’s response efforts, prioritizing patient data security and support for affected providers. During the discussion portion of the hearing, Senators probed into the specifics of the breach, UHG’s cybersecurity policies, and the company’s commitments to affected individuals and providers. Mr. Witty committed to implementing enhanced security measures, providing support to affected parties, and ensuring transparency in the aftermath of the breach. Healthsperien covered the hearing and detailed notes are provided here.


  • Representatives Brad Wenstrup (R-OH) and Earl Blumenauer (D-OR) introduced the bipartisan Hospital Inpatient Services Modernization Act. This proposed legislation includes a five-year extension of the Acute Hospital Care at Home (AHCaH or HaH) Program, allowing participating providers to continue delivering hospital-level care for Medicare Beneficiaries in the comfort of their homes. This legislation also comes as the House Ways and Means Committee is set to review the “Preserving Telehealth, Hospital, and Ambulance Access Act” introduced by Representative David Schweikert (R-AZ), which also seeks to extend the HaH waiver program by five years.


The U.S. Food and Drug Administration (FDA) issued a final rule to enhance the safety and effectiveness of laboratory developed tests (LDTs) used in healthcare decisions. LDTs are diagnostic products used within a single laboratory and are crucial in healthcare, analyzing specimens like blood or saliva to provide health information. The FDA issued a final rule clarifying that LDTs are devices under the Federal Food, Drug, and Cosmetic Act (FD&C Act) and plans to phase out its enforcement discretion approach for LDTs over four years. This aims to address risks associated with modern LDTs, such as inaccurate results. The FDA intends to exercise discretion for certain categories of LDTs to ensure continued access to necessary tests while promoting safety and effectiveness. Additionally, the FDA released draft guidance documents regarding enforcement discretion policies for unauthorized IVDs during public health emergencies. The first draft guidance offers considerations for permitting certain laboratories to use unauthorized IVDs during emergent situations, while the second draft guidance outlines factors for developing enforcement discretion policies for certain IVDs during declared public health emergencies.

Mark your calendar:

Roundtable’s Congressional Forum

June 5-6, 2024

Phoenix Park Hotel, Washington, DC

Register Here

Roundtable’s 20th Annual Conference

November 6-8, 2024

The Mayflower Hotel, Washington, DC

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