Repeal of sunset rule, workforce strategies and other updates

A framework of reconciliation is finally emerging. The Biden administration is proposing the repeal of a Trump-era regulatory review rule.


Publication of the framework Rebuilding Better Reconciliation with the Reduced Health Program

On Thursday morning, Democrats released a framework and backgrounder for President’s Build Back Better bill outlining $ 1.75 trillion in spending with up to $ 1.995 trillion in offsets. Draft legislation was posted to the Rules Committee later today. The framework represents a simplified program of the in-house version of the Build Back Better Act that was previously estimated to cost $ 3 trillion. The new proposal includes many signing efforts from the Biden administration, including $ 130 billion for an extension until 2025 of the expanded ACA tax credits that help make premiums more affordable for individuals and families. It also creates a free coverage option for low-income people in states without Medicaid extension. Home and community care services will benefit from an investment of around $ 150 billion, which is significantly lower than the $ 400 billion requested by President Biden this summer. This funding aims to remove Medicaid recipients from waiting lists for HCBS services by expanding and improving the home care workforce. Several targeted provisions, such as inclusion of conditions for continued Medicaid eligibility, a state option for extended postpartum coverage, significant investments in maternal health programs, and major investments in pandemic preparedness also remain in the printing of the Rules Committee.

For the addition of dental, hearing and vision benefits to Medicare, only hearing benefits were included. Also missing from the current version is a major drug price reform, although conversations are underway to try to revive a proposal that may gain unanimous support. Funding to establish the Advanced Health Research Projects Agency is not in the bill because it is unlikely to be able to comply with the Byrd rule in the Senate.

Refinements and amendments to the text are likely in the coming days as Democrats work out final details and a target date for a vote has yet to be announced. After the framework and the original text were released, Democratic House leaders had sought support from the progressive flank to vote and pass the bipartisan Senate physical infrastructure bill last night. However, the Democrats were unable to come to an agreement within their caucus and entered the weekend without a vote.


The Department of Health and Human Services (HHS) has proposed to repeal the SUNSET rule

The “Securing Updated and Necessary Statutory Evaluations Timely” or “SUNSET” rule, issued under the Trump administration would have required a mandatory agency review for almost all HHS regulations. If the agency determined that a given regulation was no longer relevant or necessary, or carried out a full review of a regulation, it would simply expire. The final rule provided for a five-year period for the HHS to review any regulations that were already more than 10 years old by the final effective date. Several stakeholder groups were extremely concerned about the administrative burden and volatility this would have introduced into the country’s health system. The Biden administration previously placed it on a regulatory freeze and is now proposing to repeal the regulation altogether. In the proposed repeal, the HHS expressed concerns about the strategic, operational and even potential legal challenges the rule would have created. Comments on the proposed repeal ends on December 28, 2021.

The Health Resources and Services Administration (HRSA) outlined strategies to address labor shortages

On Tuesday, HRSA released a strategic plan for healthcare workers, as required by the CARES law on coronavirus aid, relief and economic security. Recognizing health care staffing concerns, the plan’s four goals relate to appropriate resources for communities to meet localized needs and improve quality through data-driven strategies. The plan is part of a preview of how the HHS will use the $ 7.6 billion for public health personnel under the American Rescue Plan Act. The tactics outlined in the plan include targeted financial support and appropriate incentives to promote a better distribution of workers as well as data-driven forecasting to anticipate labor needs.


  • Listen here: this is the first in our two-part series examining the five key healthcare priorities on the President’s economic agenda. This week, Debbie Curtis, Amy Kelbick and Rodney Whitlock explore proposed changes in the areas of expanding the Affordable Care Act and filling the Medicaid gap.

Quick shots

  • The HHS has published an overdose prevention strategy based on prevention, harm reduction, treatment and long-term support for people with substance use disorders.

  • The United States Food and Drug Administration and the National Institutes of Health have formed a public-private partnership to spur innovation and the development of new gene therapies.

  • The Centers for Medicare and Medicaid Services (CMS) approved a New Jersey Medicaid demonstration amendment extending postpartum coverage.

  • The Texas Medical Association has filed a complaint with the United States District Court asking it to overturn the provisions of the recently released Interim Final Rule implementing the independent dispute resolution provisions of the No Surprises Act. The lawsuit, among other things, claims that the departments acted illegally in creating a rebuttable presumption that the bid closest to the eligible payment amount is the appropriate bid and ask the court to strike those provisions out.

Diagnosis next week

Congress will continue to work on reconciliation legislation. CMS is likely to begin publishing Medicare final payment rules for a number of healthcare facilities.

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