House Energy and Commerce Committee Advances Language for COVID-19 Rescue/ Reconciliation Bill

On Feb. 9, the House Energy and Commerce (E&C) committee released its draft language for its section of the COVID rescue/ reconciliation bill. It began marking up the bill on last Thursday, and it continued last Friday. At this time, we are not aware of any major amendments that have been approved. For example, a Republican amendment to add $35 billion to the existing $178 billion in the Provider Relief Fund failed on a party-line vote after Chairman Frank Pallone (D-NJ) said he didn’t want to take any money away from other elements of the COVID-19 relief package.

As previously reported, the E&C language includes $7.6 billion for CHCs, as well as $800 million for the NHSC. There is also a significant funding boost for Teaching Health Centers, an incentive for the 12 remaining states to expand Medicaid, and a provision that could expand CHCs’ 340B savings on Medicaid drugs. See an overview of these provisions below:

Funding for CHCS: $7.6 for CHCs 

  • Look-alikes ARE eligible
  • Funds can be used for expenses incurred starting January 31, 2020 (last year)
  • Allowable uses of funds are broad, and include:
    • standard COVID activities (e.g., testing, tracing, vaccinating, educating),
    • equipment and supplies, including to purchase and maintain mobile vehicles for COVID care
    • workforce – both to address COVID needs and “to carry out other health workforce-related activities”
    • “to modify, enhance, and expand health care services and infrastructure”

Workforce Funding

  • $800 million for National Health Service Corps
    • Of this $100 million goes directly to State Loan Repayment programs
  • $200 million for Nurse Corps
  • $330 million for Teaching Health Centers
    • Funds will remain available through Sept. 30, 2023
    • Will fund both existing THC programs and the development of new programs.
    • Increases the per-resident amount by $10,000
  • $7.66 billion for “public health workforce.”
    • Can be used for awards to state and local health departments, to fund a variety of public health positions (e.g., community health workers, contact tracers, lab personnel) and related costs (e.g., PPE, administration.) 
    • Health departments can use their funds to pay for public health workers employed by CHCs and other “nonprofit private or public organization(s) with demonstrated expertise in implementing public health programs and established relationships with… public health departments, particularly in medically underserved areas.” 
    • The language leaves open the possibility that awards can be made directly to organizations other than state and local health departments (e.g., CHCs), but gives no specifics. 

340B

  • Removes the “cap” on the size of the of rebate that drug makers must pay Medicaid for drugs whose price has risen significantly faster than inflation. Currently, the maximum rebate is 100% of the drug’s cost; for drugs subject to the 100% rebate, manufacturers may charge no more than (or one penny.) The E&C language proposes to lift the 100% cap, so that manufacturers could have to pay Medicaid if a drug’s price rises so fast that the rebate formula exceeds 100%. Since 340B discounts are equal in dollar value to Medicaid rebates, this provision would require drug makers to pay CHCs for these drugs also, if they are purchased under 340B.

Medicaid

  • Incentivizes states to expand Medicaid by offering a 5% increase in the FMAP for all enrollees for two years for states that implement the ACA expansion after this bill is passed. 
  • 100% FMAP for vaccine administration
  • Makes COVID vaccines a mandatory Medicaid services
  • Other coverage and financing expansions, including: extending post-partum coverage, increasing FMAP for crisis intervention, temporarily hiking FMAP for home-and-community-based services, and extending 100% FMAP into Urban Indian Health Organizations and Native Hawaiian Health Care Systems.
  • A five-year extension of the policy granting Medicaid coverage to women for 12 months after they give birth, as well as to prisoners starting 30 days before their release.
  • Increased funding for Medicaid programs to support mobile crisis intervention care for people with mental illnesses or substance use disorders.

Other Provisions of Interest

  • $340 billion for state, local, and tribal governments to address the COVID crisis
  • $46 billion for testing, contact tracing, and mitigation
  • $7.5 billion to CDC for general COVID activities
  • $6 billion for Indian health
  • $5.7 billion for vaccine and therapeutics supply chain (e.g., development, review, production, purchase)
  • $1.75 billion for block grants for community mental health services
  • $1.75 billion for block grants for prevention and treatment of substance use disorder
  • $1 billion for vaccine confidence activities
  • $50 million increase for Title X (a 17.5% increase.)

Colleen P. Meiman, Steve Carey

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