Congress is Back from Recess – What’s Next?

Congress is returning from a two week recess, with the Senate reconvening today, and the House reconvening tomorrow.  Axios reported that Sen. Kyrsten Sinema (D-AZ) told donors that advancement of a Build Back Better (BBB) reconciliation package is unlikely given other policy priorities at the forefront of the Congressional agenda. Although it could be revisited as soon as this Spring, there is not a current plan to revive BBB. 

Policymakers are expected to focus their efforts on advancing a $10 billion supplemental COVID-19 funding bill, resolving the differences between the House and Senate China competition bills, and considering an insulin drug pricing bill in the Senate.

Earlier this month, Rep. Fred Upton (R-MI) announced his retirement from Congress.  The Congressman is the lead Republican sponsor of the Cures 2.0 Act, and his departure could give momentum to the legislation or its key components. The homecare industry is lobbying to change the EVV provision in the Act that would prohibit the use of global positioning systems (GPS) and biometrics within electronic visit verification (EVV) systems.

First Complete Sequence of a Human Genome

National Institutes of Health

The Human Genome Project, completed in 2003, covered about 92% of the total human genome sequence. The technologies to decipher the gaps that remained didn’t exist at the time. But scientists knew that the last 8% likely contained information important for fundamental biological processes.

Since then, researchers have developed better laboratory tools, computational methods, and strategic approaches. The final, complete human genome sequence was described in a set of six papers in the April 1, 2022, issue of Science. Companion papers were also published in several other journals.

The work was done by the Telomere to Telomere (T2T) consortium. T2T is led by researchers at NIH’s National Human Genome Research Institute (NHGRI), the University of California, Santa Cruz, and the University of Washington, Seattle. NHGRI was the primary funder.

“Short-read” technologies were originally used to sequence the human genome. These provide several hundred bases of DNA sequence at a time, which are then stitched together by computers. Such methods still leave some gaps in genome sequences. 

Over the past decade, two new DNA sequencing technologies emerged that can read longer sequences without compromising accuracy. The PacBio HiFi DNA sequencing method can read about 20,000 letters with nearly perfect accuracy. The Oxford Nanopore DNA sequencing method can read even more—up to 1 million DNA letters at a time—with modest accuracy. Both were used to generate the complete human genome sequence.

In total, the new project added nearly 200 million letters of the genetic code. This last 8% of the genome includes numerous genes as well as repetitive DNA sequences, which may influence how cells function. Most of the newly added sequences were in the centromeres, the dense middle sections of chromosomes, and near the repetitive ends of each chromosome.

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A Staffing Crisis is Causing a Months Long Wait for Medicaid, and it Could Get Worse

Korra Elliott has tried to avoid seeing a doctor while waiting to get on Medicaid. She worries she can't afford more bills without any insurance coverage. But in early March — five months, she said, after applying and with still no decision about her application — a suspected case of the flu sent her blood pressure soaring and landed her in the emergency room.

The 28-year-old mother of four from Salem, Mo., is among the tens of thousands of uninsured Missourians stuck waiting as the state slogs through a flood of applications for the state-federal health insurance program. Missouri expanded the program last year after a lengthy legal and political battle, and it now covers adults who earn up to 138% of the federal poverty level — about $18,800 annually for an individual

Missouri had nearly 72,000 pending Medicaid applications at the end of February and was averaging 119 days to process one, more than twice the maximum turnaround time of 45 days allowed by federal rules. Adding people to Medicaid is labor intensive, and the jobs require training and expertise. The program covers many populations — children, people with disabilities, seniors, adults who are pregnant or have children, and some without children. Different rules dictate who qualifies.

Missouri simply doesn't have the workers to keep up. Last fiscal year, 20% of its employees who handled Medicaid applications left their jobs, said Heather Dolce, a spokesperson for the Missouri Department of Social Services. And the average number of job applications received for each opening in the department's Family Support Division — which oversees enrollment — dropped from 47 in March of 2021 to 10 in February of 2022.

Just about every industry is struggling to find workers now, but staffing shortages in state Medicaid agencies around the country come at a challenging time. States will soon need to review the eligibility of tens of millions of people enrolled in the program nationwide — a Herculean effort that will kick off once President Joe Biden's administration lets the covid-19 public health emergency declaration expire. If Missouri's lengthy application backlogs are any indication, the nation is on course for a mass-scale disruption in people's benefits — even for those who still qualify for the insurance.

"If you don't have people actually processing the cases and answering the phone, it doesn't matter what policies you have in place," said Jennifer Wagner, director of Medicaid eligibility and enrollment for the Center on Budget and Policy Priorities, a left-leaning think tank in Washington, D.C.

Federal officials have said they will give states 60 days notice before ending the public health emergency, so it's unlikely to expire before summer. Once it does, enrollees won't be kicked off immediately: States can take up to 14 months to complete renewals, although budget pressures may push many to move faster. A bump in federal Medicaid funds to states, provided by Congress through covid relief legislation in 2020, will end shortly after the emergency's expiration.

Ultimately, workers are needed to answer questions, process information confirming that someone's Medicaid enrollment should be renewed, or see whether the person qualifies for a different health coverage program — all before the benefits lapse and they become uninsured.

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Hospice Visits in the Last Days of Life

In February 2022, the National Quality Forum (NQF) endorsed the claims-based measure, Hospice Visits in the Last Days of Life, or HVLDL as NQF #3645. NQF is a not-for-profit, nonpartisan, membership-based organization that facilitates an evidence- and consensus-based approach to endorsing quality measures. HVLDL reflects the proportion of hospice patients who received in-person visits from a registered nurse or a medical social worker on at least 2 of the final 3 days of life. HVLDL is the re-specified measure replacing the HIS-based Hospice Visits When Death is Imminent (HVWDII). Public reporting for HVLDL will begin in May 2022 and will replace public reporting of HVWDII.

More information, including a link to the NQF website, can be found on the HQRP Quality Measure Development webpage.