HealthCare Roundtable e-News – October 3, 2022

 

Register Now for Roundtable Events

Registration for our 2022 Annual Conference

The Roundtable’s highly-regarded annual conference returns to an in-person event in Old Town Alexandria, Virginia on November 9-11, 2022. 

We have released an Updated Agenda including specific topics for the Roundtable Health Plan Workshop scheduled for Wednesday afternoon. This session is for health plan staff only. We expect to begin announcing specific speakers next week.


The Agenda – NEW Information!

We have released an Updated Agenda including specific topics for the Roundtable Health Plan Workshop scheduled for Wednesday afternoon. This session is for health plan staff only. We expect to begin announcing specific speakers next week.


A Virtual Option

Since we know many of our members have appreciated the opportunity to share our conference with plan leaders and staff, we will offer a virtual option to any member that registers at least one attendee for the in-person conference. Details will be provided to registered health plan members.


Lodging Information

The Alexandrian Old Town Alexandria

$229 Room Rate

Book by October 7, 2022

Top News

Congress Passes Continuing Resolution To Avert Government Shutdown

On Friday afternoon, the House passed a continuing resolution by a 230-201 vote to fund the federal government until December 16. The legislation also provides billions in assistance to Ukraine and disaster relief. The Senate approved HR 6833 72-25 on Thursday afternoon, and President Joe Biden is expected to sign the legislation later today, ahead of the midnight deadline to avoid a government shutdown. Included in the bill is a five-year reauthorization of the Food and Drug Administration’s (FDA) user fee program. The continuing resolution gives Congress two more months to agree on an omnibus spending bill for the rest of the 2023 fiscal year. Earlier this week, Sen. Joe Manchin (D-WV) dropped his proposal on energy permitting reform from the bill after facing opposition from both sides of the aisle.

 

Commonwealth Fund Publishes Brief on State of US Health Insurance

The Commonwealth Fund published a data brief on the state of health insurance in the United States. According to the brief, a record-low number of Americans lack health insurance, mostly due to policy changes to ensure people were covered during the COVID-19 pandemic. However, the number of uninsured or underinsured Americans will rise when many of these temporary measures end. According to the report, 43 percent of working-age adults were inadequately insured in 2022. Additionally, 29 percent of people with employer coverage and 44 percent of those with coverage through the individual market and marketplaces were underinsured. The report provides several policy recommendations to ensure Americans receive adequate coverage and remain protected from medical debt.

Administrative Action

  •  The Biden-Harris administration unveiled its national hunger and diet-related diseases strategy. President Biden underscored three principles to strengthen food security efforts to support his goal of ending hunger and increasing healthy eating and physical activity by 2030. The three principles are focused on (1) increasing healthy food access, (2) educating and providing Americans with healthy food options, and (3) boosting Americans’ physical activity. In addition, U.S. Secretary of Agriculture Tom Vilsack outlined the conference’s five pillars to address food insecurity and proposed a permanent expanded child tax credit, a pilot Medicaid program to cover healthy meals, and updated Supplemental Nutrition Assistance Program (SNAP) benefits.

  • The Government Accountability Office (GAO) released a report outlining recommendations needed to strengthen oversight and help providers educate patients on privacy and security risks in telehealth under Medicare. GAO made three recommendations for the Centers for Medicare and Medicaid Services (CMS) and one for the Office for Civil Rights (OCR).

  • The American Medical Association, American Hospital Association, the College of Healthcare Information Management Executives, and other prominent provider groups sent a letter to the U.S. Department of Health and Human Services (HHS) to postpone a regulation requiring them to share medical records. Beginning October 6, 2022, health care providers, health IT developers, and health information exchanges must share all electronic health information, with some exceptions for security and privacy. The organizations are asking for a delay to address technical challenges and enable clinicians, particularly small providers, to better prepare.

Congressional Action

Republican leaders sent a series of letters reminding Biden Administration agency leaders of the recent Supreme Court decision in West Virginia v. Environmental Protection Agency (EPA), which challenged EPA’s authority to base its policies not explicitly written in statute. The letters urge HHS and other agencies to specify “clear congressional authorization” on future rulemakings and policy measures. The letter to HHS Secretary Becerra cites two examples of policies the authors consider administrative overreach, including the Centers for Disease Control and Prevention’s (CDC) eviction moratorium and the Occupational Safety and Health Administration’s imposition of a vaccine or testing mandate.

Medicare

  • In preparation for the upcoming Medicare Open Enrollment period on October 15, CMS released information on 2023 premiums and deductibles for Medicare Advantage (MA) and Medicare Part D prescription drug plans. The projected average premium for 2023 MA plans is $18 per month, a decline of nearly 8 percent from the 2022 average premium of $19.52. The average basic monthly premium for Part D coverage is projected to be $31.50, compared to $32.08 in 2022. The announcement also provided information on the CMS Innovation Center’s MA Value-Based Insurance Design (VBID) model, which is now projected to be offered to 6 million people across 1,200 plans. The Hospice Benefit Component of VBID will also be offered by 119 MA plans in portions of 24 states and territories.

  • Last week, the American Medical Association (AMA) and more than 120 state medical associations and national specialty societies sent a letter urging Congress to institute Medicare payment reforms. The signatories highlighted their concerns with the financial instability of the Medicare physician payment system. They noted that the instability is being driven by a confluence of fiscal uncertainties physician practices face related to statutory payment cuts, the persistent lack of inflationary updates, significant administrative barriers, and the cumulative impact of the pandemic. The letter provided several recommendations to Congress on payment reform.

  • Earlier this month, CMS proposed (subscription required) establishing the Medicare Drug Rebate and Negotiations Group to enact the requirements of the Inflation Reduction Act. The proposed group includes 95 full-time employees among 6 divisions: Contract Support, Manufacturer Compliance and Oversight, Manufacturer Data and Inflation Rebate Operations, Data Assessment and Analytics, Rebate Agreements & Drug Price Negotiations, and Policy. While drug price negotiations cannot go into effect until 2026, CMS can begin collecting data on drug price growth relative to inflation on October 1st. CMS stated they plan to issue guidance to stakeholders on their framework for implementing the penalties and negotiations before regulatory rules are put into effect.

  • The Centers for Medicare & Medicaid Services (CMS) released the 2023 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2023 Medicare Part D income-related monthly adjustment amounts. The Medicare Part A inpatient hospital deductible will be $1,600 in 2023, an increase of $44 from $1,556 in 2022. In 2023, the standard monthly premium for Medicare Part B enrollees will be $164.90, a decrease of $5.20 from $170.10 in 2022. For Medicare Part D enrollees making less than or equal to $97,000 individually or $194,000 jointly will make no additional Part D monthly premiums. Beneficiaries making over this amount will be responsible for an additional monthly premium on a sliding scale. More information can be found here.

  • CMS announced it will begin publicly publishing data on the ownership of all Medicare-certified skilled nursing facilities, in alignment with the Biden Administration’s nursing home action plan. This new information will include organizational owners, whether they are a holding company or consulting firm, and indicators to track nursing homes with common ownership or managerial control. The data will be updated monthly through a public use CMS dataset, and will be integrated into the Medicare Care Compare beginning September 28th. This announcement follows the release of a Select Subcommittee on the Coronavirus Response press release and hearing on alleged neglect, care and safety violations in several for-profit nursing homes during the COVID-19 pandemic.

Medicaid

  • HHS through CMS-approved groundbreaking Medicaid section 1115 demonstration initiatives in Massachusetts and Oregon. Both demonstrations aim to test improvements in coverage, access, and quality with innovative approaches to ensure more eligible people retain their Medicaid coverage, including by approving Oregon’s demonstration to keep children enrolled in Medicaid up to age six — preventing gaps in coverage that can cause children to lose access to needed care in their formative early years. The initiatives also take steps to address unmet health-related social needs, such as by giving Massachusetts and Oregon new authority to test coverage for evidenced-based nutritional assistance and medically tailored meals, clinically-tailored housing supports, and other interventions for certain beneficiaries where there is a clinical need.

  • This week, the Medicaid and CHIP Payment and Access Commission (MACPAC) published their comment letter on the Energy & Commerce Committee Republicans’ RFI on Disability Policies. Their comments highlighted state and national trends in the delivery of long-term services and supports (LTSS) through home and community-based services (HCBS), such as the growing need for LTSS with limited state resources, leadership and capacity to keep pace, lack of affordable and accessible housing, direct service workforce shortages, and lack of public understanding of HCBS. MACPAC also recommends that the Centers for Medicare and Medicaid Services allow states the option of eliminating estate recovery, as research showed that individuals who receive Medicaid-funded LTSS generally have limited estates, and the recovery process may deter some individuals from enrolling in Medicaid and associated Medicare Savings Programs. 

Research

Modern Healthcare released an article (subscription required) highlighting a history of racial biases in clinician use of medical devices. The author found that the lack of diversity in medical device clinical trials has had many consequences, one of which is generating racial bias and inconsistencies when used. The article also noted how commonly used medical devices like pulse oximeters and thermometers have been found to be less effective in people of color or rely on antiquated race-based guidelines in treatment and diagnosis.