HealthCare Roundtable e-News – September 26, 2022

 

Register Now for Roundtable Events

Registration for our 2022 Annual Conference

After two years of virtual meetings, the Roundtable’s highly-regarded annual conference returns to an in-person event in Old Town Alexandria, Virginia on November 9-11, 2022.

The conference provides members and guests a unique opportunity to hear presentations by high-level government officials and key experts – from Congress and the Administration, academics, benefit consultants, plan administrators, advocates and industry leaders in an intimate dialogue-oriented setting.  


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

CMS Releases Guidance for Implementation of ASP+8% Policy to Boost Utilization of Generics

The Centers for Medicare & Medicaid Services (CMS) released formal guidance for the implementation of the average sales price (ASP) plus 8 percent policy, a provision included in the Inflation Reduction Act (IRA). The guidance outlines new Medicare Part B payment reimbursement raises for certain biosimilar biological products. The policy incentivizes the use of safe and effective biosimilars through a two percent increase in Medicare payments for certain drugs. For existing qualifying biosimilars for which payment was made using ASP as of September 30, 2022, the applicable 5-year period begins on October 1, 2022. For new qualifying biosimilar biological products, the applicable 5-year period starts at the beginning of the calendar year that payment is first made using ASP.

 

Murray, Burr Reach Deal on FDA User Fee Agreement, Will Attach to Continuing Resolution

On Thursday, Sens. Richard Burr (R-NC) and Patty Murray (D-WA) announced a deal on a “practically clean” deal to reauthorize the Food and Drug Administration’s (FDA) user fee programs. According to Sen. Burr, the ranking member of the Senate Committee on Health, Education, Labor, and Pensions (HELP), lawmakers will add the reauthorization to the continuing resolution. The FDA user fee authorization is renewed every five years and is set to expire at the end of the month. According to a spokesperson for Sen. Mitch McConnell (R-KY), the Majority Leader wants to eliminate several policy riders contained in the negotiated agreement.

Administrative Action

  • The Centers for Disease Control and Prevention (CDC) released a brief presenting data from the Maternal Mortality Review Committees’ (MMRCs) review of maternal mortalities from 2017 to 2019. MMRCs are multidisciplinary committees that convene at the state or local level to comprehensively review deaths during or within a year of pregnancy. The brief found that over 80 percent of pregnancy-related deaths are preventable, with nearly a quarter stemming from mental health conditions, 14 percent from excessive bleeding, and 13 percent from cardiovascular issues. The data also revealed race- and ethnicity-based inequities, where cardiovascular issues were the main cause of pregnancy-related death for Black individuals and excessive bleeding for Asian individuals.

  • This week, the Biden-Harris Administration held a virtual event to discuss key areas of progress to improve outcomes for kids and families facing cancer as part of President Biden’s vision for the Cancer Moonshot. The event included updates on federal agency programs and initiatives in the areas of data sharing, drug development, research and innovation, and patient navigation. More information on the Cancer Moonshot can be found here.

  • The U.S. Preventive Services Task Force (USPSTF) announced a request for public comment on its draft recommendation statement and draft evidence review on screening for anxiety in adults. In the draft, USPSTF recommends screening for anxiety in adults aged 64 years or younger, including those who are pregnant and postpartum. USPSTF gave the recommendation a B grade, meaning there is high certainty that the net benefit for patients is moderate. The public comment period for review of the draft recommendation statement and evidence review is from September 20 – October 17, 2022.

Congressional Action

  • On Thursday, the Senate Finance Committee published a discussion draft and summary of workforce provisions to be included in the bipartisan mental health package. The bill calls for Medicare to update and expand coverage for certain services beginning in 2024. It also expands Medicare’s Health Professional Shortage Area bonus payments to psychiatrists and other mental health professionals, and funds 400 additional Medicare Graduate Medical Education slots for psychiatry residencies. The Centers for Medicare and Medicaid Services is also directed to provide states with strategic guidance.

  • The House Energy and Commerce (E&C) Committee and Ways and Means (W&M) Committee held markups on several health-related bills. Of particular importance to commercial health plans, the W&M Committee discussed Committee Print 117-4, Improved Information in Provider Directories, Plan Definitions, and Crisis Services for Private Insurance Plans. The W&M Committee also discussed Committee Print 117-5, Improved Information for Network Coverage and Plan Documents in Private Insurance Plans. The W&M Committee approved both of the proposals, stressing how each would improve consumer understanding of mental health benefits, consumer ability to compare health plans before purchasing, and third parties’ ability to identify gaps in plan benefits.

Medicare

  • A review of 62 studies by Kaiser Family Foundation researchers comparing Medicare Advantage (MA) and Traditional Medicare on beneficiary experience, affordability, service utilization, and quality found few significant trends or differences between the two programs. MA and Traditional Medicare performed similarly in measures of beneficiary experience like access to care, care coordination, and experience with prescription drugs, as well as utilization measures such as hospitalization and physician-administered drugs. Traditional Medicare slightly outperformed MA in beneficiaries experiencing affordability issues, though it was mainly due to Traditional Medicare beneficiaries with supplemental coverage. Medicare also outperformed on other select measures, including receiving high-rated care for cancer treatment and in skilled nursing facilities and home health agencies. MA outperformed Traditional Medicare in services including preventative treatment, having a usual source of care, and hospital readmissions.

  • The National Committee for Quality Assurance (NCQA) evaluates Medicare, Medicaid, and commercial plans each year on several patient experience and outcomes measures for consumers and businesses to use. The NCQA helps health plans evaluate progress across different treatment areas and patient satisfaction. Notably, health plans saw marked improvements in managing high blood pressure, but they have room to improve in preventive care measures like child immunization. In general, Medicaid and Medicare plans scored lower in patient satisfaction but were better than commercial insurers on care quality. 

Litigation

The American Hospital Association (AHA) and American Medical Association (AMA) moved to dismiss their challenge to the federal government’s September 2021 interim final rule (IFR) concerning the No Surprises Act. The IFR created an independent dispute resolution (IDR) process that required IDR entities to choose an offer closest to their median in-network rate or qualifying payment amount when resolving payment disputes. AMA and AHA argued in federal court that the interim rule overstepped Congressional intent. The Administration released a subsequent final rule in August, which AMA and AHA claimed made the lawsuit moot. In their official statement, AMA and AHA maintain that the final rule continues to favor insurers and does not live up to Congressional intent. They also hinted at future legal challenges. 

Marketplace

On Monday, the Urban Institute published a new report highlighting that the type of health coverage a patient has can drive disparities in their care. The report details how unfair treatment in healthcare settings is associated with unmet health needs and can result in poor health care quality and health inequities. The report also suggests that publicly insured and uninsured adults indicate that they experience unfair treatment at higher rates than those with private insurance due to their income, disability status, and race and ethnicity. The Urban Institute acknowledges that additional research is needed to assess the roles insurance-related hassles and differential access to care play in shaping people’s perceptions of unfair treatment due to insurance type. 

Research

  • The Kaiser Family Foundation (KFF) released an issue brief outlining five key findings on mental health and substance use issues by race/ethnicity. The analysis highlighted the disproportionate impacts of the COVID-19 pandemic among people of color and the ongoing inequities in access to mental health care and treatment. The study cites that culturally competent care, a diverse behavioral health workforce, and a reduction in structural barriers to care could help address barriers to mental health care access for people of color.

  • A study published this week showed that nearly 1 in 10 Americans experienced depression during 2020. This was driven by a significant increase in the number of adolescents and young adults with depression, rising to nearly 1 in 5 individuals between the ages of 12-25, but increases were also noted across all sexes, races, ethnicities, and education groups. Rates of depression have increased each year since 2015, but early evidence suggests that the COVID-19 public health emergency further worsened the trend. The researchers also noted that while more individuals were experiencing depression during that period, less than 6 percent of those sought medical care or received medication for their depression.