DCMedical News: Monday, April 23, 2018
DCMedical News
Washington, D.C.
Monday, April 23, 2018
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THE BIG STORY TODAY IN HEALTH CARE
Spending, continued: A Congressional Budget Office blog (here) summarizes the current situation: the annual federal spending deficit will be roughly double the level it has averaged during the past fifty years, as a percentage of GDP.
HOSPITALS AND HEALTH CARE FACILITIES
Medicaid and Drug Abuse Treatment: At its meeting April 19-20 MACPAC (the advisory group to Congress on Medicaid and CHIP) addressed access to substance use disorder (SUD) treatment in Medicaid. The result (here) proposes support for the continuum of care with clinical components as defined by the American Society of Addiction Medicine (see DCMN 4-18). States generally cover two-thirds of the clinical services recommended, with the biggest gaps in partial hospitalization (covered in 33 states) and residential SUD treatment (17 states regarded as comprehensive). Much is made of the “16 bed limit” for mental health treatment (in place since the passage of Medicaid in 1965), but while states can pay for residential treatment in smaller facilities, many choose not to.
“SUD waivers” which would enable states to pay for a broader continuum of care have been approved in 10 states (CA, UT, LA, IN, KY, WV, VA, MD, NJ, MA), are pending in 11 states (AK, WA, AZ, NM, KS, WI, IL, MI, NC, PA, VT), and not being pursued in the other 29 states and DC). In drug coverage, all states pay for buprenorphine, 49 pay for naltrexone, and while not required to pay for methadone, 38 do. Information is much less available and coverage less generous for “recovery supports,” peer, employment and other. Least well covered appears to be medication assisted treatment: less than 3% of SUD facilities offer all three forms of medication, few physicians (with wide geographic variation) are certified for buprenorphine, and almost three-quarters of those are certified to prescribe for only up to thirty individuals. Of the existing SUD facilities, sixty per cent on average accept Medicaid, although most of that is outpatient only. The range of facilities accepting Medicaid is from 29% in California (with its notoriously low Medi-Cal payment rates) to 91% in Vermont.
HEALTH INSURANCE, MEDICARE, MEDICAID
Medicaid’s most vulnerable patients: MACPAC expressed concern regarding a proposed rule (here) on exemptions to monitoring access to Medicaid in the fee-for-service (FFS) programs, that is, beneficiaries not enrolled in “managed Medicaid.” In a staff presentation (here), MACPAC notes that the populations remaining in FFS are “often the most vulnerable, such as individuals with disabilities.” These high expense and complex patients are less attractive to the “managed Medicaid” entrepreneurs.
The proposed rule would substantially eliminate monitoring for access to service in states with “high” managed Medicaid enrollment, an additional expense to those states. The presentation noted that the Supreme Court in Armstrong v. Exceptional Child Center eliminated a private right of action to enforce equal access (opinion, Scalia, here; analysis, Nicole Huberfeld in Health Affairs, here). Un-doing the monitoring would reverse a November 2015 rule from CMS which established new requirements for states to monitor and report on access to care in FFS Medicaid. The Obama-era CMS rule required submission of monitoring plans by October of 2016 and, where access issues were identified, a corrective action plan. The comment period on the proposed rule closes May 22.
Consumer Directed: research on out-of-pocket payments continues to show how “consumer directed” health plans (CDHPs) are merely “consumer-paid,” constraining choice rather than enlarging it. This study (here) from the American Journal of Managed Care shows CDHPs increasing from 4% of covered workers in 2006 to nearly 30% in 2016. The study measured financial burden on those enrolled in CDHPs, finding that it increased from 9.7% to 16% during the first year of such a plan, with the largest burden on patients with chronic conditions and lower incomes (an increase from 33% to 48% in the first year).
PHARMA
Drug prices and cancer: The cost of cancer drugs continues to draw comment (here, report by Chan in the Journal of Oncology Practice). The Wall Street Journal discussed the strategy behind one such drug, Merck’s Keytruda (here). A report is expected today on the combination of Keytruda and chemotherapy to treat advanced lung cancer. Then there is the business of “value based” payment for drugs, and a cautionary note (here) on outcome-based payment contracts. Oh, and the President is unveiling his plan Thursday to curtail drug prices, possibly based on ideas from the FY2019 budget message (here), while the House Democratic Steering and Policy Committee gets a jump (see Events & Meetings, April 25) the day before.
EVENTS & MEETING
April 24
2:00 p.m., CMS Long-Term Services and Supports Forum, call-in (800) 837-1935, Conf. ID: 32640817
April 25
8:00 a.m., Roll Call, “Health Care Decoded,” decoding by Roll Call staff, some Members of Congress and advocates.
April 26
10:00 a.m., Ways and Means Subcommittee on Health holds hearing on “Identifying Innovative
Practices and Technology in Health Care.”
The President unveils his drug price control strategy.
May 3
8:30 a.m., HRSA, Advisory Committee on Training in Primary Care Medicine and Dentistry, continuing
on May 4th; conference call-in number: (800) 857-9729, Passcode: 1318150.
Description and additional information in the Federal Register, here.
May 6
American Hospital Association Annual Membership Meeting (Washington, DC), through May 9.
May 8
Subcommittee on Oversight and Investigations (House E&C) will hear testimony from the chief executives of AmerisourceBergen, Cardinal and McKesson, concerning pill dumping in W. Virginia and other matters.
May 16
11:00 a.m., National Advisory Council on Nurse Education and Practice (Federal Register here).
June 19
AHIP Institute & Expo, San Diego, through June 22.
June 24
HFMA Annual Conference, Las Vegas, through June 28.
June 24
AcademyHealth, through June 26, Convention Center, Seattle, Washington.
FOR REFERENCE
Members of the Senate (here) and Members of Senate Committees (here), Senate Calendar (here).
Members of the House with their House Committees (here), House Calendar (here).
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
DCMedical News is published every day that either the House of Representatives or the Senate is in session.
Past issues can be accessed by clicking on “View this email in your browser.” Subscription information is found at the bottom of these pages. Trial subscriptions may end without notice.
Additional April publication dates: 24, 25, 26, 27.
May publication dates: 7, 8, 9, 10, 11, 14, 15, 16, 17, 18, 21, 22, 23, 24, 25.
June publication dates: 4, 5, 6, 7, 8, 11, 12, 13, 14, 15, 18, 19, 20, 21, 22, 25, 26, 27, 28, 29.
July publication dates: 9, 10, 11, 12, 13, 16, 17, 18, 19, 20, 23, 24, 25, 26, 27, 30, 31.
August publication dates: 1, 2, 3.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com