DCMedical News: Wednesday, May 16, 2018
DCMedical News
Washington, D.C.
Wednesday, May 16, 2018
DCMedical News is published every day either the House or the Senate is in session. Want to subscribe? See below. Add our new domain (dcmedicalnews.org) to your white list. Welcome to our new “courtesy trial” recipients.
THE BIG STORY TODAY IN HEALTH CARE
Drugs prices, continued: Senate HELP Committee hearing on the 340B program featured criticism of the program from OIG (testimony here) and GAO. GAO’s health care director noted that there may be unintended but perverse consequences of 340B, namely more use of higher list price drugs, leading to higher rebates and more money left over to subsidize hospital operations.
CMS unveiled a drug price dashboard, at https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Information-on-Prescription-Drugs/index.html, CMS “Fact Sheet” on drug spending here. Meanwhile, STAT reports that Vermont has a bill awaiting its Governor’s signature (here) to authorize wholesalers to import drugs from Canada.
Spending, continued: Senate may stay in town to complete FY 2019 appropriations. Rescission proposal of $15 billion (expired programs, otherwise used as “pay-fors” to offset new spending increases) will produce only $1.26 billion in actual savings says the CBO, here, not the $3 billion claimed by OMB.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Veterans Choice: House VA Committee has favorably reported H.R. 5674, the “VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018.” The bill (here) would change how the VA purchases medical care and services for veterans from health care providers in the private sector. In addition, H.R. 5674 would directly appropriate $5.2 billion for the Veterans Choice Program which is, otherwise, out of money at the end of May.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
New state Medicaid requirements: Work requirements are okay, says CMS, for Arkansas, Indiana, Kentucky, New Hampshire and (new application) Ohio. However, lifetime Medicaid limits are not okay, for applicant Kansas, and also for Arizona, Maine, Utah and Wisconsin, all of which applied to be able to use life-time benefit limits for Medicaid.
HOSPITALS AND HEALTH CARE FACILITIES
Special Report: Inpatient Psychiatry FY 2019 rates. Proposed rule published: May 8, 2018, here. Comments due: June 26, 2018.
Overview: This proposed rule would update the prospective payment rates for Medicare inpatient hospital services provided by inpatient psychiatric facilities (IPFs), which include psychiatric hospitals and excluded psychiatric units of an acute care hospital or critical access hospital. The mission of these facilities is “Admit only patients whose admission to the unit is required for active treatment, of an intensity that can be provided appropriately only in an inpatient hospital setting, of a psychiatric principal diagnosis that is listed in the International Classification of Diseases, Tenth Revision, Clinical Modification.”
Background: Establishment of a prospective payment system for inpatient psychiatric facilities was first authorized in the Balance Budget Refinement Act of 1999. Adjustments for geography (labor rates), teaching, rural location and other factors are discussed in the text of the proposed rule. The quality reporting program is discussed at pg. 21115, with the “Meaningful Measures” additions beginning at pg. 21117. Some 1,636 facilities or units are affected, broken down by geography, ownership, size and teaching status on pg. 21132.
Rates: For FY 2019, adjust the 2012-based IPF market basket update (currently estimated to be 2.8 percent) by a reduction for economy-wide productivity (currently estimated to be 0.8 percentage point), and further reduce the 2012-based IPF market basket update by 0.75 percentage, resulting in a proposed estimated IPF payment rate update of 1.25 percent for FY 2019. The IPF PPS federal per diem base rate would increase from $771.35 to $782.01, but providers who failed to report quality data for FY 2019 payment would receive a FY 2019 federal per diem base rate of $766.56. Overall estimate: from rates, an increase of $50 million in expenditures, but from quality demerits a decrease of $68 million.
PHARMA
Opioid bills: Several move along in the House, with the Ways and Means Committee scheduled today (see EVENTS) to mark up four bills, to develop guidance for pain treatment and also for opioid use disorder for hospitals; one which would require Part D plans to establish “drug management programs for at risk beneficiaries”; one which would require MA and Part D plans to include educational materials on the risk of opioids; and one to expand opioid treatment programs paid for by Medicare.
EVENTS & MEETING
May 16
9:00 a.m., HHS Secretary Azar on "Fixing Health Care: Driving Value Through Smart Purchasing and Policy," AEI, 1789 Massachusetts Avenue NW, D.C.
11:00 a.m., National Advisory Council on Nurse Education and Practice (Federal Register notice here).
2:00 P.M., Ways and Means Committee markup of Opioid bills.
Through May 18, “2018 Medicare Advantage Summit,” Better Medicare Alliance, Hyatt Regency on Capitol Hill, Washington, DC, three days’ agendas here.
May 17
Through May 18, American Bar Association Antitrust in Healthcare, Arlington, VA, 202-662-1090, $995.
May 22
9:30 a.m., Washington Post, “America’s Health Future,” Verma, Murthy, Eyles (AHIP), contact molly.gannon@washpost.com.
May 23
9:30 a.m., Bipartisan Policy Center, “Using Medicare for to Improve Chronic Care,” 1225 I NW, DC.
May 24
8:30 – Noon, Health Care Costs in America, Alliance for Health Policy, Kaiser/Jordan Conference Center, 1330 G Street NW, Washington, DC.
May 30
9:30 a.m. – 5:00 p.m., HHS Pain Management Task Force (open to the public), inaugural meeting, Federal Register meeting notice and task force membership here.
June 19
AHIP (America’s Health Insurance Plans) Institute & Expo, San Diego, through June 22.
June 24
HFMA (Healthcare Financial Management Association) Annual Conference, Las Vegas, through June 28.
AcademyHealth, through June 26, Convention Center, Seattle, Washington.
July 25
7:30 a.m. – 4:30 p.m., Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), volume requirements for aortic valve replacements and percutaneous coronary interventions. Maria Ellis, MEDCAC, (410) 786-0309, maria.ellis@cms.hhs.gov. Federal Register notice here.
Aug. 20
Meeting of Medicare Advisory Panel on Hospital Outpatient Program (through August 21), APCs, OPPS, the works. Evaluation of Advanced Primary Care (APC) groups; packaging of Outpatient Prospective Payment System (OPPS). Information here (Fed Reg 5-3-2018), 7500 Security Boulevard, Baltimore, MD.
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.
May publication dates: 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.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com