DCMedical News: Friday, May 18, 2018
DCMedical News
Washington, D.C.
Friday, May 18, 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
Congress roars, defends the purse: Energy & Commerce Committee leaders believe they triumphed in the case entitled United States House of Representatives vs. Alex M. Azar, II, et al, originally known as House v. Burwell. A settlement agreement was made which, according to these leaders, preserves a lower court ruling that the Obama administration funded those parts of the Patient Protection and Affordable Care Act calling for Cost-Sharing Reduction (CSR) reimbursement illegally (without an appropriation from Congress). The Energy & Commerce and Ways & Means Committees undertook the original investigation (found here) of the decision to fund the CSR payments, and then issued an addendum at the end of 2016 (here). The 150-page July 2016 report chronicles the various maneuvers of the Administration and Congress to attempt to fund (or thwart the funding of) CSRs, the legal analysis of justification, and the results. Through July, 2016 more than $7 billion had been spent on the CSRs. The follow up addendum report concluded, according to the House Committee leaders, that “high ranking officials in Treasury, HHS, and OMB discussed and deliberated using money appropriated for tax credits to fund the CSR program,” and that “numerous federal employees raised concerns about using the tax credit account to make the CSR payments.”
The one-page settlement reaffirms, in the minds of House leaders, their primacy with regard to a funding bill.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
Global burden of cardiovascular disease (CVD): Falls unevenly on the states, as shown here and here, with one resulting conclusion that “long-term decline in CVD may be ending and that new interventions delivered earlier in the life course may be required to alter this new trajectory.”
HOSPITALS AND HEALTH CARE FACILITIES
Special Report: Skilled Nursing Facilities FY 2019 rates. Proposed rule published: May 8, 2018, here. Comments due: June 26, 2018.
Overview: This is an update of the Prospective Payment System (PPS) for Skilled Nursing Facilities (SNFs) for FY 2019. There is a new case mix classification methodology, the “Patient-Driven Payment Model” (PDPM), replacing the Resource Utilization Group’s version, Version IV (RUG-IV). Also, there are proposed rules for the quality reporting program and the SNF value-based purchasing program, both of which impact the payment rate to SNFs.
Background: Discussion of the proposed revisions to the SNF PPS case mix classification methodology begins on page 21034, with focus on issues relating to the current case mix system, problems, and proposed solutions. This discussion continues, including the new PDPM clinical categories (pg. 21043), the proposed collapse of clinical categories for physical and occupational therapy classifications (pg. 21044), and various examples of proposed case mix classification groups. An illustration of hypothetical resident characteristics is found on pg. 21060.
The quality measures currently adopted for FY 2020 SNF QRP are found on pg. 21083, followed by a discussion of the value-based performance standards. A Request for Information on electronic health information exchange is found on pg. 21089. Proposed savings (from replacement of the RUG-IV and implementation of the PDPM) are found on pg. 21093.
Rates: Labor calculation (a key component) can be viewed on the wage index homepage, at http://www.cms.gov/medicare/Medicare-Fee-for-Service-Payment/SNFPPS/WageIndex.html. The urban and rural per diem rate is found on pgs. 21023. The historical rates are found on pgs. 21025-7. A computation example for the impact of the wage index can be found on pg. 21032. Estimated SNF VBP program impacts are found on pg. 21097.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
STLDI a $38 billion unintended federal bill over the next decade: The CMS Office of the Actuary issued a letter on April 6th (here) on the estimated potential effects of the short-term, limited-duration insurance policy rule. The rule (here) would amend the definition of a short term policy, such that the maximum life of a “short term” policy would increase from three months to one year. Nothing, says the actuary, would prevent underwriting of policies and issuing new policies to individuals at the end of the one-year period. Because the STLDI plans are not considered individual market insurance policies, they are exempt from the statutory requirements of the individual market under PPACA, including, for example, the Essential Health Benefit requirements or the actuarial valuation requirements. The STLDI plans are not eligible for federal subsidies and would in all likelihood be offered to individuals in good health, “at a substantially lower premium than available in the individual market.” “Because the STLD plans are expected to enroll healthier individuals, those remaining in the Marketplace would be relatively less healthy, causing the average Marketplace gross premiums to rise” by an estimated 6% by 2022. Gross premiums will rise, net premiums for subsidized enrollees will remain the same, and therefore the premium tax credit will increase by $38.7 billion over the decade 2019-2028.
PHARMA
Blueprint appears in the Federal Register: An extraordinary document (“HHS Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs,” here) appeared in the May 16th Federal Register, a reprint of HHS Secretary Azar’s program, but with an invitation for comments, to be submitted by July 16. The theme of the “blueprint” (see DCMN of 5-11) was increasing competition, supporting better negotiation for drug discounts to government funded programs, creating incentives for pharmaceutical companies to lower list prices, and reducing out-of-pocket spending for patients at the pharmacy. The paper contains an extensive essay on previous actions by the Trump administration, already taken to improve competition and “end the gaming of regulatory processes.” Got some ideas? Get ‘em in, by July 16th.
READING, PUBLICATIONS
Pharma background: Collection of briefs and policy options on current pharma topics, sponsored by Health Affairs, Commonwealth and Memorial Sloan Kettering, found here, 78 pages, policy discussions begin on page 49.
EVENTS & MEETING
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.
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: 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