DCMedical News: Monday, June 11, 2018
DCMedical News
Washington, D.C.
Monday, June 11, 2018
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THE BIG STORY TODAY IN HEALTH CARE
Opioid legislation (see DCMN 6-8). Appropriations (first “mini-bus” FY 2019 appropriations bill passes in the House 235-179). Continued struggle over pieces of PPACA (see DoJ memorandum abjuring defense of PPACA here) and reports on FY 2019 insurance premiums below).
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Health Systems Jumping Into MA Plans: Lumeris reports (here) on a survey of 90 “major health system” executives that “27 percent of major U.S. health system executives participating in a recent survey intend to launch a Medicare Advantage plan in the next four years.” The survey also found that only 29 percent of those respondents planning to launch a Medicare Advantage plan felt confident in their organization's ability to do so successfully.
Housing and Health: Health Affairs has published four health policy briefs on housing and health, including a literature review (here), an essay on housing mobility and health outcomes (here), zoning and health (here) and the low income housing tax credit (here).
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
CBO Reports on C-SRs and Silver Loading: The Congressional Budget Office (CBO) has reported (here) on the “Budgetary Treatment of Cost-Sharing Reductions” (C-SRs). The import is this: “Insurers who participate in the marketplaces established under the Affordable Care Act (ACA) are required to offer cost-sharing reductions (CSRs) to eligible people. CSRs decrease deductibles and other out-of-pocket expenses like copayments. To qualify for CSRs, people must generally purchase a silver plan through a marketplace and have income between 100 percent and 250 percent of the federal poverty guidelines (also known as the federal poverty level).”
“Before October 12, 2017, the federal government reimbursed insurers for the costs of CSRs through direct payments. However, on that date, the Administration announced that, without an appropriation for that purpose, it would no longer make such payments to insurers. Because insurers are still required to offer CSRs and to bear their costs even without direct payments from the government, most have covered those costs by increasing premiums for silver plans [“silver loading”] offered through the marketplaces for the 2018 plan year, and CBO expects all insurers to do so beginning in 2019.” (Emphasis added.)
CBO reports that the means of payment for the “silver loaded” premiums (and therefore for the C-SRs) is that “Entitlement for subsidies for CSRs is being funded through higher premiums and larger tax credits based on those premiums instead of through direct payments.” In addition to this question—how CBO will treat C-SRs in budgeting—answers are found in the report here to questions raised May 25 in a letter resulting from a House Budget Committee hearing January 30 and follow-up letter from Rep. Mark Meadows on May 25.
As noted previously (DCMN 6-8) HHS Secretary Azar told the House Education and Workforce Committee that “silver loading” will continue to be allowed for 2019.
Kaiser Report on 2019 Premiums on the PPACA Exchanges: A new Kaiser Family Foundation report (here) tracks premium changes for lowest-cost bronze (least expensive) and second lowest-cost silver (“loaded,” that is, the benchmark for premium tax credits and the only plan that offers the C-SRs, almost two-thirds of the enrollees) premiums for 2019. Links within the report will take the reader to similar reports 2014-2018.
New York’s United Hospital Fund Reports on Association Health Plans: The report (here) has specific examples of potential problems with AHPs, a bibliography and this conclusion, “With the final AHP rule expected imminently, watchers will be on the lookout for big and small differences between the proposed and final rule, including whether working owners will be allowed to join AHPs and under what terms, potential grandfathering in of existing AHPs, the possible weakening of anti-discrimination standards, the timing of the rule’s implementation, and the question of employer-level or large group rating. But by far, the key element that has ACA supporters concerned is state preemption, and how tightly the final regulation will tie states’ hands.”
Maine Court Orders Implementation of Medicaid Expansion: (Superior Court decision here), Governor to appeal.
EVENTS & MEETINGS
June 12
HHS Secretary Azar testifies before Senate HELP Committee, the first public hearing on the Administration’s proposals to limit drug prices.
June 14
1:00 – 2:15 p.m., Alliance for Health Policy, Prescription Drug Costs: Can Increased Competition Restrain Prices?
June 20
AHIP Institute & Expo, San Diego, California.
June 24
Academy Health, Annual Research Meeting, Seattle, Washington.
June 29
Noon – 1:30 p.m., Alliance for Health Policy, Congressional Briefing on Health Care Costs in America.
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.
Special Report: Medicare Inpatient Prospective Payment System, Hospitals, Long Term Care Hospitals and Critical Access Hospitals, FY 2019, proposed rule. Publication date: May 7, 2018. Comment due date: June 25, 2018.
This is the ninth part of a multi-part series on the Hospital Inpatient Prospective Payment System (IPPS) FY 2019 proposed rule. Our series began with the edition of May 21; previous editions of DCMN may be accessed by clicking on “View this email in your browser.” This IPPS proposed rule is arguably the single most important federal rule-making for hospitals each year. The 480-page Federal Register document is here.
New Codes for New Technologies:
“Each year in the proposed rule, CMS addresses the applications for new technology add-on payments under the IPPS by presenting its evaluation and analysis of the applications. CMS does not make proposals in the rule, but rather describes any concerns it may have with regard to whether a particular technology meets the criteria for payment as a new technology and seeks additional information as needed for use in making a decision on the applications in the final rule. Included among the 15 applications for new technology add-on payment for FY 2019 presented in this year’s proposed rule are applications for Chimeric Antigen Receptor (CAR) T cell therapy.
Separately, for FY 2019, CMS is proposing to reassign CAR T-cell therapy to a higher-weighted MS-DRG, and is seeking comment on alternative MS-DRG assignment.”
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.
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June publication dates: 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: prn, Senate may be in session.
September publication dates: 4, 5, 6, 7, 12, 13, 14, 17, 18, 20, 21, 24, 25, 26, 27, 28.
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com