DCMedical News: Monday, June 18, 2018
DCMedical News
Washington, D.C.
Monday, June 18, 2018
DCMedical News is published every day either the House or the Senate is in session.
(All courtesy subscriptions will end on or before July 31. Subscription information below.)
THE BIG STORY TODAY IN HEALTH CARE
PPACA in the Courts: Key provisions of PPACA are in the courts. Medicaid as a social insurance program vs. Medicaid as welfare with a work requirement is one issue (see Medicaid, below). Second, a three judge panel of the U.S. Court of Appeals for the Federal Circuit (Moda case, decision here, news coverage here) upheld the government’s position that it need pay out in redistribution of funds for “risk corridor” payments only as much as it collected from insurers, leaving insurers with $12 billion in unreimbursed expense. A third major issue is the constitutionality of PPACA, in the absence of a tax (penalty for not having health insurance reduced to zero). A Department of Justice Memorandum arguing against PPACA’s continued constitutionality is here, news coverage here, one of many amici briefs—this one from the American Medical Association, arguing in favor of PPACA’s constitutionality--here.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Medicaid and Work Requirements: A decision is expected in June from a D.C. Federal Court concerning a suit brought by advocacy groups against the Secretary of HHS (Stewart v. Hargan/Azar, Complaint here, Washington Post coverage here), contesting the right of HHS to issue regulations or approve §1115 waivers which would require Medicaid beneficiaries to undertake work, community service or a combination of the two.
The public controversy began with a letter January 11 (here) from CMS to State Medicaid directors, inviting proposals to include work requirements as a condition of receipt of Medicaid benefits. The following day, January 12, CMS approved (letter here) an application to that effect from Kentucky. Mixed results from analogous efforts (such as those in the Temporary Assistance for Needy Families program) in the past had been noted by MACPAC (here), with more recent MACPAC commentary on work requirements here. MACPAC is the Congressional advisory body on Medicaid and CHIP.
Other commentary on the issue and on the suit can be found here, (“Medicaid Recipients Will Drown in Paperwork,” New York Times, January 18); here, (Kaiser Family Foundation guide to the Kentucky Medicaid Waiver, January 26); here (“Problems With Medicaid Work Requirements,” JAMA Forum, February 10).
Arkansas became the first state to actually implement work requirements (here, InsideHealthPolicy, June 1). Useful perspective is also found here (Sara Rosenbaum in a Commonwealth Fund report on “Medicaid and the Role of the Courts,” June 12) and here, (a Health Affairs article on Medicaid and social determinants of health, June 13).
MedPAC Makes June Report to Congress: The report may set off or reinvigorate contests between competing financial interests in the health field. The report is here, a summary here, the press release here. Today and this week DCMN will feature excerpts from the report, a consolidation of Medicare-driven health policy issues.
There are ten chapters in the MedPAC report, including “(1) the effects of the Hospital Readmissions Reduction Program; (2) using payment to ensure appropriate access to and use of hospital emergency department services; (3) rebalancing Medicare’s physician fee schedule toward ambulatory evaluation and management services; (4) paying for sequential stays in a unified prospective payment system for post-acute care; (5) encouraging Medicare beneficiaries to use higher quality post-acute care providers; (6) issues in Medicare’s medical device payment policies; (7) applying the Commission’s principles for measuring quality to population-based measures and hospital quality incentives; (8) recent performance of and long-term issues confronting Medicare accountable care organizations; (9) managed care plans for dual-eligible beneficiaries; and (10) Medicare coverage policy and use of low-value care.”
Medicare Star Ratings Wrong? So says Rush University Medical Center (here), echoing complaints from academic medical centers generally, and also complaints from the AHA and America’s Essential Hospitals. Safety performance is in question, with Rush contending that CMS did not evenly weight the eight measures in the safety-of-care measures group. Consumers may or may not consult the Star ratings, but health plans definitely use them in contract negotiations. Medicare has announced (here) that it will not issue July Star ratings, but has denied that the Rush allegations of error are responsible.
EVENTS & MEETINGS
June 19
9:30 a.m., Bipartisan Policy Center, “Counting the Costs: Introduction to CBO’s Updated Health Insurance
Model,” info at http://bipartisanpolicy.org/events/, CBO officials.
June 20
AHIP Institute & Expo, San Diego, California.
8:30 a.m.-5:00 p.m., COGME: Council on Graduate Medical Education, 5600 Fishers Lane, Rockville, Md., conf. call 800-619-2521 code 9271697, KCarter@hrsa.gov, Federal Register notice here.
June 21
8:30 a.m.-2:00 p.m., COGME continues.
June 24
Academy Health, Annual Research Meeting, Seattle, Washington.
June 27
10:00 a.m., Senate Health, Education, Labor and Pensions (HELP) Committee, hearing on "How to Reduce Health Care Costs: Understanding the Cost of Health Care in America," Ashish Jha, other academics, Niall Brennan of HCCI.
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 fourteenth 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.
CAR-T Therapy Chimeric Antigen Receptor (CAR) Therapy: CMS is seeking feedback on how best to pay for these new therapies. One means would be for a new technology add-on payment for KYMRIAH and YESCARTA, to have these T-cell immunotherapies assigned to MS-DRG 016, which would now be for “Autologous Bone Marrow Transplant with CC/MCC or T-cell Immunotherapy.” In the alternative, there could be a new MS-DRG, but, in any event, the addition must be budget neutral. CMS is seeking discussion on the impact of either method on the health care delivery system.
Price Transparency: While PPACA requires hospitals to publicly report standard charges, CMS expresses concern that patients are receiving insufficient information on out-of-network bills, and on their own financial responsibility. The requirement now would be for hospitals to make available list of standard charges on their websites, and in machine readable format, for ready comparison. The “prices” might be chargemaster, average contracted rate or some combination, based on what is most useful to patients. More education of patients, more CMS enforcement are proposed.
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.
Subscription information is found at the bottom of these pages. Trial subscriptions may end without notice.
June publication dates: 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