DCMedical News: Monday, July 9, 2018
DCMedical News
Washington, D.C.
Monday, July 9, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE
Supreme Court: Televised announcement by the President of his nominee, 9:00 p.m.
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
CMS Aiding Small and Rural Practices with MIPS: (GAO report here), Aiding Doctors to Waive MIPS by Participating in MA at-Risk Plans (here).
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Rural Hospital Survival: Profile of Survival of Western New York rural hospitals here.
DSH Reductions: A notice in Friday’s Federal Register (here) has the final FY 2016 and the preliminary FY 2018 rules for distribution of DSH (“Disproportionate Share Hospital”) funds. There are no reductions for FY 2016 and FY 2018. Here is the history: “The Patient Protection and Affordable Care Act of 2010 (Pub. L. 111–148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111–152) (collectively, the Affordable Care Act), amended Medicaid DSH provisions, adding section 1923(f)(7) of the Act. Section 1923(f)(7) of the Act would have required reductions to states’ FY DSH allotments from FY 2014 through FY 2020, the calculation of which was described in the Disproportionate Share Hospital Payment Reduction final rule published in the September 18, 2013 Federal Register (78 FR 57293). Subsequent legislation, most recently by the Bipartisan Budget Act of 2018 (Pub. L. 115–123, enacted February 9, 2018), delayed the start of these reductions until FY 2020. A proposed rule delineating a revised methodology for the calculation of DSH allotment reductions previously scheduled to begin in FY 2018 was published in the July 28, 2017 Federal Register (82 FR 35155).”
The total for FY 2016 is $11.4 billion, of which $1 billion goes to Texas, $1.2 billion to California, $1.75 billion to New York. The total for FY 2018 is $11.8 billion, of which $1.1 billion goes to Texas, $1.2 billion to California, $1.8 billion to New York. (Both 2016 and 2018 totals are net of the approximately $500 million to the 17 “Low DSH” states.)
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
CMS Reports on Exchange Enrollment: CMS issued its semi-annual report (here) July 2 on exchange enrollment and subsidies for the 2017 plan year and for February 2018, including month-by-month enrollment figures. Results:
“As of March 15, 2018, 10.6 million individuals had effectuated coverage through the Federal and State-Based Exchanges for February 2018, meaning that they selected a plan, paid their first month’s premium, if applicable, and had coverage in February 2018. The total number of members with February 2018 coverage is about 9 percent lower than the number of individuals (11.8 million) who made plan selections during the 2018 Open Enrollment period, as reported in the 2018 Open Enrollment Final Report released by CMS in early April. The number of individuals with effectuated coverage for February 2018 is approximately 3 percent higher than February 2017 effectuated enrollment of 10.3 million individuals, as of March 15, 2017.”
Also, “Based on historical enrollment trends for the Exchanges, CMS anticipates that a significant number of people who effectuated coverage in early 2018 will not stay in their plans for the full year. For example, while 10.3 million individuals had effectuated coverage for February 2017 (as of March 15, 2017), by the end of the year, only 8.9 million individuals remained in their plans, according to data released today. This is likely caused by consumers struggling to pay premiums as costs continue to increase.”
Also, “This report also shows that the proportion of the population that enrolled on Federal and State-Based Exchanges and received advance premium tax credits (APTC) increased slightly for February 2018, to 87 percent, from an average of 84 percent for the 2017 plan year. The average total monthly premium per enrollee increased by 27 percent for February 2018 over the average total monthly premium per enrollee for the 2017 plan year; however, the average monthly amount of APTC per enrollee receiving APTC rose more sharply, by 39 percent, compared to the 2017 average monthly APTC per enrollee receiving APTC.”
CMS also issued (here) a companion report, on trends in enrollment. The findings:
“Average monthly enrollment in individual market plans decreased by 10 percent between 2016 and 2017 at the same time premiums increased by 21 percent. Most of the decrease in enrollment between 2016 and 2017 occurred among people who did not receive APTC subsidies. Non-APTC enrollment declined by 20 percent, compared to a 3 percent decline in APTC subsidized enrollment. The decline in the non-APTC portion of state markets grew larger and more widespread between 2016 and 2017. Non-APTC enrollment declined in 43 states, with six states losing over 40 percent of their non-APTC enrollment.”
Finally, CMS issued an Exchanges Trend Report (here), with these findings: “Data from the call center shows that the consumer satisfaction rate remained at an all-time high – averaging 90 percent – throughout the entire Open Enrollment period. This is up from 85 percent last year. 63 percent of uninsured consumers who have visited Federal platform Exchanges in the past year indicate they didn’t purchase a health plan through the Federal platform because the health insurance premium was too expensive, which is up from 52 percent from the end of last year’s Open Enrollment Period. Despite significant improvements to the agent and broker program, lack of competition in the Exchanges and limited availability of commissions continues to pose challenges to the agent and broker community.”
In a press release (here) summarizing the three reports, CMS Administrator Seema Verma said: “As the Trump Administration took office, there were warning signs that we were dealing with a crisis in the individual health insurance market and Obamacare was failing its consumers. These reports show that the high price plans on the individual market are unaffordable and forcing unsubsidized middle class consumers to drop coverage.”
EVENTS & MEETINGS
July 10
12:30 p.m., Pew, State Efforts to Lower Drug Spending, state and foundation representatives, 901 E. St., N.W., 202-540-6677, edavis@pewtrusts.org
July 13
9:00 a.m.-Noon, “Strategies for stabilizing the individual market,” USC-Brookings, 1775 Massachusetts Avenue, N.W., Paul Ginsburg, academics.
July 13
9:00 a.m-Noon, Brookings, PPACA repair by the states, study of four states, discussion, (202) 797-6105,
events@brookings.edu.
July 17
9:00 a.m. – 5:00 p.m., National Committee on Vital and Health Statistics (NCVHS), Standards (patient medical record information, electronic exchange of such information, health terminology and vocabulary).
Federal Register notice here.
July 18
8:30 a.m. – 3:00 p.m., NCVHS Meeting, Continued.
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 of meeting here, National Coverage Determination request for comment (6-28-2018) 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). Federal Register notice (5-3-2018), here.
Aug. 22
7:30 a.m. – 4:30 p.m., Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), CAR-T cell therapies, collection of patient reported outcomes in cancer clinical studies.
Maria Ellis, MEDCAC, (410) 786-0309, maria.ellis@cms.hhs.gov. Federal Register notice (6-15-2018) here.
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.
Trial subscriptions may end without notice, and all will end July 31.
July publication dates: 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