DCMedical News: Tuesday, July 10, 2018
DCMedical News
Washington, D.C.
Tuesday, July 10, 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 Appointment: Brett Kavanaugh, DC Circuit, Yale/Yale. On the docket: PPACA, state-federal relations, and of course Roe v. Wade.
Appropriations: The House Appropriations Committee will meet this Wednesday in an attempt to complete action on the FY 2019 Labor-HHS-Education spending measure. The draft bill is here, the committee report here. The House bill proposes a $1.25 billion increase for Health and Human Services, largely for medical research funding; proposes elimination of $286 million for the Title X family planning program; proposes new restrictions on funding of PPACA and on funding for gun violence research; but avoids dismantling of the Agency for Healthcare Research and Quality.
The Senate version proposes a $2.3 billion increase for DHS and seeks to avoid partisan divisions. The draft bill text (S. 3158) is here, the committee report here.
HOSPITALS AND OTHER HEALTH CARE FACILITIES
Home Health Payments in FY 2019: CMS is proposing (Federal Register 7-12, here) to increase payment for home health visits by 2.1 percent, or $400 million, on average in 2019, but also changing (in 2020) payment for therapy visits and allowing payment for remote patient monitoring. Also, beginning in 2020, CMS would pay home health agencies based on 30-day episodes rather than the current 60-day span, and on the basis of “value of care” rather than the number of therapy visits a patient receives.
MEDICARE, MEDICAID, COMMERCIAL HEALTH INSURANCE
Medicaid and Work: MACPAC paper (here), Kaiser Family Foundation on Stewart v. Azar (Kentucky) here.
$ Ten Billion Plus on Hold for Exchange Carriers: CMS announced (here) it was suspending risk adjustment payments after a federal court ruling rejected the methodology used for the payments. A federal district court in New Mexico struck down (here) payment calculations based upon a statewide average premium, focusing on CMS’ use of a “budget neutral” formula. A Massachusetts federal court (here) upheld the formula.
The risk adjustment transfer amounts for the 2017 benefit year are $10.4 billion, which includes transfers across catastrophic, small group, and individual non-catastrophic risk pools. “We were disappointed by the court’s recent ruling. As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold. CMS has asked the court to reconsider its ruling, and hopes for a prompt resolution that allows CMS to prevent more adverse impacts on Americans who receive their insurance in the individual and small group markets,” said CMS Administrator Seema Verma.
The Blue Cross Blue Shield Association’s CEO Scott Serota said “We are extremely disappointed that the administration has frozen payment transfers under the Affordable Care Act’s (ACA) risk adjustment program . . . Without a quick resolution to this matter, this action will significantly increase 2019 premiums for millions of individuals and small business owners and could result in far fewer health plan choices. It will undermine Americans’ access to affordable coverage, particularly for those who need medical care the most. . . The action taken today will create turmoil not only for those in the individual market – particularly as insurers finalize their offerings for the next open enrollment that begins in November – but also for the millions of businesses that rely on the small group market to provide affordable insurance options for their employees.”
Texas vs. HHS: The 20 Republican states challenging HHS to strike the Affordable Care Act in Texas v. HHS filed a motion (here) proposing that, if the judge agrees with the Department of Justice’s call to eliminate preexisting conditions coverage, the decision should only apply to the GOP-led states filing the suit, not other states, an effort to prevent further appeal from the other states. Senate Majority Leader Mitch McConnell (R-KY) has said that no Republican Senator agreed with the DOJ’s position.
More litigation from conservative states: the group of 20 states argued in a court filing (here) for a nationwide preliminary injunction to provide relief from the health law before the start of 2019.
How Are the Plans Doing? Daniel Sack checks in on the markets in JAMA, here.
EVENTS & MEETINGS
July 10
10:00 a.m., National Coalition on Health Care, Affordability, SVC-203/202, Capitol, Gerard Anderson, Paul Ginsburg, others, events@nchc.org.
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 11
2:00 p.m., 1100 Longworth HOB, Committee on Ways and Means considers bills from its Subcommittee on Health concerning expansion of HSAs and related matters, summary of bills here.
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: 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