DCMedical News: Thursday, October 4, 2018
DCMedical News
Washington, D.C.
Thursday, October 4, 2018
DCMedical News is published every day either the House or the Senate is in session. To subscribe, please see below.
THE BIG STORY TODAY IN HEALTH CARE
Opioids bill passes the Senate, goes to the President for Signature: The bill, HR 6 (here, one page summary here, section-by-section analysis here), is a 660-page giant amalgam which will repeal a prohibition on Medicaid paying for “Institutions for Mental Disease” where those institutions have more than 16 beds.
The bill also authorizes funds to expand access to addiction treatment, including medication-assisted treatment of Medicare beneficiaries; control the importation of synthetic opioids; promote the development of alternative pain treatment (alternative, that is, to opioids); and address a myriad of health policies only slightly related to opioids. In the latter group, the “sunshine law” is expanded to require reporting payments by drug and device makers to nurses and physician assistants, as well as the doctors already covered. Also, a loophole is closed in legislation requiring biologics makers to report to the Federal Trade Commission any settlements that might delay competition for “biosimilar” (generic biologics) products. Other provisions allow both expansion and flexibility in the FDA’s labeling, packaging, mailing and disposal authorities.
Elimination of the Medicaid IMD exclusion may be particularly important: Prior to the passage of Medicaid in 1965, inpatient behavioral health services were paid for by the states, as noted in a June Kaiser Family Foundation brief (here). An IMD was defined in the Medicaid statute as a “hospital, nursing facility, or other institution of more than 16 beds, that is primarily engaged in providing diagnosis, treatment, or care of persons with mental diseases, including medical attention, nursing care, and related services” ( 42 U.S.C. § 1396d (i)). KFF reports “the IMD payment exclusion was aimed at preventing states from shifting mental health services provided by states onto the federal budget through Medicaid. With growing incidence and prevalence of behavioral health challenges in recent years, some states sought to use §1115 waivers to pay for IMD or similar institutional services. The Social Security Act allows the Health and Human Services Secretary to waive certain provisions of federal Medicaid law for an “experimental, pilot, or demonstration project” but does not specifically allow funding of IMDs. However, the Secretary has allowed Substance Use Disorder (SUD) funds to be used in IMD settings. Maryland, for example, was denied IMD waiver authority, but given approval to use SUD funds for IMD-based treatment.
The results of waiver experiments over two decades were studied by the GAO (States Fund Services for Adults in Institutions for Mental Disease Using a Variety of Strategies, here), with some experiments in the 1993-2009 era, others beginning in May of 2017 for four states, and flexibility for Medicaid managed care organizations to use IMDs, beginning in May of 2016. A year ago President Trump committed to “unlock treatment for people in need” and “took aim specifically at a longstanding policy that prohibits states from using federal Medicaid funding on certain mental health facilities.” (HealthLeaders, 10-27-2017). CBO has variously estimated the cost of eliminating the IMD exclusion from $1 billion to $60 billion per year.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Kaiser Report on the Cost of Health Insurance: The annual report by the Kaiser Family Foundation on health insurance was released Wednesday (here, summary here, Health Affairs article here, cost “no crisis” says KFF Pres. Drew Altman, here). The report says “Annual premiums for employer-sponsored family health coverage reached $19,616 this year, up 5% from last year, with workers on average paying $5,547 toward the cost of their coverage. The average deductible among covered workers in a plan with a general annual deductible is $1,573 for single coverage. Fifty-six percent of small firms and 98% of large firms offer health benefits to at least some of their workers, with an overall offer rate of 57%.”
Pre-Existent Conditions and Elections: House leaders, including the Chairman of the Rules Committee, have put forward a bill (H. Res 1089, here) “Expressing the sense of the House of Representatives that a replacement for the Patient Protection and Affordable Care Act should have certain features.” Those features include a variety of difficult-to-ensure goals, including protections for individuals with preexisting conditions.
READING AND REFERENCE
Minchin, M., et. al., “Quality of Care in the United Kingdom after Removal of Financial Incentives,” NEJM, 9-6-2018 (here).
Berns, J., et. al., “Dialysis-Facility Joint-Venture Ownership—Hidden Conflicts of Interest,” NEJM, 10-4-2018 (here).
McWilliams, J., et. al., “Medicare Spending after 3 Years of the Medicare Shared Savings Program,” NEJM, 9-20-2018 (here).
Lamkin, M., “Physician as Double Agent—Conflicting Duties Arising from Employer-Sponsored Wellness Programs,” NEJM, 10-4-2018 (here).
EVENTS & MEETINGS
Oct. 15
4:05-5:45 p.m., HHS Secretary Azar on “Affordable Medicines: Access, Innovation and the Public Interest,” at the National Academy of Medicine, Washington, DC. Additional information here.
Oct. 18
3:00 to 4:40 p.m. CMS Administrator Seema Verma at Brookings on Medicare Part D, followed by a panel (Kavita Patel, Samuel Nussbaum and others). Introduction: “Today, 43 million Americans have prescription drug coverage through Medicare Part D, roughly double the number since the program’s introduction in 2006. In the wake of fast-growing drug prices and the rise of specialty drugs, renewed attention has focused on reforming Part D’s benefit structure and providing plans with more tools to obtain lower drug prices. The Trump administration has issued a series of recommendations in their Blueprint to Lower Drug Prices and the president’s budget, and the administration has already begun to advance several pricing reforms through regulation.”
Information at: https://www.brookings.edu/events/a-conversation-with-seema-verma/
Oct. 25
1:00 to 5:00, “Top Minds,” Chernew, Dafny and more, “Disrupting the Health Care Landscape: New Roles for Familiar Players,” NEJM Catalyst webinar, https://join.catalyst.nejm.org/events, also sign up for “New Marketplace Survey: Payers and Providers Remain Far Apart,” which reports that “health care stakeholders are not working together to achieve value-based care, but instead are waiting on government regulators to change the payment model – including, possibly, single-payer health care.”
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
October publications dates: 5, 9, 10, 11, 12, 15, 16, 17, 18, 19, 22, 23, 24, 25, 26
November publication dates: 13, 14, 15, 16, 26, 27, 28, 29, 30
December publication dates: 3, 4, 5, 6, 7, 10, 11, 12, 13, 14
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com