DCMedical News: Friday, November 30, 2018
DCMedical News-DCMN
Washington, D.C.
Friday, November 30, 2018
DCMedical News is published every day either the House or the Senate is in session.
THE BIG STORY TODAY IN HEALTH CARE
Loss of Life: Longevity of Americans has gone down again, according to a new report (here) from the CDC. Says The New York Times (here), “Suicide, at 50-year Peak, Pushes Down US Life Expectancy.” Says The Wall Street Journal (here), “U.S. Life Expectancy Falls Further.” Culprits this year: Fentanyl, part of the more than 70,000 overdose deaths. Who is committing suicide? CDC’s Morbidity and Mortality Weekly Report edition of November 16 (here) shows 2012 and 2015 numbers and percentages by gender and occupation. Highest percentages in 2015 among men were in construction, art and entertainment and installation, with one of the highest percentage increases 2012-2015 in health care professionals. For women, the highest percentages were in art and entertainment, protective services and health care support.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
§1332 Waiver Ideas Offered by CMS: The Centers for Medicare & Medicaid Services (CMS) has released four waiver concepts for states’ use to promote lower cost health insurance coverage options through State Relief and Empowerment Waivers, fact sheet here. The four models are: (1) Account-Based Subsidies: Under this waiver concept, a state can direct public subsidies into a defined-contribution, consumer-directed account that an individual uses to pay for health insurance premiums or other health care expenses; (2) State-Specific Premium Assistance: States can use the State-Specific Premium Assistance waiver concept to create a new, state-administered subsidy program; (3) Adjusted Plan Options: States would be able to provide financial assistance for different types of health insurance plans, including non-Qualified Health Plans. For example, states could choose to expand the availability of catastrophic plans beyond the current eligibility limitations by waiving section 1302(e)(2) of the ACA; and (4) Risk Stabilization Strategies: To address risk associated with individuals with high health care costs, a state can implement a state-operated reinsurance program or high-risk pool by waiving the single risk pool requirement under section 1312(c)(1) of the ACA. The “fact sheet” does not follow the Administrative Procedures Act requirements for notice and comment, but it does reference the October 24, 2018 Federal Register “guidance” on §1332, here.
DRUGS AND DEVICES
340B Price Ceiling Rule Penalties to be Implemented January 1, 2019: CMS published (here) a final rule on the effective date for the price limits in the “safety net” 340B drug pricing program. HHS originally published a notice of proposed rulemaking (NPRM) in June 2015 to implement civil monetary penalties (CMPs) for manufacturers who knowingly and intentionally charge a covered entity more than the ceiling price for a covered outpatient drug; to provide clarity regarding the requirement that manufacturers calculate the 340B ceiling price on a quarterly basis and how the ceiling price is to be calculated; and to establish the requirement that a manufacturer charge a $.01 (penny pricing policy) for drugs when the ceiling price calculation equals zero. The rule, in today’s Federal Register, contains a dialogue between comments offered in the long rule-making process, together with CMS’ responses to those comments.
Medicaid Federal Upper Payment Limits: The updated Affordable Care Act Federal Upper Limits (FUL) calculated in accordance with the Medicaid Covered Outpatient Drug final rule with comment are now available on the Medicaid.gov website, https://www.medicaid.gov/medicaid/prescription-drugs/pharmacy-pricing/index.html. Background and explanation of terms for the upper limits program at https://www.medicaid.gov/medicaid/prescription-drugs/federal-upper-limits/index.html.
READINGS & REFERENCES
“Implementation of Choosing Wisely: Promise and Pitfalls,” in The Joint Commission Journal on Quality and Patient Safety, here. “Overuse of low-value services has been estimated to cost the health care system in the United States more than $200 billion per year, not to mention the potential patient harms and inconvenience of unnecessary care.” Focus and results: “The multifaceted intervention specifically targeted decreasing unnecessary routine blood tests, osteoporosis screening for women who did not have an indication, and imaging for uncomplicated headaches. The study demonstrated impressive reductions in all of these unnecessary tests, and results were sustained even after monthly reports to physicians about their use of these tests ended.”
Evaluation and Management Payment Chart for 2019: From CMS, November 1, 2019, here.
EVENTS & MEETINGS (Events Newly Added to This List Noted in Bold)
Nov. 29
The “Office of the National Coordinator” annual meeting, continuing November 30, two day tentative agenda (Jared Kushner!) here.
8:00 a.m. to 11:00 a.m., STAT Plus correspondents in a discussion of drug pricing, at Hogan Lovells in Washington, information at https://www.statnews.com/conversation-drug-pricing-2019/?utm_source=STAT+Newsletters&utm_campaign=bb45b691af-STATPlus_1113_event_subs_COPY_01&utm_medium=email&utm_term=0_8cab1d7961-bb45b691af-149691333
10:30 a.m.: Senate Health, Education, Labor and Pensions Committee marks up S.2076 (here), on dementia and Alzheimer’s; H.R.315, “Improving Access to Maternity Care” (here); reauthorization of “Emergency Medical Services for Children” (here) and reauthorization of the “Traumatic Brain Injury Program” in Room 430 Dirksen SOB.
Dec. 4
9:00 a.m., CMS sponsors a “Town Hall” meeting “To discuss fiscal year (FY) 2020 applications for add-on payments for new medical services and technologies under the hospital inpatient prospective payment system (IPPS).” Registration required by 11-19-2018, Federal Register notice here.
Dec. 5
9:00 a.m., Health Affairs and CMS’ National Health Expenditure Accounts Team hold a media briefing on "National Health Spending in 2017: Growth Slows to Pre-Great Recession Rates and Share of GDP Stabilizes,” National Press Club.
Dec. 6
9:30 a.m., Bipartisan Policy Center, “Bipartisan Leadership in Health Care: Chronic Care Act of 2018,” with Senators Hatch, Wyden. Register at https://bipartisanpolicy.org/events/bipartisan-leadership-in-health-care-chronic-care-implementation
2:00 p.m. Business Roundtable CEO Innovation Summit: “America: The Innovation Nation.” 901 Wharf St., SW, Washington, Contact: Rayna Farrell rfarrell@brt.org, Agenda and Speakers here.
Dec. 7
Noon, Alliance for Health Policy, “Aging in America,” information at 202-789-2300 info@allhealthpolicy.org
Dec. 10
The American Bar Association (ABA) holds the 16th annual Washington Health Law Summit, December 10-11, information at 202-662-1090 at 202-662-1000, registration at https://www.americanbar.org/events-cle/mtg/inperson/332144284/.
Dec. 18
First meeting, the HHS Deputy Secretary’s Innovation and Investment Summit. Program announced, here; participants selected, list here; FAQs 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
December publication dates: 3, 4, 5, 6, 7, 10, 11, 12, 13, 14
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com