DCMedical News: Tuesday, April 9, 2019
DCMedical News-DCMN
Washington, D.C.
Tuesday, April 9, 2019
DCMedical News is published every day both the House and the Senate are in session. Subscription information below.
THE BIG STORY IN HEALTH CARE
Budget Limits:
The House will vote tomorrow on whether or not to raise spending limits to allow veterans greater access to private health services. The “cap adjustments” would allow up to $10 billion for the VA program in fiscal 2020 and $12 billion in fiscal 2021, beyond the current spending limits. The Veterans Choice Act of 2014 (P.L. 113-146, here) is a temporary measure which would be made permanent by the House proposal. Spending caps, appropriations for FY2020 and the debt limit all have a deadline of September 30, 2019, the end of the current federal fiscal year.
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicare-for-All
Senator Sanders will unveil an updated version of his Medicare-for-All proposal Wednesday, this one including home and community-based care and skilled long-term care facilities. The Kaiser Family Foundation unveiled (here) a feature-by-feature guide to public health insurance plan proposals now before Congress, including Medicare-for-All, a Medicare public plan option, a Medicare “buy-in” for older adults and a Medicaid “buy-in” plan.
Negating STLDI
The House Education and Labor Committee will meet today to mark up a bill to negate the rule (here) authorizing the Short-Term, Limited Duration health insurance plans.
Final Rule on MA, Part D, PACE and Related Medicare Changes
The 616-page rule is scheduled to be published in the April 16 Federal Register; the advance copy can be found here. The proposed rule was published November 1, 2018.
Telehealth for Medicare Advantage plans, “MA plans will be permitted to offer – as part of the basic benefit package – MA additional telehealth benefits beyond what is currently allowable under the original Medicare telehealth benefit . . . In addition, MA plans will continue to be able to offer MA supplemental benefits (that is, benefits not covered by original Medicare) via remote access technologies and/or telemonitoring.”
Not Our Lookout:
MACPAC writes to the OIG about reshaping safe harbors for drug rebates and discounts. The letter from the Medicaid and CHIP Payment and Access Commission (here) concerns elimination of “safe harbor protection for drug rebates paid by drug manufacturers to Medicare Part D plans and Medicaid managed care organizations (MCOs), either directly or through pharmacy benefit managers (PBMs) acting under contract with Medicare Part D plans or Medicaid MCOs,” in favor of “discounts provided at the point of sale (POS) that reduce the price paid by the beneficiary and for fixed-fee payments from drug manufacturers to PBMs for certain services rendered on behalf of the manufacturer.”
The group notes, “the proposed changes to the safe harbors are primarily focused on creating discounted prices at the point of sale and changing beneficiary cost sharing for Medicare Part D beneficiaries. The goal of these changes is not particularly relevant to Medicaid, due to the nominal cost sharing for Medicaid beneficiaries and the statutory rebates that Medicaid receives.”
MedPAC also had reservations (letter, here). The Medicare Payment Advisory Commission noted that “limiting the ability of Part D plan sponsors and their PBMs to use rebates could also lead to uncertain and potentially undesirable outcomes, and thus the Commission has substantial concerns about the proposed changes.”
READINGS AND REFERENCES
Right to Repair: an editorial from The New York Times (here), with implications for the health field (for example, here).
FQHCs: The Commonwealth Fund publishes a study (here) which shows “Community Health Centers in Medicaid Expansion States See Improved Financial Stability, Capacity to Serve Patients.”
U.S. House of Representatives:
Members at https://www.house.gov/representatives, Committees and Members at https://www.house.gov/committees.
U. S. Senate:
Members at https://www.senate.gov/general/contact_information/senators_cfm.cfm, Committees and Members at https://www.senate.gov/committees/membership_assignments.htm.
House and Senate 2019 Calendar of Regularly Scheduled Sessions, here.
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
April publication dates: 10, 11, 12, 29, 30
May publication dates: 1, 2, 7, 8, 9, 10, 14 15, 16, 17, 20, 21, 22, 23
Notes to: Fred Hyde, MD, JD, MBA; fredhyde@aol.com.