HealthCare Roundtable e-News – August 14, 2023

 

Top News

Stakeholders Advocate for Extended Comment Periods on Proposed Mental Health Parity Rule

In a letter addressed to Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, Employee Benefits Security Administration (EBSA) Assistant Secretary Lisa Gomez, and Internal Revenue Service (IRS) Commissioner Danny Werfel, various health plans, employers, and associations advocated for an extension of the comment periods for the recently released Notice of Proposed Rulemaking and Technical Release related to the Mental Health Parity and Addiction Equity Act. Specifically, they ask for an additional 60 days for the comment period on the Proposed Rule and an additional 90 days for the comment period on the Technical Release.

The reason behind this request is the significant and wide-ranging nature of the proposed changes, which stakeholders need ample time to evaluate and provide meaningful feedback on. They emphasize the importance of carefully considering these proposals to align them with the intended goals of the Consolidated Appropriations Act, 2021, without imposing undue burdens on providers, plans, and patients. The overlapping timelines for commenting on both the Proposed Rule and the Technical Release pose challenges for stakeholders, who require more time to address the Technical Release’s intricacies effectively. The letter underscores the potential risk of compromising the quality of rulemaking in crucial regulatory areas if the comment periods are not extended, emphasizing the need for thorough review to prevent unintended negative consequences for all involved parties.

The letter was signed by Academy of Managed Care Pharmacy, AHIP, Alliance of Community Health Plans, Association for Behavioral Health and Wellness, Blue Cross Blue Shield Association, Business Group on Health, National Coordinating Committee for Multiemployer Plans, and The ERISA Industry Committee.

 

Report Highlights Impact of High-Quality Employer-Sponsored Health Insurance on Health, Longevity, and Productivity

A new report by Deloitte sheds light on the impact of high-quality employer-sponsored health insurance (ESI), indicating that ESI can improve employees’ health and longevity while yielding retention and productivity benefits for employers. Among its findings, the study indicated that high-quality ESI could increase the average American life span from 77.9 years to 90 years by 2024, with more of these years spent in good health. The research also suggested that robust ESI programs could cut health care costs by up to a third by utilizing cost-effective preventative options to avoid more costly treatments. Going forward, the report highlighted important efforts, including work to improve mental health, health literacy, and healthy habits, along with other initiatives that could be affected by robust ESI. Additionally, the report’s authors suggested ways that the health care industry could expand care equitably and that organizations in other industries could encourage healthier decision-making.

 

AARP Report Highlights Soaring Costs and Implications of Inflation-Based Rebates for Part D Drugs

The American Association of Retired Persons (AARP) Public Policy Institute released a report analyzing how the prices of 25 top Part D drugs have changed since entering the market. The publication seeks to provide additional context on the new inflation-based rebates included in the Inflation Reduction Act (IRA), which passed in 2022. Under the IRA, drug companies will need to pay a rebate to Medicare if their prices increase faster than the rate of general inflation. The AARP report finds that the list prices of these top 25 Medicare Part D drugs have, on average, more than tripled since they first entered the market, greatly outpacing the rate of general inflation. Additionally, the report indicates that, on average, over half of the current list prices of the top 25 drugs stem from price increases after the products first entered the market. The Congressional Budget Office has estimated that the IRA’s inflation-based rebate provision will reduce enrollee and Medicare Part D program spending by billions of dollars and will reduce drug prices in the commercial insurance market.

Administrative Action

The Centers for Medicare and Medicaid Services (CMS) suspended the independent dispute resolution (IDR) process, which is used by providers and payers to reconcile surprise billing payment disputes under the No Surprises Act. This decision comes directly as a result of the recent ruling by a federal district judge in Texas that vacated CMS’ December 2022 IDR fee increase and sections from the October 2021 interim final rule on claims batching. The judge agreed with the Texas Medical Association that the Administration violated the Administrative Procedures Act with its fee increase and rules on claims batching. CMS noted that the Departments of Health and Human Services (HHS), Labor, and Treasury (collectively, the Departments) have temporarily suspended the Federal IDR process, including the ability to initiate new disputes until the Departments can provide additional instructions. CMS has not provided a timeline on how long the portal may be suspended.

Congressional Action

  • Senators James Lankford (R-OK) and Bob Casey (D-PA), along with 49 other Senate colleagues, authored a letter to Senate Majority Leader Chuck Schumer (D-NY) and Senate Minority Leader Mitch McConnell (R-KY) urging them to address looming cuts to the Medicaid Disproportionate Share Hospital (DSH) program. The program faces $8 billion in cuts if no action is taken before October 1, 2023, the end of the fiscal year. The Affordable Care Act (ACA) required incremental cuts to the Medicaid DSH program over time as lawmakers assumed that the ACA would increase health insurance coverage, leading to hospitals no longer needing additional payments to cover the costs of uncompensated care. The assumed coverage levels have not materialized, leaving hospitals to care for elevated levels of uninsured and underinsured patients and thus bearing the weight of the corresponding lack of reimbursement. Additionally, the letter references how Congress has previously acted in a bipartisan manner on eleven occasions to avoid Medicaid DSH cuts that would impact hospitals across the country.
  • Senator Bill Cassidy (R-LA), ranking member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, called on the Department of Health of Human Services (HHS) to implement the No Surprises Act (NSA), which aims to protect consumers facing surprise medical bills when receiving care from out-of-network providers in circumstances outside their control. Senator Cassidy notes in his letter that HHS has deviated from statutory instructions while implementing the NSA, creating confusion and uncertainty for patients and providers. This letter comes on the heels of a recent ruling by a District Court judge who overturned HHS’ administrative fee increase resulting in the Department temporarily pausing the mediation of new billing disputes. The letter outlines key questions for HHS related to the development of the qualifying payment amount, independent dispute resolution process, batching claims, and audit and enforcement activities. Senator Cassidy is requesting that HHS respond to all the questions by close of business September 15.

Regulatory Action

The U.S. Food and Drug Administration (FDA)  approved  Zurzuvae  (zuranolone), the first oral medication indicated to treat postpartum depression (PPD) in adults. Previously, treatment for PPD was only available as an IV injection given by a healthcare provider in certain healthcare facilities. Around one in nine new mothers has postpartum depression, according to the Office on Women’s Health. Postpartum depression is characterized by sadness and/or loss of interest in activities that one used to enjoy and a decreased ability to feel pressure. Symptoms can also include cognitive impairment, feelings of sadness or inadequacy, loss of energy or suicidal ideation. Zurzuvae’s efficacy for treating PPD in adults was demonstrated in two randomized, double-blind, placebo-controlled, multicenter studies. The FDA granted the application Priority Review and Fast Track designation.


Registration Open for 2023 Annual Conference

The Public Sector HealthCare Roundtable 2023 Annual Conference Moves to Washington, DC

The conference features a new location, a revised format, and a great agenda!

Wednesday, Nov. 1 to Friday, Nov. 3, 2023

 

The Roundtable’s highly-regarded annual conference provides members and guests a unique opportunity to hear presentations by high level government officials and key experts – from Congress and the Administration, academics, benefit consultants, plan administrators, advocates and industry leaders in an intimate dialogue-oriented setting.

After years of successful conferences in Old Town Alexandria, we have outgrown our space at the Alexandrian Hotel. This year we will hold our conference at the historic Mayflower Hotel in Washington, DC. The new location will undoubtedly improve the overall experience for all of our attendees.

In recent years, many of our attendees have urged us to schedule more free time in the conference agenda for networking. Since we understand the importance of this networking time, we have revised this year’s agenda to incorporate longer breaks and more time before evening receptions.

This year, the conference will begin at Noon on Wednesday, November 1st and will conclude at Noon on Friday, November 3rd. By adding time on Wednesday, we have been able to add critical content, lengthen our breaks, and add free time prior to any evening activities.

Although we certainly believe the best way to experience our conference is in-person, this year’s conference will once again feature a virtual option. Any health plan that registers at least one individual to join us in Washington, will be eligible to register online attendees.

Visit the Roundtable’s website for a preliminary Agenda, a Registration Form, and the Mayflower Hotel registration link.

We will be updating the agenda and announcing specific speakers over the course of the next couple of months.