HealthCare Roundtable e-News – August 7, 2023


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.

Top News

CMS Releases 2024 Projected Medicare Part D Premium and Bid Information

Last week, the Centers for Medicare and Medicaid Services (CMS) released its annual Medicare Part D premium and bid information for Calendar Year (CY) 2024 (fact sheet), which provides information to help Part D plan sponsors finalize their offerings and individuals understand overall Part D premium trends ahead of Medicare Open Enrollment. The average total monthly Part D premium is projected to decrease from $56.49 in 2023 to $55.50 in 2024. CMS attributes the decrease in premium due to changes made to the Part D program from the Inflation Reduction Act (IRA), including the IRA’s premium stabilization provision and its improved basic Part D benefit.


MedPAC Releases Annual Data Book on Medicare Program, Beneficiaries, and Payment Systems

MedPAC released its annual Data Book “Health Care Spending and the Medicare Program,” which contains a range of Medicare information presented through tables, graphs, and brief discussion. Notably, the data book found that as of February 2023, about 5.5 million enrollees were in employer group plans, or about 18% of all MA enrollees. Additionally, employer plan enrollment grew by 6% from 2022 and has more than doubled since 2013. The Data Book also includes information on national health care and Medicare spending, along with Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care in the Medicare program, and Medicare beneficiary and other payer liability. The report also contains information about provider settings, the Medicare Advantage program, and prescription drug coverage for Medicare beneficiaries, including Part D. MedPAC’s annual Data Book includes some information derived from MedPAC’s March and June reports along with information unique to the annual publication.


National Uninsured Rate Reaches All-Time Low in Early 2023

The U.S. Department of Health and Human Services (HHS), through the Office of the Assistant Secretary for Planning and Evaluation (ASPE), released a report stating that the uninsured rate reached an all-time low of 7.7% among all U.S. residents. The report cites the Affordable Care Act (ACA) open enrollment period as the biggest factor in the rise of health care coverage. ASPE estimates that over 6.6 million people have gained health insurance coverage since 2020. It further explains that the uptick in health coverage ran parallel with the implementation of the American Rescue Plan’s enhanced ACA subsidies, the Inflation Reduction Act’s continuation of those subsidies, recent state Medicaid expansions, and significant marketplace enrollment outreach conducted by the Biden-Harris Administration. However, ASPE did acknowledge that the first quarter of the year generally marks the lowest uninsured rate. Additionally, the end of Medicaid continuous coverage in April will lead to a rise in uninsured Americans.


New Research Reveals Estimated Negotiated Drug Prices Under Medicare’s Historic Drug Pricing Negotiation Program Set to Begin in 2026

New research (publicationresearch brief) estimated the maximum negotiated price for the 10 drugs expected to be negotiated by Medicare in 2026. Medicare will negotiate drug prices starting in 2026 and, legally, the negotiated price cannot be higher than the price Medicare plans currently pay after discounts or higher than a maximum percentage of the price based on how long a drug has been on the market. The research, which was published in the Journal of Managed Care and Specialty Pharmacy, found that in 2026, minimum discounts will only apply to 4 of 10 drugs likely subject to negotiation. For most drugs, net prices will establish the ceiling for the negotiated price, according to the research. The study also concluded that negotiated prices will need to fall below the ceiling for the negotiated price established by the statute to achieve the $3.7 billion dollars in savings predicted by the Congressional Budget Office. In August 2022, President Biden signed the Inflation Reduction Act (IRA) of 2022, which provided Medicare, for the first time, with the ability to directly negotiate the prices of certain high-expenditure drugs. By September 1, 2023, the Centers for Medicare and Medicaid Services will publish the list of the first 10 drugs covered under Part D selected for initial price applicability year 2026 under the program. The first round of negotiations will occur during 2023 and 2024 and will result in prices that will be effective beginning in 2026.


KFF Poll Reveals Public Sentiment on Prescription Drug Costs and Usage

The Kaiser Family Foundation (KFF) published its latest polling data on public opinion regarding prescription drugs and their prices. Among the key findings, KFF found that about six in ten adults say that they are currently taking at least one prescription drug, and a quarter say they currently take four or more prescription medications. Additionally, about eight in ten adults say that the cost of prescription drugs is unreasonable, although 65 percent say that affording prescriptions is either “very” or “somewhat” easy. The research also sheds light on patient behaviors impacted by drug costs, with data indicating that three in ten adults report not taking their medicines as prescribed at some point in the past year due to costs. KFF’s polling also provides information on topics like perceptions about drug company profits driving costs, perceptions across political groups, and favored actions to lower drug costs, among other topics.

Regulatory Action

The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2024 inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) final rule. General acute care hospitals that are paid under the IPPS, successfully participate in the Hospital Inpatient Quality Reporting (IQR) program and are meaningful electronic health record (EHR) users will receive an increase in operating payment rates of 3.1%. The increase reflects a projected FY 2024 IPPS hospital market basket update of 3.3%. Additionally, CMS expects the LTCH standard payment rate to increase by 3.3%. CMS also instituted the following changes: 1) The continuation of the low-wage hospital policy finalized in the FY 2020 IPPS/LTCH PPS final rule to address wage index disparities. 2) Changes to graduate medical education payments for training in rural emergency hospitals, due to growing concern over closures of rural hospitals. 3) To view rural reclassified hospitals the same as geographically rural hospitals for the purposes of calculating wage index. 4) The addition of 15 new health equity hospital categorizations for the FY 2024 IPPS payment impacts.


Centers for Medicare and Medicaid Innovation (CMMI) Chief Strategy Officer, Purva Rawal, Director Elizabeth Fowler, Director Meena Seshamani, and Chief Transformation Officer, Douglas Jacobs, published an article exploring CMS’s historic and future commitment to advancing accountable care for Medicare beneficiaries. In 2021, the Centers for Medicare and Medicaid Services (CMS) set a goal of transitioning 100 percent of traditional Medicare beneficiaries into accountable relationships by 2030. Currently, more than 588 ACOs are serving more than 13.2 million beneficiaries, with additional growth expected of 10-20% expected as finalized policies go into effect. To advance this goal, CMS leadership lays out its vision to use the Medicare Shared Savings Program (MSSP) as the chassis for care transformation by aligning features and testing of other ACO models with the MSSP. Through this strategy, CMS is creating ways to incentivize more provider participation in accountable care relationships through efforts including Advance Investment Payments (AIP), finalized in the CY 2023 Medicare Physician Fee Schedule (MPFS), the new Accountable Care Prospective Trend (ACPT) to incorporate into financial benchmarks for Shared Savings Program ACOs, and finalizing a policy reducing the negative regional adjustment, among others.


On Wednesday, the Centers for Medicare and Medicaid Services (CMS) issued a new State Medicaid Directors letter outlining how states can apply to have certain home and community-based service (HCBS) waiver flexibilities from the COVID-19 public health emergency (PHE) extend past the initial six-month deadline. Under the American Rescue Plan Act (ARPA), states were allowed to amend their existing 1915(c) and 1115 waivers to incorporate Appendix K emergency flexibilities to allow HCBS services to be safely delivered during the COVID-19 PHE. These Appendix K flexibilities were originally set to expire six months after the end of the COVID-19 PHE, on November 11, 2023, unless the state chose to amend their HCBS waivers to permanently incorporate eligible flexibilities. However, under the guidance issued today, states will be allowed to maintain eligible Appendix K flexibilities past the November deadline, so long as they have submitted a request to CMS to permanently incorporate them into a HCBS waiver. CMS will allow these states to continue providing these services under the Appendix K authority until the effective date of their updated, approved waiver. CMS anticipates this extension will prevent lapses due to the procedural challenge of reviewing and approving the waiver amendments by November and hopes it will minimize system disruptions.