HealthCare Roundtable e-News – January 23, 2020

FTC to Increase Oversight on Anti-Competitive Hospital Behavior, ‘Mega-Mergers’

FTC Commissioner Christine Wilson confirmed last week that the agency will move forward in its investigation of anti-competitive behavior within US hospital systems. At a Council for Affordable Health Coverage event, Wilson touted the success her commission’s health care enforcement efforts have had on lowering consumer spending, and gave assurances that the commission will continue in its commitment to oversight of the industry. (InsideHealthPolicy).

Democrats and Republicans alike have shared their support for the administration’s push to oversee mergers within the sector. Presidential candidate Sen. Elizabeth Warren (D-Mass.) for instance, took aim at hospital mergers in her 2019 rural health plan, and has also proposed that the FTC be authorized to review non-profit hospitals and work with states to repeal COPAs.

According to the commission, one major consideration is to give nurses more practice authority within medical facilities as a way to improve access to care. Commissioner Wilson also noted that more access to resources would be crucial in the FTCs ability to tackle anti-competitive practices. (InsideHealthPolicy).

MedPAC Considers Medicare Part D Redesign Policies

During last Thursdays MedPAC meeting, Congressional Medicare advisors largely praised a proposed restructuring of the Medicare Part D program that would restructure the catastrophic benefit to eliminate enrollee cost-sharing and make plans responsible for paying a larger share of seniors’ drug costs. The Commission will vote on the congressional recommendations when they reconvene in March.

The commission explained that this restructuring would require the current risk-adjustment model to be changed, and a new catastrophic benefit structure would have to be phased into the program. It would also require CMS to adjust for the expansion of the non-low-income subsidy coverage-gap benefits, and the recent increase in manufacturer discounts and rebates.

The commissioners largely welcomed the redesign recommendation-Noting that changes in the Part D program, have compromised the overall structure of the program. “I think there really is some urgency in doing something about this because the Part D approach has been undermined,” Commissioner Paul Ginsberg of the Brookings Institution said.

The Commission will vote on the congressional recommendations when they reconvene in March.

States Expected to Take Action on Drug Prices, Importation

According to Trish Riley, Executive Director, National Academy for State Health Policy (NASHP), states are expected to make progress on legislation and initiatives to lower drug prices in 2020. NASHP asserts that drug imports, bulk purchasing, insulin spending caps, and drug price review boards will all be policies of priority for state-level lawmakers in the coming year.

“It’s not a year that you’d expect blockbuster stuff just because they are short sessions,” Riley said. “That said, we expect to see some importation stuff, even amid the uncertainty about what the federal regs really mean.” Vermont and Florida submitted initial plans on importation to HHS last year, and Maine and Colorado are said to be drafting plans to implement their importation laws this year. (InsideHealthPolicy).

Additionally, state-level legislative support for insulin spending-caps continues to grow: Massachusetts, Maine, New Hampshire, Illinois, and Wisconsin are seeking to implement price limits for insulin, and Governor Andrew Cuomo (D-NY) has expressed his desire to cap monthly insulin costs at $100 for all insured residents.(InsideHealthPolicy).

Insurance Industry Stakeholders Await Draft Exchange Rule Setting For 2021

Insurers preparing for the 2021 plan year are growing frustrated with HHS, who midway through January, has yet to release the draft exchange rule on networks, open enrollment, drugs and other key issues. Although the administration has released the proposed rate review calendar and other technical guidance, insurers need more information from HHS in order to develop plan designs and rates.

CMS has not provided much in terms of timeline for the release the 2021 Notice of Benefit and Payment Parameters

There is speculation that there will be small changes to the risk adjustment or the risk adjustment data validation program. And insurance sources additionally suspect that the rule could include policies that further CMS’ goal to use private web-based brokers for enrollment over