HealthCare Roundtable e-News – January 29, 2024


Top News

CMS Releases RFI to Enhance Medicare Advantage Transparency and Competition

The Biden-Harris Administration is intensifying efforts to boost competition and transparency in the health care sector, particularly within the Medicare Advantage (MA) insurance market, as MA has grown to over 50% of Medicare enrollment and is projected to receive over $7 trillion in the next decade. As a result, the Centers for Medicare and Medicaid Services (CMS) has issued a Request for Information (RFI) to gather public input on improving MA data capabilities and transparency, aiming to empower Americans with Medicare, ensure timely access to care, prevent misuse of taxpayer funds, and foster healthy market competition. Health and Human Services Secretary Xavier Becerra underscores the significance of transparency in MA managed care plans, emphasizing its role in informed decision-making for patients, aiding research and doctor evaluations, and aligning with the administration’s commitment to competitive spending of Medicare dollars on quality healthcare.

CMS Administrator Chiquita Brooks-LaSure reaffirms the administration’s dedication to improving the Medicare Advantage program through the RFI, which seeks input on various aspects of the MA program, including access to care, prior authorization, provider directories, supplemental benefits, marketing, care quality, and market competition. The RFI builds on existing CMS efforts to enhance MA data transparency, including comprehensive payment data collection, addressing Medical Loss Ratios (MLRs), and increasing encounter data completeness requirements. CMS is seeking input on the most effective ways to improve MA data capabilities and enhance transparency for the public. Comments are due by May 29, 2024.


Senate Finance Committee Releases Plan to Prevent and Mitigate Generic Drug Shortages

U.S. Senate Finance Committee Ranking Member Mike Crapo (R-ID) and Chair Ron Wyden (D-OR) released a white paper outlining bipartisan policy options for preventing and mitigating generic drug shortages. The paper presents concerns about drug shortages raised by witnesses at a December 5, 2023 Senate Finance Committee hearing, and it also outlines ways in which the Committee may modify Medicare and Medicaid programs to address the shortages. The Committee is specifically exploring modifications to Medicare Part A and B payment reforms to stabilize the availability of generic sterile injectable (GSIs) medicines, incentives for providers and other prescription drug supply chain stakeholders to prioritize shortage prevention and mitigation efforts, including increasing transparency, new Medicare Part D initiatives to encourage pharmacies to purchase generic medicines from drug manufacturers that boost drug supply chain resilience, and Proposed reforms to the Medicaid Drug Rebate Program to focus on generic medicines shortages.

Administrative Action

  • The Department of Health and Humans Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) announced an action plan centered on educating patients about their rights to emergency medical care under the Emergency Medical Treatment and Labor Act (EMTALA). These actions also focus on improving hospitals’ abilities to fulfill their obligations under EMTALA. The Department created this plan in response to helping CMS commit to informing patients who may be experiencing health crises, such as pregnancy loss, about emergency health care required under federal law. The plan directs the Department to post new information on the CMS website regarding patient rights under EMTALA and how to submit a complaint if care is denied, and also circulate training materials to hospital and provider associations’ duties under EMTALA. The Biden-Harris Administration has prioritized patient access to care under federal law and has recognized this type of emergency care can sometimes include abortion access.
  • On the 51st Anniversary of Roe v. Wade, HHS Secretary Xavier Becerra released a series of actions to increase and protect contraception access, supporting President Biden’s Executive Order to strengthen family planning services. The Secretary wrote a letter to Medicare plans, health insurers, and State Medicaid and CHIP programs focused on reaffirming reproductive health care services such as contraception. Additionally, HHS and the U.S. Departments of Labor and the Treasury (the Departments) posted a Frequently Asked Questions (FAQs) – PDF to clarify provisions of the Affordable Care Act (ACA) related to contraception coverage obligations for health plans and issuers. The Departments released a new pathway for plans and issuers to cover, at no cost, a greater extent of FDA-approved contraceptive drugs and devices. HHS also updated the Medicare Part D formulary clinical review process for 2024 to include intramuscular long-acting contraceptives and intrauterine devices (IUDs), expanding coverage for different types of birth control. Lastly, CMS is working with local Medicare Administrative Contractors (MACs) to build public awareness of Medicare Part B coverage for IUDs.
  • The Senate Special Committee on Aging held a hearing on Assisted Living Facilities (ALFs), their role within the broader long-term care continuum, and the challenges older adults and their families face in accessing information on ALF costs and quality of care. Chairman Casey (D-PA) opened the meeting by remarking that despite the significant growth in sector, with an estimated 1 million individuals residing in over 130,000 facilities, Congress had not held a hearing or taken action to improve the oversight of these facilities in two decades. His office has also launched a form for individuals to share their experiences of navigating ALF costs and quality. Committee members commented on recent data and patient stories that highlighted lapses in care at ALFs, lack of investment in front-line direct care workers, and the lack of affordable care options for individuals and families that do not have access to Medicaid-funded ALF services. Several panelists and Senators suggested that Congress develop solutions to develop solutions to increase ALF price and quality transparency, similar to Care Compare and other systems for Skilled Nursing Facilities.

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