HealthCare Roundtable e-News – July 1, 2024


Top News

CMS Announces Cost Savings for Prescription Drugs through Medicare Rebate Program

The Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS) announced that Medicare enrollees will pay less for 64 drugs available through Medicare Part B. The Part B drugs will have a lowered coinsurance rate for the quarter from July 1, 2024 through September 30, 2024 because each drug company raised prices faster than the rate of inflation.  More than 750,000 Americans with Medicare use these drugs, which treat conditions including cancer and osteoporosis, every year. The Medicare Prescription Drug Inflation Rebate Program, a part of the Inflation Reduction Act, will allow some people with Medicare who use the drugs during this time period to save between $1 and $4,593 per day.


Congressmembers Urge Greater AI Oversight from CMS in MA Coverage Decisions

45 House Members and four Senators, led by Reps. Judy Chu (D-CA), Jerrold Nadler (D-NY), and Sen. Elizabeth Warren (D-MA), released a bipartisan, bicameral letter urging the Centers for Medicare and Medicaid Services (CMS) to increase oversight of artificial intelligence (AI) and software tools used to guide coverage decisions in Medicare Advantage (MA) plans. Multiple MA insurers currently use unregulated algorithms and AI tools to determine when to cut off payment for patient treatments, leaving seniors either to live without coverage or pay for their care themselves. Some of the actions that members of Congress encouraged CMS to take including to clarify the specific elements that must be contained in prior authorization denial notices, establish an approval process to review AI and algorithmic tools and their inputs to ensure the integrity of their use, and to prohibit the use of AI/algorithmic tools and software from use in coverage denials until a systematic review of their use can be completed.


House Appropriations Subcommittee Releases FY2025 Bill for Labor, Health and Human Services, Education, and Related Agencies, Cuts Spending by 11% 

The House of Representatives Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies held a markup for the FY2025 Labor, Health and Human Services, Education, and Related Agencies Act, which funds the operations of those agencies. The measure reflected the Republican majority through its budgetary restraint, amounting to 11% cuts when compared to FY2024. Subcommittee did not offer any amendments during the markup and, after tense opening remarks from leadership from both parties, passed the bill along strict party lines. In addition to cuts in the Department of Labor and Department of Education, and related agencies, the Republican Bill for FY2025 includes major Health and Human Services (HHS) cuts. Cuts were also made to Health Resources and Services Administration (HRSA), the Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH).

Administrative Action

The U.S. Department of Health and Human Services (HHS) Office of Climate Change and Health Equity (OCCHE) released two case studies on how Boston Medical Center and OhioHealth are leveraging the Inflation Reduction Act (IRA) to reduce carbon emissions. Boston Medical Center initiated a pilot program providing solar energy credits to patients, while OhioHealth utilized IRA tax incentives to fund free electric vehicle charging stations in rural areas. These studies, part of OCCHE’s Catalytic Program on Utilizing the IRA, aim to guide similar health organizations in using IRA funds for sustainability and health equity. The program also offers webinars and tools to aid providers in planning and executing such projects. Many providers, including Boston Medical Center and OhioHealth, presented their plans to use the IRA as part of the Catalytic Program’s webinar series over the summer, all of which are available online. Additionally, OCCHE announced that new case studies will be introduced throughout the year.

Congressional Action

The House Committee on Ways & Means Subcommittee on Health held a hearing on Improving Value-Based Care for Patients and Providers. Subcommittee Chairman Vern Buchanan (R-FL) expressed support for movement away from the fee-for-service model towards value-based care and called upon the CMS Innovation Center (CMMI) to produce models that generate savings. Subcommittee Ranking Member Lloyd Doggett (D-TX) echoed the Chairman’s concerns and expressed worry over CMMI’s evaluation methods of models. Witnesses and Representatives explored a variety of value-based problems and solutions including improvements to the physician fee schedule, CMMI congressional oversight, and changing the metrics used to determine quality care. Healthsperien covered the hearing, and detailed notes are available here.

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