HealthCare Roundtable e-News – June 12, 2023

 

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Innovations in Virtual Care: How Public Sector Purchasers Are Navigating the Changing Telehealth Policy Landscape

Webinar: Tuesday, June 20 at 2 PM EDT

As a result of the pandemic, policymakers, providers, and payers have had to acclimate to an increased need and interest in virtual care options. Telehealth has demonstrated the potential to support more equitable access to high-quality, affordable health care. Following the unwinding of the Public Health Emergency (PHE), policymakers and members of the health care community are navigating how to maintain, and increase, access to telehealth services and make permanent PHE telehealth flexibilities. Join us to hear from the Public Sector HealthCare Roundtable senior policy team and policy experts on the evolution of telehealth policy and how it’s enabled the development of new virtual care solutions. 

This webinar is being presented in conjunction with Hinge Health.

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2023 Federal Advocacy Workshop

Washington, DC | Wednesday, July 12, 2023

The Public Sector HealthCare Roundtable will present a hybrid Federal Advocacy Workshop on Wednesday, July 12, 2023. The Workshop will focus on the Roundtable’s federal priorities, particularly as they relate to current initiatives of the Biden Administration and timely Congressional activity. In addition to hearing from Administration officials and Congressional staff, the workshop will include engagement and networking with many of the Roundtable’s allies and friends.

The Workshop agenda will include the following presentations:

  • Federal Health Care Policy: Progress and Priorities
  • What’s Next in Health Care: Perspectives from Capitol Hill
  • Past, Present, and Future: Trends in the Employer-Sponsored Market and the Potential Impacts of Policy Reforms
  • Trends in Specialty Drug Spend
  • Partnerships for Success: Advancing Shared Priorities
  • Amplifying Your Voice: Advocacy as a Tool

Whether your health plan is able to actively advocate on behalf of our shared priorities or not, the agenda will include information that is very relevant to your role as a public sector health care purchaser. Whether we call it advocacy, education, or simply information-sharing, it’s important for federal officials to understand how their policies and programs impact the benefits you provide to the public employees, retirees, and survivors of your plans.

The Workshop – which will be complimentary for Roundtable members and friends – will take place at the Healthsperien Office, 601 Massachusetts Avenue, NW, Suite 520 West, Washington, DC. The program will begin at 11:00 AM and will conclude at 3:30 PM.

For those attending in person – The agenda has been developed to make it possible for many to come to DC in the morning and leave in the early evening. For those who choose to arrive on Tuesday, July 11, the Roundtable will be hosting a casual reception and dinner. Roundtable staff will also be available to help attendees plan (contact lists and handouts) Hill visits on Tuesday, July 11, Thursday, July 13, or both. Although the Roundtable hasn’t secured a block of hotel rooms, we have prepared a list of hotel recommendations that are within easy walking distance to the Healthsperien office. Click here for hotel recommendations.

For those attending virtually – The agenda will be presented in two segments – a morning program and an afternoon program – for the convenience of online participants.

Registration Form is now available.


Top News

NCHS Releases Data Brief on the Characteristics of Adults Who Did Not Take Medication as Prescribed to Reduce Costs

Last week, the CDC’s National Center for Health Statistics (NCHS) released a brief examining the characteristics of adults aged 18–64 who did not take medication as prescribed due to cost. The cost-saving measures described in the brief include skipping doses, taking less medication than prescribed, or delaying filling a prescription. NCHS notes that cost-saving strategies such as these may worsen health conditions, resulting in more serious illness, and require additional expensive treatment, and therefore have implications for other health care costs. Specifically, the brief highlighted the following key findings: 1) 8.2 percent of adults aged 18-64 who took prescription medication in the past 12 months reported not taking medication as prescribed due to cost. Women (9.1%) were more likely than men (7.0%) to not take medication as prescribed. 2) Uninsured adults were more likely than adults with other health coverage, Medicaid, or private health insurance to not take medication as prescribed due to cost. 3) Adults with disabilities (20.0%) were more likely than adults without disabilities (7.1%) to not take medication as prescribed to reduce costs. 4) Adults without prescription drug coverage were more likely to not take medication as prescribed to reduce costs compared with adults with public or private prescription drug coverage.

 

Ways & Means Committee Advances Telehealth Expansion Act and Chronic Disease Flexible Coverage Act to the House Floor

Last week, the House Committee on Ways & Means held a markup on several social security and small business health care bills including H.R. 1843, the Telehealth Expansion Act of 2023. The Committee approved the telehealth bill, with five Democrats joining Republicans in a 30-12 vote. H.R. 1843 would amend the Internal Revenue Code of 1986 to permanently extend the exemption for telehealth services from certain high deductible health plan rules. The bill featured an amendment from Chairman Smith (R-MO) that would make the safe harbor created via the CARES Act permanent with an effective date of after December 31st, 2024. Ranking Member Neal (D-MA) expressed concerns over the bill by stating that there is still more to learn about telehealth to ensure it doesn’t worsen health disparities or quality of care. Ranking Member Neal also was concerned that Republicans have previously used high-deductible health plans to undermine the Affordable Care Act and benefit the wealthy. More than 30 million Americans are currently on high-deductible plans, and face uncertainty about their telehealth access post-2024.

The markup also included the passage of H.R. 1843, the Chronic Disease Flexible Coverage Act. The bill codifies Internal Revenue Service (IRS) guidance relating to the treatment of specific services and items for chronic conditions as meeting the preventive care deductible safe harbor for purposes of high deductible health plans in connection with health savings accounts. The bill would specifically allow people with high-deductible health plans used along with health savings accounts to have 14 preventive care services related to chronic disease management covered before the plan deductible is reached. H.R. 1843 received strong bi-partisan support during the session and was ultimately approved in a 34-6 vote. The Roundtable is a member of Smarter Health Care Coalition, which focuses on ensuring patients have access to high-value health care, played a key role in advocating for the adoption of this legislation.

 

Pharmaceutical Manufacturer Merck Sues U.S. Government to Halt Medicare Drug Price Negotiation

On Tuesday, pharmaceutical manufacturer Merck & Co filed a lawsuit against the United States government, seeking an injunction of the Medicare drug price negotiation program contained in the Inflation Reduction Act (IRA). The lawsuit, filed in the U.S. District Court for the District of Columbia against the U.S. Department of Health & Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS), argues that the program violates the Fifth and First Amendments to the U.S. Constitution. Merck argues that under the law, drugmakers would be forced to negotiate prices for drugs at below-market rates, which the company asserts violates the part of the Fifth Amendment that requires the government to pay just compensation for private property taken for public use. Merck also argues that the law violates the First Amendment protection of free speech by forcing companies to sign agreements conceding that the negotiated prices are fair. The lawsuit is the first attempt by a drug manufacturer to challenge the law and could be the first of many. CMS is expected to publish the first list of 10 Medicare Part D drugs selected for negotiations, with new prices going into effect in 2026 by September 1, 2023.

Administrative Action

On Tuesday, the Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA), published their National Model Standards for Peer Support Certification for substance use, mental health, and family peer workers. Building a national certification program for peer specialists was a primary goal outlined by President Biden in his 2022 State of the Union Address. The national model standards were created to help accelerate the universal adoption, recognition, and integration of the peer workforce across all elements of the U.S. healthcare system. The national model standards are not intended as a substitute for any state certifications but instead have been developed as guidance for states, territories, tribes, and others, to promote quality and encourage alignment and reciprocity across often disparate state peer support certifications. SAMHSA collaborated with federal, state, tribal, territorial, and local partners including peer specialists, and requested and incorporated public comments, to develop the new standards.

Congressional Action

The House Education and the Workforce Committee removed the Telehealth Expansion for Workers Act of 2023 from a recent markup after previously announcing they would vote on the legislation. This move represents a slowdown in progress toward a floor vote. The bill, which is a priority of the telehealth industry, would permanently extend a recently expired pandemic provision allowing employers to offer telehealth services as a tax-free benefit separate from other health plans. Supporters say that the bill would improve access to care and help employees not eligible for other employer-sponsored health insurance coverage. Opponents of the bill raise concerns regarding regulatory oversight of the telehealth benefit plans and argue that the bill could mislead consumers into thinking that the plans offer more extensive coverage than they do. 

Medicare

On Thursday, the Centers for Medicare and Medicaid (CMS) announced a new primary care model, the Making Care Primary (MCP) Model, that will be tested under the Center for Medicare and Medicaid Innovation in eight states— Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington. The MCP Model will run for 10.5 years, from July 1, 2024, to December 31, 2034, and will provide participants with additional revenue to build infrastructure, make primary care services more accessible, and better coordinate care with specialists. The primary goals of the MCP are to: 1) Ensure patients receive primary care that is integrated, coordinated, person-centered and accountable; 2) Create a pathway for primary care organizations and practices—especially small, independent, rural, and safety net organizations—to enter into value-based care arrangements; and 3) Improve the quality of care and health outcomes of patients while reducing program expenditures. CMS is currently working with State Medicaid Agencies in the participating states to engage in full care transformation across public programs, with plans to engage private payers in the coming months.

Litigation

  • The parties in the court case Braidwood vs HHS have been asked to report to the Fifth Circuit of Appeals by June 9th on a possible agreement that would allow the district court order barring HHS from enforcing the Affordable Care Act’s preventive service mandate to be stayed throughout the appeal of the case. Judge Reed O’Connor’s March 31 order is currently on administrative hold as the Fifth Circuit panel weighs the government’s request to set aside the order as it applies to people beyond the plaintiffs.

  • On Thursday, the United States Supreme Court issued a decision in the closely watched Health and Hospital Corporation of Marion County v. Talevski case. The court ruled in favor of Talevski, upholding an individual’s right to sue over poor treatment. The 7-2 ruling supports decades of precedent and protects patients’ access to critical health. An adverse ruling would have impacted the rights of beneficiaries across a broad range of state-administered public programs, including the Supplemental Nutrition Assistance Program (SNAP), child welfare, and many others. Low-income Americans and several vulnerable communities would have been significantly restricted by an adverse decision and lost the ability to hold government officials and health providers accountable. The ruling hinged on the interpretation of Section 1983, which provides an individual’s right to sue state government employees and others acting “under control of state law” for civil rights violations.

Research

  • Last Friday, the U.S. Conference of Mayors released a new survey which takes a close look at how mayors are working to address various dimensions of the mental health crisis in their communities. Included in the survey were questions regarding the ability of local agencies to meet residents’ service needs, mental health problems affecting young people and the services to meet their needs, the relationship between homelessness and mental health problems, emergency response initiatives, police officer mental health and wellness, and behavioral health worker shortages. Responses were collected from 117 cities in 36 states and showed that 97 percent of mayors noted requests for mental health services increased in their city in the past two years. Meanwhile, 88 percent of responses said they do not have access to adequate mental health resources to address the crisis. Additionally, almost all (93%) cities have reported that they improved their emergency response to people experiencing a behavioral health crisis and 81 percent have found that programs providing stable housing for a year or more for people with mental illness helps to improve mental health outcomes.

  • On Tuesday, the American Health Care Association (AHCA) and National Center for Assisted Living (NCAL) released a survey of more than 400 nursing home providers from across the U.S. highlighting that the sector continues to face a serious workforce crisis. The lack of interested and qualified caregivers is forcing more than half of nursing homes to turn away new patients, and more than one-quarter have downsized their facility or closed completely. The survey also underscores how an unfunded, federal staffing mandate will be impossible for nursing homes to meet given the current labor market conditions. Importantly, one-third of nursing homes say their workforce situation has worsened since the end of 2022. In order to continue providing high-quality care, 98 percent of providers have had to ask current staff to work overtime or extra shifts, 75 percent have had to hire expensive temporary agency staff, and more than half have had to limit new admissions due to staffing shortages.