HealthCare Roundtable e-News – June 17, 2024

 

Top News

Bipartisan Bill Seeks to Streamline Medicare Advantage Prior Authorization

Congresswoman Suzan DelBene (D-WA-01) introduced the updated Improving Seniors’ Timely Access to Care Act, co-sponsored by Representatives Mike Kelly (R-PA-16), Larry Bucshon, M.D. (R-IN-08), and Ami Bera, M.D. (D-CA-06). Senators Roger Marshall, M.D. (R-KS), Kyrsten Sinema (I-AZ), John Thune (R-SD), and Sherrod Brown (D-OH) also supported the bipartisan legislation. The bill aims to streamline the prior authorization process under Medicare Advantage to improve care for seniors and reduce administrative burdens on healthcare providers. As of 2023, nearly 31 million seniors were enrolled in Medicare Advantage.

The bill proposes several key measures: implementing an electronic prior authorization process, increasing transparency regarding prior authorization requirements, and clarifying the authority of the Department of Health and Human Services (HHS) to establish timeframes for expedited determinations. Additionally, it aims to expand beneficiary protections to enhance enrollee experiences and outcomes. The legislation also requires HHS and other agencies to report to Congress on program integrity efforts. The bill seeks to codify recent regulatory advancements to prevent future reversals and further improve the prior authorization process. Supported by 130 House members, 42 Senate members, and over 370 national and state organizations, the bill addresses significant administrative burdens in the healthcare system.

 

House Energy and Commerce Committee Mark Up 13 Health Bills 

The House Energy and Commerce Committee considered 13 health bills in a full committee markup aiming to continue to increase access to care, lower costs, and address waste, abuse, and fraud. All 13 bills passed unanimously. The legislation covered a myriad of topics including telehealth, improving access to care, fraud prevention in Medicare and Medicaid, and increasing transparency of providers. Healthsperien covered the markup, and a detailed summary can be found here.

Administrative Action

11 Advisors on the Food and Drug Administration’s (FDA) Peripheral and Central Nervous System Drugs Advisory Committee voted in favor of approval for Eli Lilly’s Alzheimer’s Drug, Donanemab. Panelists say the benefits outweigh the risks of the drug as long as there is continued data collection and analysis for patients who are Black or Hispanic and patients with Down’s Syndrome or low tau protein levels. 19 of 22 witnesses supported the approval of donanemab with the remaining three citing concerns about side effects. If ultimately approved, the FDA would issue a black box warning to the label, the agency’s strongest warning for serious adverse reactions.

Congressional Action

The House Committee on Energy & Commerce Subcommittee on Health held a hearing “Checking-In On CMMI: Assessing The Transition To Value-Based Care.” Deputy Administrator and Director of the Center for Medicare and Medicaid Innovation (CMMI) Dr. Elizabeth Fowler testified to the successes of CMMI including continuous development of innovative programs that improve quality of care, reduce costs, and promote health equity. Generally, Republican Representatives focused their questioning on the limited cost savings CMMI has yielded, the few models that have been approved for broader implementation, and concerns about agency overreach. With their line of questioning, Democratic Representatives generally highlighted successes CMMI has brought including increased coverage, improved health equity, improved quality of care, and some models demonstrating moderate cost savings. Healthsperien covered the hearing and will have comprehensive notes available soon.

Regulatory Action

The Consumer Financial Protection Bureau (CFPB) proposed a rule that would remove medical debt from most credit reports, improve privacy, increase credit scores and loan approvals, and prevent coercive debt collection behaviors. If the proposed rule were promulgated in its current form, 15 million Americans would have a combined $49 billion in medical debt removed from their credit reports. Specifically, the proposed rule would: eliminate the exception that allows medical debt to be used by lenders to make credit eligibility determinations, ban credit reporting companies from including medical debt information on credit reports sent to creditors, and prohibit lenders from using medical devices as collateral on a loan and ban lenders from repossessing medical devices if collecting on a loan. Comments on the proposed rule are welcome on or before August 12, 2024.

Research

The Commonwealth Fund recently published a study on the Affordable Care Act’s (ACA) “firewall” provision that prevents workers with affordable employer-sponsored insurance (ESI) from receiving premium tax credits (PTCs) in the individual marketplace. The ACA’s “firewall” provision prevents workers from receiving PTCs if they have access to affordable ESI, defined as costing less than 8.39% of household income. Eliminating this firewall could help low-income workers access more affordable coverage. Using the Urban Institute’s Health Insurance Policy Simulation Model, it was estimated that removing the firewall would shift 1.8 million people out of ESI, with many finding more affordable marketplace coverage and some enrolling in Medicaid, reducing the uninsured population by 1.4 million. Despite this, ESI tax subsidies are substantial, incentivizing most employees to remain in ESI.


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