HealthCare Roundtable e-News – June 5, 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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Save the Date

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 for the Federal Advocacy Workshop will open on June 8th.


Top News

Congress Passes Bill to Raise Debt Ceiling, Preventing First-Ever U.S. Default

The Senate passed The Fiscal Responsibility Act of 2023 in a 63-36 decision Thursday evening. The vote followed a Wednesday evening vote in the House that saw a bipartisan coalition vote in favor of passing the legislation via a 314-117 vote. The bill will now advance to President Biden’s desk where he is expected to sign the bill into law prior to the June 5th deadline. The bill will increase the federal debt limit, suspend the federal debt limit until January 2025, and limit elements of nondefense discretionary spending for the next two years. The Act’s primary distinguishing feature is the reimposition of enforceable discretionary spending caps for fiscal years 2024 and 2025 which are expected to save over $200 billion in the first two years. The Act specifically includes:

  • SNAP. The Act increases the SNAP age of exemption from work requirements on able-bodied recipients without children from 50 to 55, phased in over three years. The time frame of working at least 20 hours a week, or 80 hours a month, continues to apply. Otherwise, recipients will receive benefits for only three months every three years. This change sunsets in 2030.
  • COVID-19 Funding. Provisions in the Act would claw back unobligated COVID-19 funding and make agencies offset the cost of discretionary rules that cost more than $1 billion over 10 years or $100 million in any single year, or attest they are implementing statutorily required rules in the most cost-effective manner through 2024. The Act would rescind roughly $28 billion in unobligated COVID-19 funds from more than 120 accounts.
  • TANF. Currently, states can receive credit for caseload reductions, as measured against certain levels. The Act would update the reference period to 2015 from 2005, which could incrementally reduce caseloads.
  • Health care Fraud and Abuse Control. The Act has provisions that would increase health care fraud and abuse funds to $604 million in additional new budget authority for fiscal 2024 and $630 million in additional new budget authority for fiscal 2025.

 

Comparison of Out-of-Pocket Spending on Ultra-Expensive Drugs in Medicare Part D Versus Commercial Insurance

Late last week, JAMA Network published a research study investigating out-of-pocket spending for ultra-expensive drugs in the Medicare Part D program versus commercial insurance. This cohort study, including 37,324 Part D beneficiaries and 24,159 commercially insured individuals, showed that Medicare Part D beneficiaries without low-income subsidies spent 2.5 times more out of pocket on ultra-expensive drugs and were subject to greater variation in this spending compared with commercially insured patients aged 45 to 64 years. The study notes that the Inflation Reduction Act, which established a $2000 out-of-pocket cap in Part D, has the potential to lower out-of-pocket costs for more than 125,000 Part D beneficiaries who use ultra-expensive drugs and are ineligible for low-income subsidies, thus ameliorating increases in out-of-pocket spending when transitioning from commercial insurance to Part D.

 

CMS Outlines Plans to Broadly Cover New Class of Alzheimer’s Drugs

The Centers for Medicare and Medicaid Services (CMS) issued a press release outlining plans to broadly cover a new class of Alzheimer’s drugs once the medications receive full approval from the Food and Drug Administration (FDA). CMS will cover the new set of drugs for patients enrolled in Medicare Part B who meet the criteria for coverage which includes patients’ physicians and clinical teams participating in registries to collect evidence about how the drugs work in the real world. If the FDA grants traditional approval, Medicare will move to fully provide coverage for use in appropriate settings that also support the collection of real-world information to study the usefulness of these drugs for people with Medicare. CMS has faced intense pressure from lawmakers and patient advocacy groups to change its restrictive national coverage decision that limits coverage for new Alzheimer’s drugs to patients in clinical trials in the absence of full FDA approval. The first drug expected to be covered by the expanded plan, Eisai’s Leqembi, could be granted full approval from the FDA as soon as this summer.

Regulatory Action

  • The U.S. Food and Drug Administration (FDA) released a proposed rule that would implement a new type of patient medication guide known as patient medication information (PMI). The agency believes the new PMI would prevent health care misinformation and disinformation, reduce preventable adverse drug reactions, and improve medication adherence and health outcomes by providing patients with simple and straightforward medication information. Available in print and online for products that are used, dispensed, or administered on an outpatient basis, the PMI would replace current medication guides and become a requirement for brand and prescription drugs in addition to certain biological products. The proposal would be implemented over five years, and the current medication guide and patient package insert regulations would remain in place but no longer apply to prescription drug products once the FDA-approved PMI replacement is implemented for the specific medication.

  • The Centers for Medicare and Medicaid Services (CMS) published a final rule withdrawing COVID-19 vaccination requirements for certain workers at CMS-covered health care facilities. On November 5, 2021, the Biden administration and CMS issued an interim final rule (IFC) which required Medicare- and Medicaid certified providers to be vaccinated against COVID-19. CMS recognizes that vaccines are important for preventing severe illnesses and promoting public health. However, CMS highlighted that the Agency has been evaluating its policies on an ongoing basis and that the incidence of severe COVID-19 has declined significantly since the IFC was issued. Thus, they are withdrawing the health care staff COVID-19 vaccination provisions. CMS still strongly encourages facilities, when the opportunity exists and resources allow, to facilitate the vaccination and education of all individuals who provide services infrequently or frequently.

Congressional Action

On Wednesday night, the U.S. House of Representatives passed the compromise debt ceiling bill with broad bipartisan support suspending the debt ceiling through January 2025 with a 314-117 vote. The legislation will next be sent to the Senate for a vote before going to the White House for President Biden’s signature ahead of the Monday deadline. This follows a letter sent to the speaker of the house on Tuesday by the Congressional Budget Office, which estimates that the legislation would result in $1.5 trillion in savings over a decade.

Medicare

The Center for Medicare & Medicaid Innovation (CMMI) released Performance Year (PY) 8 results for the Independence at Home Demonstration (IAH). The IAH Demonstration uses a payment incentive and unique delivery model for home-based primary care for Medicare fee-for-service (FFS) beneficiaries with multiple chronic illnesses and functional limitations. The demonstration tests whether home-based primary care designed to provide comprehensive, coordinated, continuous, and accessible care to high-need patients across all treatment settings: 1) Reduces preventable hospitalizations, readmissions, and emergency department visits; 2) Improvises health outcomes commensurate with beneficiaries’ stage of chronic illness; 3) Improves the efficiency of care; 4) Reduces the cost of health care services; and 5) Achieves beneficiary and family caregiver satisfaction.

Medicaid

On Wednesday, The Kaiser Family Foundation released early data showing that as states begin to unwind the COVID emergency continuous enrollment provision and resume Medicaid disenrollment, there are varying disenrollment rates. While only 11 states have reported data from their unwinding process, their numbers show that over half a million people have already been disenrolled, with nearly 250,000 in Florida alone. The disenrollment rate ranges from 54% in Florida, down to just 10% in Virginia and Pennsylvania. In some states like Arkansas, Iowa, and Florida, early renewals are mostly among people that states think are no longer eligible or did not respond to renewal requests while the continuous enrollment provision was in place. As shown in the survey, two-thirds of Medicaid enrollees are unaware that the states are now permitted to resume disenrollment, leading to higher turnover in the process. 

Research

The Robert Wood Johnson Foundation (RWJF) published a survey, providing insights into nurses’ experiences and perceptions of discrimination in the health care setting. The survey found that nurses feel discrimination and racism are highly prevalent in the workplace, both from patients and colleagues. More than half of the surveyed nurses noted that much of the discrimination they see in the workplace stems from the culture of racism common to their nursing schools. Furthermore, the survey uncovered that Asian, Black/African American, and Latino/Hispanic nurses are significantly more likely than White nurses to have seen or experienced microaggressions. As part of the survey, one-on-one interviews were conducted with a group of front-line nurses.