HealthCare Roundtable e-News – March 11, 2024

 

 

Top News

Biden-Harris Administration Receives Counteroffers in First Round of Medicare Drug Negotiations

The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS) announced that all manufacturers participating in the first round of Medicare drug price negotiations have responded with counteroffers. The recent counteroffers follow HHS sending the initial offers on February 1, as the agency was given the power to do so through the recently implemented Inflation Reduction Act (IRA). If HHS and a participating manufacturer agree on a maximum fair price by the end of the negotiation period, those new prices will be published on September 1, 2024, and take effect at the start of 2026. While the drug negotiation prices will not go into effect until 2026, the IRA is already lowering costs for beneficiaries through an expansion of the Low-Income Subsidy program under Medicare Part-D that went into effect at the beginning of this year. Nearly 300,000 low-income individuals are benefiting from the program’s expansion.

 

FTC, DOJ, and HHS Prompt Investigation into Private Equity and Corporations’ Influence in Health Care

The Federal Trade Commission, the Department of Justice’s (DOJ) Antitrust Division, and the U.S. Department of Health and Human Services (HHS) initiated a cross-government public inquiry to address the growing influence of private-equity and other corporations within health care. Private equity and other corporate firms are increasingly participating in health care system transactions. This inquiry will investigate the effects of this trend on quality of care, patient health, workers’ safety, and affordable care. The three agencies issued a Request for Information (RFI) soliciting public feedback about transactions conducted by health systems, private payers, private equity funds, or other alternative asset managers involving health care providers, facilities, or services. Comments regarding deals related to dialysis clinics, nursing homes, hospice providers, primary care providers, hospitals, home health agencies, home- and community-based services providers, behavioral health providers, billing, and collections services are encouraged. Given the modern market realities of health care, this RFI seeks to inform policy efforts that will target consolidation in the health care system as well as promote and preserve competition in markets. The three involved agencies also participated in a workshop titled, “Private Capital, Public Impact: An FTC Workshop on Private Equity in Health Care” to further discuss the impact of private equity on health care.

Congressional Action

  • The U.S. House of Representatives Energy & Commerce Health Subcommittee held a hearing on several legislative proposals aimed at increasing treatments and access for people with rare diseases. The hearing, which was held on National Rare Disease Day, included testimonials from six expert witnesses. There was significant concern on the Republican side of the committee over the drug negotiation program that came out of the Inflation Reduction Act (IRA), as many members felt that limited returns on drugs would lead to slowing innovation from manufacturers. Democrats argued against amending the IRA outright, citing out-of-pocket costs already being reduced for seniors and the benefits of the drug pricing negotiations, as over 9 million seniors take one or more of the drugs being capped. There was some notable consensus on streamlining access for patients traveling across state lines to receive care at a specialized facility, particularly in making the Medicaid processing of out-of-state services more efficient. Healthsperien’s comprehensive coverage of the hearing can be found here.

 

  • On Saturday, President Biden signed the six-bill government funding package after the House and Senate passed the measures late last week ahead of the Friday, March 8 partial government shutdown deadline. This set of bills provides funding agreements for federal government agencies including Agriculture-FDA, Energy-Water, Military Construction-VA, Transportation-HUD, Interior-Environment, and Commerce-Justice-Science. Congress will likely begin to move on the remaining six funding bills, State-Foreign Operations, Legislative Branch, Labor-HHS-Education, Homeland Security, Financial Services, and Defense, this week to meet a March 22 deadline. These two six-bill packages would total $1.66 trillion in spending for fiscal 2024, which is below the $1.7 trillion in discretionary spending during the previous year.

 

  • The United States Senate Committee on Health, Education, Labor and Pensions (HELP) announced a Request for Information (RFI) on policies that the HELP Committee should consider during the reauthorization of the Older Americans Act (OAA). The OAA was last reauthorized in 2020 and will expire on September 30, 2024. The RFI solicits feedback on the impact of certain pandemic-era flexibilities, and policies that were enacted by the 2020 OAA reauthorization that supported the needs of older adults throughout the country. The RFI has two sections of questions, with one set focusing on more general aspects of the OAA reauthorization and the other being more targeted towards specific components of the reauthorization. Written responses to the RFI must be submitted to OAA@help.senate.gov, by March 21, 2024.

Medicare

Beginning in Calendar Year (CY) 2021, the Value-Based Insurance Design (VBID) Model permitted Medicare Advantage Organizations (MAOs) to incorporate the Medicare hospice benefit into their Medicare Advantage (MA) benefits package, known as the Hospice Benefit Component. However, due to escalating operational difficulties and decreasing MAO participation, CMS has decided to conclude the Hospice Benefit Component at the end of this year and will not accept applications for the CY 2025 Request for Applications for the component. The Hospice Benefit Component of the VBID Model aimed to alleviate coverage inconsistencies for MA enrollees electing hospice and assessed if MAOs covering the Medicare hospice benefit would enhance care quality while remaining budget neutral. Policies within the component, including comprehensive palliative care and concurrent care, fostered collaboration between MAOs and hospice providers, aiming to mitigate care fragmentation at end-of-life stages. CMS gathered insights from various stakeholders to gauge the component’s impact on care quality and safety. The decision to discontinue the Hospice Benefit Component does not indicate its success; CMS plans to evaluate it separately. Despite operational challenges, the Hospice Benefit Component fostered significant partnerships between MAOs and hospice providers, transforming serious illness care delivery in the MA program. CMS indicated that it would utilize the lessons learned from the component and release clarifying guidance later this year.


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