HealthCare Roundtable e-News – May 28, 2024

 

Congressional Forum – June 5-6, 2024

Still Time to Register to attend the Roundtable’s 2024 Congressional Forum

The Phoenix Park Hotel, Washington, DC

Whether you actively advocate with the Administration or your Members of Congress or not, you should plan to participate in the Roundtable’s Congressional Forum. You’ll learn first hand from industry leaders, DC allies, and key friends in Congress about the issues which impact health care purchasers today.

Check out the Final Agenda Here.

To Register, please email the Roundtable Administrator today!

We look forward to welcoming you to Washington!


Top News

KFF Publishes Analysis on States’ Shift to Medicare Advantage Plans for Retirees in 2024

The Kaiser Family Foundation (KFF) published an analysis on trends in employer-sponsored health benefits for Medicare-age retirees. In 2024, nearly all states and D.C. offer Medicare Advantage (MA) plans to their Medicare-age retirees, with 12 states providing these plans exclusively. This shift from traditional retiree health benefits to MA reflects a broader trend among large employers aiming to manage costs and streamline administration. MA plans are seen as a cost-saving measure for states, potentially reducing their retiree health liabilities significantly. For example, Connecticut projected substantial savings and a reduction in unfunded liabilities by switching to MA. However, this shift also presents tradeoffs for retirees, such as potentially limited provider networks and the need for prior authorization for some services, which has led to legal challenges in places like Delaware and New York City.

The analysis highlights that nearly all states offer some form of health benefits to Medicare-age retirees, with a growing number adopting MA as a sole option. This trend is coupled with a decrease in states offering only supplemental plans for traditional Medicare. The cost-saving benefits for states, juxtaposed with the potentially higher out-of-pocket costs and restricted provider access for retirees, underscore the complex considerations involved in this transition.

 

CMS Releases New Option for Individual Online Reporting of Potential Violations of EMTALA

The Centers for Medicare and Medicaid Services (CMS) launched an option for individuals to more easily file Emergency Medical Treatment and Labor Act (EMTALA) complaints online. EMTALA requires Medicare-participating hospitals to provide medically appropriate and necessary care to screen, stabilize, and transfer any patient that presents at an emergency department. The web document integrates education materials on patients’ rights under EMTALA with information on how to file a complaint electronically. This move follows the Biden-Harris Administration’s comprehensive plan to promote patient access and education on federal legal entitlements.

Administrative Action

  • The Center for Medicare & Medicaid Services Office of Minority Health (CMS OMH) announced, Dr. Martin Mendoza as the new Chief Health Equity Officer of the Centers for Medicare and Medicaid Services and the Director of the Office of Minority Health. Dr. Mendoza will lead the CMS OMH towards the advancement of the integration of health equity in CMS’s partnerships, programs, and policies. Dr. Mendoza has experience working in the U.S. Department of Health and Human Services (HHS) OMH, U.S. Food and Drug Administration, and National Institutes of Health.

 

  • The National Institutes of Health (NIH) announced a new proposed policy within its Intramural Research Program (IRP) to ensure patient access to products developed through NIH-funded research. Organizations partnering with NIH through patent licensing agreements will be required to submit plans to promote access to resulting drugs, biologics, vaccines, or devices. NIH is seeking public input on this draft policy and its accompanying license agreement language to finalize the policy. Additionally, NIH will host an informational webinar on June 11, 2024, to discuss the proposed policy. As the largest public funder of biomedical research, NIH aims to foster partnerships that turn scientific discoveries into health improvements. NIH-funded technologies have historically contributed significantly to the U.S. economy and public health. However, access to these products often remains limited due to high costs or availability issues. The new policy intends to address these challenges by requiring licensees to develop access plans that consider affordability, availability, acceptability, and sustainability. The policy will apply to commercial licenses for NIH-owned inventions and will adopt a tiered approach, with more specific provisions for late-stage products closer to market launch. The NIH seeks feedback on promoting access, transparency, flexibility, support for licensees, and metrics for assessing policy impact. Input is welcome from a wide range of stakeholders, including patients, healthcare providers, and industry partners. Comments on the policy are due by July 22, 2024.

Congressional Action

  • House Ways and Means Committee Chairman Jason Smith (R-MO) and House Budget Committee Chairman Jodey Arrington (R-TX) sent a letter to the Congressional Budget Office (CBO) and Joint Committee on Taxation requesting an analysis of the budgetary effects of making existing ACA subsidies permanent. Specifically, the letter requests CBO and JCT provide an analysis on the budgetary effects on outlays, revenues, and the deficit for each fiscal year in the ten-year budget window, as well as the cumulative five and ten-year estimates; the change in Americans’ sources of health coverage, including the number of individuals who would no longer have employer-sponsored insurance over the ten-year window; and the percentage of the new Affordable Care Act premium tax credit spending, if the policy was made permanent, that would go to households with incomes above 400 percent of the federal poverty level for coverage years beginning January 1, 2025 and ending January 1, 2035.

 

  • The Senate Judiciary Committee held a full committee hearing exploring competition in the prescription drug market. Witnesses represented the pharmaceutical industry, patient advocates, and intellectual property lawyers. Discussion focused on balancing intellectual property rights with competition promotion. Healthsperien covered the hearing and detailed notes will be available soon.

 

  • The Senate Committee on Finance held a hearing that addressed the significant challenges and opportunities facing rural health care. Chairman Wyden (D-OR) highlighted the critical need for sustaining rural health to maintain rural life, emphasizing the difficult balance between rising costs and quality care. He noted the importance of telehealth, chronic disease management, and workforce issues as key areas that go hand in hand with rural health care. Senator Lankford (R-OK), who was sitting in for Ranking Member Crapo (R-ID) for this hearing, echoed these concerns, emphasizing the impact of hospital closures on his state and the administrative burdens, costs of nursing home care, pharmacy reimbursements, and in-network care access issue for rural patients as well. Witnesses elaborated on the disparities between rural and urban healthcare, with rural areas being more vulnerable and facing financial and staffing challenges than their urban counterparts. They stressed the importance of addressing chronic disease prevention, social determinants of health, and behavioral health services for rural patients, particularly post-pandemic, and spoke about the need for comprehensive solutions for these issues. Healthsperien covered the hearing and detailed notes can be found here.

 

  • The U.S. Senate Special Committee on Aging held a hearing on the impact of the Older Americans Act (OAA) reauthorization on local communities. The hearing consisted of four witnesses, among them were an older American who has benefitted from some of the OAA programs, two directors of an Area Agency on Aging (AAA), and the director of the Connecticut Ombudsman program. Much of the discussion in the hearing revolved around the food nutrition programs that are a product of the OAA. Witnesses advocated for more flexibilities with the dollars being directed to them regarding the nutrition programs and encouraged members to increase funding towards OAA programs. Furthermore, the witnesses agreed that a lack of sufficient staffing levels is an underlying cause of issues with the older adult population in long-term care facilities. Republicans argued for more flexibilities within funding so that states and localities can better tailor their services towards their constituents. Overall, members of the Special Committee on Aging generally agreed on the importance of the OAA and its programs, with a consensus that there needs to be more funding allocated towards it. Healthsperien covered the hearing and will have comprehensive notes available soon.

 

  • The House Budget Committee held a hearing exploring the budgetary impacts of healthcare monopolies. Chairman Arrington focused on addressing healthcare monopolies to reducing healthcare spending to help limit the federal debt. Ranking Member Boyle noted the successes of the Affordable Care Act and that healthcare monopolies negatively impact physicians and patients. Witnesses generally supported legislation that removes current legislative incentives for physicians and hospitals to consolidate and ensures the long-term financial stability of independent practices. Healthsperien covered the hearing and will have comprehensive notes available soon.

Mark your calendar:


Roundtable’s Congressional Forum

June 5-6, 2024

Phoenix Park Hotel, Washington, DC

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November 6-8, 2024

The Mayflower Hotel, Washington, DC


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