HealthCare Roundtable e-News – May 30, 2023

 

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 1st.


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.

Registration for this webinar will open on June 1st.

Top News

Biden-Harris Administration Releases Proposed Rule to Advance Prescription Drug Transparency in Medicaid

Last week, the U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), announced that it is proposing steps to further drive down prescription drug costs in Medicaid and build on President Biden’s executive order to lower prescription drug costs. Under the proposal in CMS’ notice of proposed rulemaking (NPRM), Medicaid would have an increased ability to hold drug manufacturers accountable for what Medicaid programs pay for drugs. The proposed rule would give CMS authorities to increase the transparency of prescription drug costs and the administration of drug benefits in Medicaid. Specifically, the proposed rule:

  • Increases Transparency of Prescription Drug Costs: Proposes to provide CMS and states with additional tools like a drug price verification survey to understand drug prices and enables states to better negotiate what Medicaid pays for drugs.
  • Increases Transparency of Managed Care Plans: Proposes that contracts between states, Medicaid-managed care plans, and third-party contractors, such as PBMs, reflect transparent reporting of drug payment information among third-party contractors.
  • Increases Transparency in Drug Classifications: Proposes to address the potential misclassification of drugs as brand name or generic, ensuring states would receive the appropriate rebates. If there is misclassification, it proposes to give CMS the ability to take corrective action.

The proposed rule is set to be published in the Federal Register on Friday, 5/26. The public comment period will be open through July 25, 2023.

 

U.S. House Committee on Oversight and Accountability Holds Hearing on The Role of Pharmacy Benefit Managers (PBMs) in Prescription Drug Markets Part I: Self-Interest or Health Care

The U.S. House Committee on Oversight and Accountability held a hearing on the The Role of Pharmacy Benefit Managers (PBMs) in Prescription Drug Markets Part I: Self-Interest or Health Care. Chairman Comer (R-KY) provided opening statements on the importance of this hearing to understand how PBMs have shielded payers from learning how PBMs are profiting off of payers in the health care system. Ranking Member Raskin (D-MD) also provided opening statements mentioning that this committee must continue the work of previous Chairs Elijah Cummings (D-MD) and Carolyn Maloney (D-NY) in exploring the dangerously high prices of prescription drugs as a social problem. The four witnesses who provided their testimonies were from the Community Oncology Alliance, AffirmedRx, Panama Pharmacy, and Families USA. Pro-PBM arguments from the panel highlighted how PBMs can negotiate a better rate since they act as a middleman to drive down the amount of money pharmaceutical companies are using to profit. General Anti-PBM arguments emphasized: 1) Independent community pharmacies disappearing due to DRI fees handed out by PBMs (unpredictable fees handed out by PBMs after prescriptions); 2) The use of PBMs extracting rebate payments from drug makers even though rebates were not passed along to the consumers, among other topics.

 

U.S. House Committees on Energy & Commerce Holds Full Committee Markup of 19 Bills

The House Committee on Energy & Commerce held a full committee markup of 19 bills. This included a markup of 6 health-related bills pertaining to transparency reporting, consolidation, and patient access in health care. While most of the bills discussed throughout the markup passed advanced without conflict, House Democrats were divided on the passage of the Medicaid VBPs for Patients (MVP) Act with concerns regarding codifying the bill prior to seeing it’s impacts on Medicaid spending. H.R. 3290 was also narrowly adopted in a 29-22 vote. 1) H.R. 1418, the Animal Drug User Fee Amendments of 2023, as amended, by a vote of 49-0. 2) H.R. 2544, the Securing the U.S. Organ Procurement and Transplantation Network Act, as amended, by a vote of 48-0. 3) H.R. 3561, the Promoting Access to Treatments and Increasing Extremely Needed Transparency Act of 2023, or the PATIENT Act of 2023, as amended, by a vote of 49-0. 4) H.R. 2666, the Medicaid VBPs for Patients (MVP) Act, as amended, by a vote of 31-19. 5) H.R. 3284, the Providers and Payers COMPETE Act, as amended, by a vote of 49-0. 6) H.R. 3290, to amend title III of the Public Health Service Act, as amended, by a vote of 29-22.

Administrative Action

  • On Wednesday, the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) released a report summarizing the progress that HHS has made on improving access to language assistance services to persons with limited English proficiency (LEP). This report was issued in response to President Biden’s Executive Order (EO) 13985, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government. The EO intends to increase access to government services to address barriers in federal programs. The first annual report summarizes the progress HHS has made to date, as well as mapping out specific benchmarks that must be reached to further increase access for persons with LEP. The report identified four key areas in which reducing barriers and increasing language access are necessary, including internet access, telephone access, access to programs and activities, and federal funds to provide language services. Similarly, the report outlined four goals HHS will strive for in 2023: 1) The creation of a new HHS Language Access Coordinator position 2) Creation of a centralized language access center hub for HHS 3) Updating and revising HHS’s 2013 Language Access Plan 4) Taking steps to address problems identified in OCR investigations of LEP complaints filed against HHS.

  • The U.S. Department of Health and Human Services (HHS) announced that they awarded 13 grants to communities to create new and enhance existing mobile crisis response teams through the Substance Abuse and Mental Health Services Administration (SAMHSA). The new response teams will provide mental health and substance use care in high-need areas in coordination with local law enforcement. Recipients of the funding must improve crisis system capacity by providing post-crisis follow-up, developing and implementing protocols for coordination with law enforcement, providing evidence-based crisis training to providers and first responders, mapping community crisis systems, and improving use of data. Communities that have received grants may also support a range of other activities that enhance their crisis systems. The new grants aim to help advance President Biden’s strategy to address the national mental health crisis by building on mobile crisis grants awarded last year and other efforts to support crisis care tied to the 988 Suicide & Crisis Lifeline.

  • The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), awarded more than $65 million to 35 HRSA-funded health centers to address the maternal mortality crisis. The funds will support maternal health care through health centers, funding innovative solutions to reduce disparities for at-risk patients and improve maternal health outcomes. The health centers will use the funding to develop patient-centered models of care delivery that address the clinical and health-related social needs of patients at the highest risk of maternal mortality. The announcement supports the Biden-Harris Administration’s Maternal Health Blueprint, a whole-of-government strategy aimed at improving maternal health, particularly in underserved communities. 

Regulatory Action

The Food and Drug Administration (FDA) approved Opiant Pharmaceuticals Nasal Spray, which is used to reverse opioid-related overdoses in adults and pediatric patients 12 years of age and older. Sold under the name Opvee, the spray is advertised to act faster and have longer lasting effects in comparison to Naloxone which is commonly used to combat opioid overdoses. This approval follows the Biden Administration boosting the availability of Narcan to try and curb the nations’ opioid crisis that resulted in over 100,000 deaths in 2021. 

Congressional Action

  • On Friday, May 19th, Senators Menendez (D-NJ) and Sullivan (R-AK) introduced the Tech to Save Moms Act, which would promote the development of telehealth and other digital tools to reduce maternal mortality, and is included in the recently reintroduced Black Maternal Health Momnibus Act. The bill includes: 1) Requiring the Center for Medicare and Medicaid Innovation to consider models for integrating telehealth and maternal healthcare; 2) Funding technology-enabled collaborative learning and capacity building models for maternity care providers in rural and underserved areas; 3) Establishing a grant program to promote digital tools to improve maternal health outcomes; and 4) Commissioning a comprehensive study on the use technology in maternity care to reduce maternal mortality, morbidity and disparities.

  • The United States House Committee on Oversight and Accountability held a hearing titled, “The Role of Pharmacy Benefit Managers (PBMs) in Prescription Drug Markets Part I: Self-Interest or Health Care?” Chairman Comer (R-KY) provided opening statements on the importance of this hearing to understand how PBMs have shielded payers from learning how PBMs are profiting off of payers in the health care system. Ranking Member Raskin (D-MD) also provided opening statements mentioning that this committee must continue the work of previous Chairs Elijah Cummings (D-MD) and Carolyn Maloney (D-NY) in exploring the dangerously high prices of prescription drugs as a social problem. The four witnesses who provided their testimonies were from the Community Oncology Alliance, AffirmedRx, Panama Pharmacy, and Families USA. Pro-PBM arguments from the panel highlighted how PBMs can negotiate a better rate since they act as a middleman to drive down the amount of money pharmaceutical companies are using to profit. General Anti-PBM arguments emphasized: 1) Independent community pharmacies disappearing due to DRI fees handed out by PBMs (unpredictable fees handed out by PBMs after prescriptions); 2) The use of PBMs extracting rebate payments from drug makers even though rebates were not passed along to the consumers, among other topics.

  • Senators Mark Warner (D-VA) and Tim Scott (R-SC) reintroduced a bipartisan bill to empower nursing homes to better screen and vet potential employees and improve and broaden accessibility to training programs for in-house Certified Nurse Assistants (CNAs). The Ensuring Seniors’ Access to Quality Care Act would provide nursing homes with access to the National Practitioner Data Bank, a national criminal background check system, to improve the homes’ ability to verify the records of potential caregivers. Currently, nursing homes do not have National Practitioner Data Bank authorization and must use state-level criminal checks that do not provide the same depth and breadth of information. The bill also helps relax regulations that prohibit certain senior living facilities from conducting training for in-house CNAs. Existing regulations state that facilities that have been deemed to have deficiencies such as poor conditions are automatically prohibited from conducting CNA staff training programs for two years even if the problem has been resolved. This period without training can limit a facilities’ ability to retain existing staff and maintain adequate levels of training. The legislation would provide pathways for senior living facilities to reinstate their CNA training programs.

  • Late last week, Representatives David Trone (D-MD), Brian Fitzpatrick (R-PA), Susan Wild (D-PA), and John Joyce (R-PA) reintroduced (one-pager) the bipartisan Higher Education Mental Health Act to address concerns about student mental health throughout the nation’s colleges and universities. The bill would establish a national commission to study the mental health concerns facing students at institutions of higher education, provide a report to Congress with information on the services available to students with mental health conditions, and create a roadmap focused on improving the mental health services available at colleges and universities. More than 75% of mental health conditions begin before the age of 24, and legislators note the importance of understanding the challenges this population faces and how it impacts their mental health. This legislation comes at a time of increasing rates of usage of mental health counseling centers, social isolation, and loneliness. A senate companion of the legislation is led by Senators Bob Casey (D-PA) and Tim Kaine (D-VA).

  • Last week, House committees held hearings on price transparency, hospital consolidation, and a markup of 17 bills, including reforms to PBM practices. Healthsperien was there to cover the hearings; full notes are now available and linked: 1) The House Ways and Means Health Subcommittee held a hearing on anticompetitive and consolidated markets, focusing on how the healthcare marketplace has become more consolidated and less competitive in recent years, leading to higher prices and fewer options for patients (see full notes here). 2) The House Energy and Commerce Health Subcommittee conducted a markup of 17 bills, many of which focused on price transparency, the 340B Drug Pricing Program, and pharmacy benefit managers (see full notes here) 3) The House Ways and Means Committee held a hearing on health care price transparency, focusing on methods of consumer involvement, data sharing, and price transparency across the U.S. healthcare system (see notes full here).

  • Senators Carper (D-DE), Cassidy (R-LA), and Representatives Blumenauer (D-OR) and Wenstrup (R-OH) introduced the Program of All-Inclusive Care for the Elderly (PACE) Part D Choice Act of 2023. If passed, the bill would allow Medicare-only PACE enrollees to choose between the PACE Part D plan, currently available, or a qualified standalone Part D plan that may be more affordable. The legislators in the announcement estimate that this bill could improve access to the PACE program and save Medicare beneficiaries nearly $1,000 a month.

Medicare

  • Recently, the Centers for Medicare and Medicaid Services (CMS) updated their Frequently Asked Question (FAQ) regarding if hospital bills for outpatient physical therapy (PT), occupational therapy (OT), speech language pathology (SLP) services, Diabetes Self-Management Training (DSMT), and Medical Nutrition Therapy (MNT) can be provided to beneficiaries in their homes through telecommunication by hospital-employed staff. CMS has determined that through the end of CY 2023, PT, OT, SLP, DSMT, and MNT providers can continue to bill for services when furnished remotely in the same way they have been during the public health emergency (PHE). CMS recognizes that therapists and many of the practitioners providing such services remain on the list of distant site practitioners for Medicare telehealth services.

  • Recent reporting indicates (subscription required) that Medicare Administrative Contractors (MACs) have jointly decided that they will continue to pay for remote monitoring devices for Medicare fee for service (FFS) patients. A group of MACs representing most of the country convened earlier this year to make the decision. The decision represents a win for the telehealth industry, especially given the Centers for Medicare and Medicaid Services (CMS) statement earlier this month that they would no longer cover the service for new patients after the COVID-19 PHE ended on May 11th.

  • Last week, the Centers for Medicare & Medicaid Services’ Office of Minority Health (CMS OMH) released a report this week detailing the quality of care received by individuals enrolled in Medicare Advantage (MA). The Disparities in Health Care in Medicare Advantage Associated with Dual Eligibility or Eligibility for a Low-Income Subsidy and Disability report presents summary information on the performance of MA plans on specific measures of quality of health care reported in 2021. The report specifically compares the quality of care for four groups of MA enrollees that are defined based on the combination of two characteristics: (1) dual eligibility for Medicare and Medicaid or eligibility for a Part D Low-Income Subsidy (LIS) and (2) disability. This report utilizes analysis of data from the Healthcare Effectiveness Data and Information Set (HEDIS) to draw its conclusions.

Medicaid

  • On Wednesday, the Centers for Medicare & Medicaid Services (CMS) released the 2023-2024 Medicaid Managed Care Rate Development Guide, which serves as a resource for states to use when setting capitation rates with managed care plans. The guide outlines federal standards for rate development and describes information required from states and their actuaries as part of actuarial rate certifications for rating periods between July 1, 2023 and June 30, 2024.

  • During the COVID-19 pandemic, states paused redeterminations in Medicaid in exchange for increased federal funding. With the end of continuous enrollment on March 31, 2023, states are currently in the process of redetermining eligibility for individuals enrolled in Medicaid. Kaiser Family Foundation’s Survey of Health Insurance Consumers