HealthCare Roundtable e-News – May 31, 2022


Roundtable Engagement

Last week, the Roundtable submitted comments to the Federal Trade Commission request for information on the business practices of pharmacy benefit managers and their impact on the independent pharmacies and consumers. To read the Roundtable’s comments, please click here.

Top News

Representative Susan Wild (D-PA) and 19 other frontline House Democrats sent a letter to Senate Majority Leader Chuck Schumer (D-NY) and Senate Finance Committee Chairman Ron Wyden (D-OR) calling on them to include prescription drug pricing reform provisions in a reconciliation bill. Specifically, the members requested that the bill include reforms passed by the House last fall related to limiting the cost of insulin at $35 per month, capping out of pocket costs for seniors in Medicare Part D at $2,000 per year, penalizing drug corporations that raise prices faster than the rate of inflation, and, lastly, granting Medicare the authority to negotiate the prices of certain drugs. Though negotiations over reconciliation legislative have been ongoing for more than six months, there is skepticism that a package of any kind will ultimately come to fruition. The full letter can be found here.

Administrative Action

CMS announced a strategy for implementation of the home and community-based settings (HCBS) regulation, in partnership with the Administration for Community Living (ACL). According to the strategy, states will need to receive approval for their Statewide Transition Plan by March 17, 2023. CMS encourages states that do not currently have final STP approval to submit a draft STP to CMS by July 31, 2022. Additionally, states and providers must be in compliance with all settings criteria not directly impacted by PHE disruptions, including PHE-related workforce challenges, by March 17, 2023. Finally, time-limited corrective action plans (CAPs) will be available to states to authorize additional time to achieve full compliance with settings criteria that are directly impacted by PHE disruptions, when states document the efforts to meet these requirements to the fullest extent possible, and are in compliance with all other settings criteria. 

The Health Resources and Services Administration (HRSA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), the Administration for Children and Families (ACF), and the Administration for Community Living (ACL) outlined HHS’ plan to improve the health care system’s capacity to meet mental health needs, connect more people to care, and create a continuum of support to address mental health by coordinating across federal programs. Such programs include SAMHSA’s Community Mental Health Services Block Grant (MHBG), mental health and behavioral health care covered by Medicaid and Children’s Health Insurance Program (CHIP), ACF’s Title IV-E Prevention Program for children and families involved with the child welfare system and early childhood mental health supports, CDC’s evidence-based primary prevention program and ACL’s programs for people with disabilities, including children with mental health needs.

Congressional Action

The Washington Post hosted a live discussion between moderator Leigh Ann Caldwell, Senator Chris Murphy (D-CT), and Senator Bill Cassidy (R-LA) to address their push for the Mental Health Reform Reauthorization Act (S.4170). Senator Cassidy remarked that S.4170 will provide increased resources for school-based clinics, and increased cross-training for other kinds of providers. Additionally, Senator Cassidy highlighted his interest in Coordinated Care Programs to isolate and quickly treat students showing signs of mental illness. Senator Murphy emphasized the tools in the bill would enforce insurance companies to pay more for mental health services.

Senators Chuck Grassley (R-IA) and Maria Cantwell (D-WA) introduced the Pharmacy Benefit Manager Transparency Act of 2022 which aims to increase drug pricing transparency. The legislation would ban unfair pricing schemes, provide exceptions to liability for PBMs that pass along 100 percent of rebates to health plans or payers and fully disclose prescription drug rebates, costs, prices, reimbursements, fees and other information, and require pharmacy benefit managers (PBMs) to report how much money they make through spread pricing and pharmacy fees to the Federal Trade Commission (FTC).

Members of the Senate Finance Committee released a discussion draft entitled Ensuring Access to Telemental Health Services, as part of the committee’s ongoing work to improve mental health care across the nation. The discussion draft includes removing Medicare’s in-person visit requirement for tele-mental health services, establishing benefit transparency for mental health care services delivered via telehealth, preserving access to audio-only mental health coverage in Medicare when necessary, incentivizing states to use their CHIP programs to establish local solutions.

Recently, the Senate Special Committee on Aging released the Advancing Integration in Medicare and Medicaid Act, which would require states to develop strategies to integrate and coordinate care for “dual eligible” beneficiaries. Many believe this legislation will likely also be integrated into the Senate Finance Committee’s broader mental health package.


Larry Levitt, the executive vice president for Health Policy at Kaiser Family Foundation (KFF), moderated a Zoom panel with Richard Frank, Harvard health economics professor, Rachel Sachs, associate professor of Law at Washington University, and Kristen Axelson, economist at DLA Piper. The panelists discussed ways the Biden Administration could address the high cost of prescription drugs in the U.S. Specifically, they highlighted the role private figures, like Mark Cuban, have in negotiating drug prices and emphasized that determinants of drug prices should include other out-of-pocket costs to the patient, including emergency room visits, ambulatory fees, and imaging. Comprehensive notes from the panel can be found here.


The U.S. Department of Health and Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS) approved California, Florida, Kentucky, and Oregon actions to expand Medicaid and Children’s Health Insurance Program (CHIP) coverage to 12 months postpartum, positively affecting more than 126,000 new families across those states. California, Florida, Kentucky, and Oregon join South Carolina, Tennessee, Michigan, Louisiana, Virginia, New Jersey, and Illinois in extending Medicaid and CHIP coverage from 60 days to 12 months postpartum. Indiana, Maine, Minnesota, New Mexico, Pennsylvania, West Virginia, North Carolina, Washington, and Connecticut, as well as the District of Columbia, have all proposed this change too.