HealthCare Roundtable e-News – October 18, 2022


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Top News

President Biden Urges HHS to Take Further Action on Lowering Drug Pricing

On Friday, President Joe Biden signed an executive order urging the Department of Health and Human Services (HHS) to take further action to lower drug prices. The executive order will build on provisions included in the Inflation Reduction Act. HHS will use its Innovation Center, created under the Affordable Care Act (ACA), to explore new methods to lower drug costs and promote access to new drug therapies for Medicare beneficiaries. The agency will have 90 days to report its plan to use the Innovation Center to lowering drug costs. In September, HHS released two reports that illustrate the urgency of addressing the rising cost of prescription drugs in the United States.


Secretary Becerra Renews PHE 90 Days, Through Midterm Elections

On Thursday, Secretary Xavier Becerra of the Department of Health and Human Services (HHS) announced his renewal of the public health emergency (PHE) determination due to the ongoing consequences of the COVID-19 pandemic, for an additional 90 days. The Biden Administration has previously committed to providing 60-day notice prior to ending the PHE, which has been in place nationwide since January 27, 2020.


Commonwealth Fund Releases Blog Post on Effectiveness of PDABs

The Commonwealth Fund released a blog post on the effectiveness of prescription drug affordability boards (PDABs) in reducing drug prices. According to the post, PDABs are becoming more popular at the state level as a tool to make medicines more affordable for consumers and alleviate pressure on the state health care budgets. However, the post questions their effectiveness. Most states that have passed legislation to establish a PDAB are still operationalizing their boards. A PDAB’s success in lowering costs depends on its ability to obtain resources, expertise, and data, and then translate the information into innovative solutions.


Department of Treasury, IRS Release Final Rule on ACA “Family Glitch”

The Department of the Treasury and Internal Revenue Service (IRS) released a final rule fixing the Affordable Care Act (ACA) “family glitch.” The fix is estimated to expand coverage to 200,000 previously uninsured individuals and lower coverage costs for nearly 1 million more individuals. The Office of Tax Analysis at the Treasury Department projects the change will also increase the federal deficit by an average of $3.8 billion per year over the next 10 years.

Under prior rules, an individual can qualify for ACA tax credits if the cost of their employer coverage is over approximately 10 percent of their household income. However, the cost calculation is only based on the premium charged to that one individual. If the individual’s family is also on the plan, subsidy eligibility calculations do not include these added family premium costs. A family could be ineligible to receive tax credits, even if the entire plan costs more than 10 percent of the family’s household income. This gap in coverage is known as the “family glitch.” The final rule now counts the added cost of covering additional family members when calculating the affordability of coverage. Linked here is a fact sheet from the proposed rule in April.


  • In its continued efforts to warrant Medicare coverage of evidence-based medical devices, the Centers for Medicare and Medicaid Services (CMS) is considering a new rule to develop an expedited coverage pathway. By conducting clinical trials approved by CMS, medical device manufacturers can expedite the timeline for Medicare Parts A and B coverage, and CMS can reach better, informed decisions about technology efficacy. In creating a rule to promote Medicare access to cutting-edge medical technologies while balancing high-quality evidentiary standards, CMS will consider the following four key principles:

    • Manufacturers voluntarily participate, and the process is limited to medical devices that fall within the Medicare statute and relevant to the Medicare population.
    • CMS can do an early evidence review and coordinate the best Medicare coverage pathway depending on data strength.
    • Manufacturers can also request CMS to initiate a coverage review process before FDA market authorization, which may require an additional development plan and ensuring appropriate safeguards and protections.
    • If more clinical research is needed, CMS will minimize burden on manufacturers, providers, and patients while promoting high-quality data collection.

  • CMS announced they are extending the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model for 2 years. The Model, which launched on October 1, 2018, was set to end on December 31, 2023, and will now conclude on December 31, 2025. BPCI Advanced is an Advanced Alternative Payment Model under the Quality Payment Program and tests whether linking payments for an episode of care will incentivize healthcare providers to practice innovation and care redesign to improve care coordination and reduce expenditures while maintaining or improving the quality of care for Medicare beneficiaries. This two-year extension will include a new application opportunity. CMS plans to announce a Request for Applications (RFA) in early 2023 for Medicare-enrolled providers and suppliers and Medicare Accountable Care Organizations to participate in the Model’s two-year extension (2024-2025).

  • Last week, the Bipartisan Policy Center published their analysis of telehealth use by Medicare beneficiaries during the COVID-19 public health emergency (PHE) and their recommendations for continuing telehealth after the end of the PHE. They note the rapid expansion of telehealth utilization during the PHE, with disparities in access for Black, Latino, and low-income individuals, and widespread beneficiary satisfaction with telehealth services they have received. Given this success, the center recommends extending most of the current telehealth flexibilities for two years after the end of the PHE, to allow researchers additional time to evaluate the programs. The Center also suggests that access to telehealth should be maintained for all Medicare beneficiaries.


  • The Center for Health Care Strategies (CHCS) published an issue brief calling for state Medicaid agencies to develop health equity strategic plans. The brief outlines five core components for the equity plans to address and highlights specific resources and best practices that other states have utilized. First, CHCS recommends agencies develop their own internal culture of equity to get staff buy-in and commitment. The report also recommends that state agencies, MCOs, and network providers improve community engagement, particularly for people of color and those who experience inequities. States are advised to improve their collection and utilization of demographic data to stratify quality measures and track disparities. State agencies may consider implementing value-based purchasing programs that link payment to health disparity reductions. Finally, state agencies should review their benefit and care delivery design to ensure they are best leveraging care delivery models.

  • The National Academy for State Health Policy (NASHP) released an actuarial analysis of a Medicaid palliative care benefit for high-utilization beneficiaries. While no Medicaid programs currently offer a stand-alone palliative care benefit, palliative care can provide patient and family relief by offering physical and psychosocial support for patients with serious chronic illnesses like cancers, kidney failure, and neurologic disorders. Based on past hospice care utilization costs, the researchers estimated the potential cost avoidance savings to range from $231 to $1,165 per member per month through fewer inpatient admissions and outpatient emergency visits. If implemented across state Medicaid programs, a palliative care benefit could be a cost-neutral way to improve members’ and families’ quality of life.


America’s Health Rankings released the sixth edition of the Health of Women and Children Report. The report found that rates of behavioral health challenges have increased among women and children in recent years, though the rates vary by geography and race/ethnicity. The rates of teen suicide have increased by 29 percent since 2012-2014. The report underscores the rise of maternal morbidity – rates of maternal mortality were 3.9 times higher among Black mothers compared to Hispanic mothers. The data also demonstrates the impact of the COVID-19 pandemic on women’s employment and access to neighborhood amenities, disproportionately burdening women of color.