Still Time to Register for Annual Conference
The Roundtable’s highly-regarded annual conference provides our members and guests a unique opportunity to hear presentations by high-level government officials and key experts – from Congress and the Administration, academics, benefit consultants, plan administrators, advocates, and industry leaders in an intimate dialogue-oriented setting. This in-person event will take place in Old Town Alexandria, Virginia on November 9-11, 2022. There’s still time to register for this important annual event!
Although we have filled our block of rooms at The Alexandrian Hotel, we’re now working to secure hotel reservations convenient to our conference hotel. For information about alternate accommodations, contact Roundtable Administrator Tom Lussier at Tom@healthcareroundtable.us.
OMB Begins Review of Proposed Rule on Prior Authorization for MA, Exchange, Medicaid
On Thursday, Oct. 13, the Office of Management and Budget (OMB) began its review of a proposed rule to streamline prior authorization for Medicare Advantage (MA), Medicaid, CHIP managed care plans, and exchange plans. The proposed rule would also improve the electronic exchange of health care data while continuing the Centers for Medicare and Medicaid’s (CMS’s) efforts toward improving interoperability and reducing burden in the health care market. The review is occurring as stakeholders push the Senate to take up the Improving Seniors’ Timely Access to Care Act of 2022 (H.R.3173). Last month, the House passed the legislation which establishes requirements and standards relating to prior authorization processes under MA plans. The Senate could include the legislation in the end-of-year government funding package.
CMS to Prioritize MA Dental Benefits, Insulin Costs in 2023
According to Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure, the agency will focus (subscription required) on health equity and accountability goals for Medicare Advantage (MA) plans in 2023. Brooks-LaSure emphasized the agency’s focus on dental care and insulin costs. This summer, CMS released the proposed 2023 Physician Fee Schedule, which expands existing policy to include dental services after congressional Democrats dropped plans to add dental benefits to Medicare in their budget reconciliation package. Traditional Medicare currently includes very limited dental coverage. Brooks-LaSure also encouraged enrollees to check their health and drug options during the open enrollment period this fall, especially regarding insulin products. Earlier this month, a CMS spokesperson told Inside Health Policy the agency may allow beneficiaries using insulin to switch Medicare plans after the current open enrollment period ends, due to the new out-of-pocket cap on insulin prices.
OMB Begins Annual Review of NBPP Rule, Including New Regulations
Last week, the Office of Management and Budget (OMB) began its review of an annual proposed rule that sets exchange policies for the 2024 plan year. The Notice of Benefit and Payment parameters (NBPP) details policy changes related to Affordable Care Act (ACA) compliant plans, such as payment parameters and provisions related to the risk adjustment programs. The rule addresses cost-sharing parameters and user fees for issuers offering plans on Federally-facilitated Exchanges and State-based Exchanges using the federal platform. The proposed rule is expected to add qualitative wait times to the network adequacy requirements and could limit insurers’ ability to sell non-standardized plans.
United States Surgeon General Dr. Vivek Murthy released a new framework outlining the role of workplaces as engines of mental health and well-being. The report underscores how workers’ daily stresses can affect their health and organizational performance and makes the case for organizations to support their employees’ emotional and mental well-being. The framework identifies five essentials for workplace mental health – including protection from harm, connection and community, work-life harmony, mattering at work, and opportunities for growth – to help organizations develop, institutionalize, and update policies to support the mental health and well-being of workers.
- The Biden-Harris Administration announced the availability of Over-the-Counter (OTC) hearing aids for adults with mild-to-moderate hearing loss, following a final rule issued by the FDA in August 2022. Individuals can now buy hearing aids at stores or online without a prescription, exam, or audiologist fitting. The FDA estimates this could lower average costs by as much as $3,000 per pair—providing significant relief for the nearly 30 million Americans with hearing loss, including nearly 10 million adults under age 60.
- The Department of Health and Human Services of the Inspector General (HHS OIG) released a report describing how home health agencies (HHA) adapted during the COVID-19 public health emergency. Like other healthcare providers, HHAs struggled with staff shortages and implementing infection control strategies. While telehealth and other regulatory flexibilities partially eased these concerns, there were significant shortfalls. Given these challenges, and the potential end of the public health emergency in 2023, HHS OIG provided three recommendations to CMS: 1) evaluate how HHAs utilize telehealth across service types and patient characteristics; 2) examine how the regulatory flexibilities may have impacted home health care quality; and 3) develop or update emergency preparedness training for HHAs on responding to infectious disease outbreaks based on the lessons learned during COVID-19.
- The U.S Department of Health and Human Services (HHS) has announced a new funding opportunity of $15 million to scale certified community behavioral health clinics (CCBHCs) through the Bipartisan Safer Communities Act (BSCA). CCBHCs currently serve an estimated 1.5 million people and are a critical part of the safety net, providing care for people with serious mental illnesses and substance use disorders as well as those that are underserved including children and youth, and veterans. Starting in 2024, ten states will be chosen to develop behavioral health demonstration projects for a year, which includes clinic certification and establishing prospective payment systems for Medicaid reimbursable services.
- The Food and Drug Administration (FDA) Obstetrics, Reproductive and Urologic Drugs Advisory Committee voted this week to remove Covis Pharma’s preterm birth drug Makena from the market after over ten years in the FDA’s accelerated approval pathway. The advisory committee largely agreed that Makena’s ability to reduce preterm birth and improve neonatal outcomes was limited with respect to its adverse effects. The developer, Covis Pharma, believes Makena should be allowed to stay on the market while the company conducts follow-up confirmatory studies. Black women are at higher risk for preterm birth rates, which can cause chronic health problems for babies throughout their lives. Although the advisory committee voted to remove the drug from the market, the ultimate decision is left to the FDA.
- Last week, the Government Accountability Office (GAO) published two reports examining maternal health outcomes and access to obstetric services. Their analysis found that maternal deaths increased during the COVID-19 pandemic, and COVID-19 infections contributed to one out of four maternal deaths in 2020 and 2021. GAO noted that disparities in Black maternal mortality, preterm births, and low birthweight births persisted or grew during the pandemic, in comparison to white or Hispanic and Latina women. The Department of Health and Human Services (HHS) attributed some of these disparities to the pandemic’s worsening of social determinant of health factors such as living environment, chronic stress related to racism, and access to care.
- GAO’s second report similarly found that rural access to hospital obstetric services has declined since 2004, and that most of the closures occurred in rural counties with sparse populations, majority Black populations, and low incomes. Stakeholders GAO interviewed recommended three strategies to improve rural access to obstetrics services: increase Medicaid reimbursement, increase remote consultations between providers, and establishing regional partnerships between larger and smaller rural hospitals for care coordination and training.
The Centers for Medicare and Medicaid Services (CMS) released an evaluation report on phase two of the Medicare Advantage (MA) Value-Based Insurance Design (V-BID) model. This report covers the first two years of model implementation from 2020-2021. The model is designed to encourage the use of high-value care, promote person- and family-centered care, increase enrollee choice and access to high-quality, timely, and clinically appropriate care, and/or reduce the cost of care. The BDI component of the model allows participating MA organizations (MAOs) to offer V-BID flexibilities, rewards, and incentives, including additional supplemental benefits, rewards such as gift cards for completing activities focused on improving health outcomes, and rebates to plans that bid below the benchmark that can be passed directly from the MAO to plan enrollees as cash benefits. At-a-glance reports regarding the V-BID model and Hospice Benefit Component can be found here and here, respectively.
- CMS recently approved Arizona’s Medicaid section 1115 demonstration program, which bolsters healthcare quality and outcomes by addressing social determinants of health. The Housing and Health Opportunities program will address housing insecurity and its health effects by: 1) providing services to help more people become and stay stably housed; 2) supporting community and transitional housing for those with unique clinical needs; 3) offer rent and housing support for up to six months for those transitioning out of settings such as congregate settings, homeless shelters, and the child welfare system; and 4) offer case management, outreach, and education of these services
- In guidance the Centers for Medicare and Medicaid Services (CMS) released earlier this week, CMS notified states that coverage for individuals enrolled in Medicaid through the optional COVID-19 group will end on the last day of the public health emergency (PHE). The fifteen states and three territories that elected to provide this coverage for COVID-19 vaccinations, testing, and treatments could choose to use state-only funding to continue coverage for these individuals (e.g. to continue a course of treatment or pay for vaccinations administered after the end of the PHE) but cannot claim the federal match. Additionally, states claiming the enhanced Federal Medical Assistance Percentages cannot terminate Medicaid enrollment for this coverage group before the end of the month in which the PHE ends due to the continuous enrollment requirement. To mitigate coverage gaps, CMS encouraged states to consider initiating Medicaid redeterminations for this group to see if they qualify for full Medicaid coverage before the end of the PHE.
- Last week, the Fall 2022 edition of the American Society on Aging’s (ASA) Generations Journal was published. National Partnership for Healthcare and Hospice Innovation (NPHI) President, Carole Fisher, serves as the Guest Editor of this edition. Chosen because of her prominence within the palliative care space, Carole organized the Fall 2022 issue around the theme of ‘Normalizing the Conversation Around Death and Dying.’ Generations Journal is the quarterly journal of the ASA. Each issue is devoted to bringing together the most useful and current knowledge about a specific topic in the field of aging, with an emphasis on practice, research, and policy.
- The Alliance for Connected Care released a study on telehealth utilization and the potential financial impact of long-term telehealth expansion on the Medicare program. Key highlights from the report are provided below: According to the study, total evaluation and management (E&M) visits in 2021 remain below 2019 levels, even with telehealth services included. In 2021, telehealth services leveled off at around 5 percent of all E&M services. Telehealth did not add to the total volume of Medicare services in any subset of the telehealth-eligible services examined with the exception of home-based E&M visits. Patients who used telehealth did not have more revisits than patients with in-person care.