HealthCare Roundtable e-News – September 14, 2021

E&C Set to Mark Up Reconciliation Policies with Focus on Fixing Medicaid Coverage and HCBS Investments

The House Energy & Commerce Committee is set to begin marking up reconciliation policies this week, including provisions that will assist in plugging the Medicaid coverage gap and expanding Medicare to cover dental, vision and hearing benefits. The committee will also mark up policy on a proposed $190 billion investment in home- and community-based services (HCBS).

Democratic leaders on the Energy & Commerce Committee highlight that their legislative package, which support Democrats’ Build Back Better Act, will deliver more jobs, cut taxes, and lower costs while also making the wealthiest few and big corporations pay their fair share.

The committee confirmed that it is looking to expand Medicaid eligibility in states that have yet to do so under the Affordable Care Act by offering premium tax credits to people in the coverage gap and then transitioning into covering those people through a federal Medicaid program. The proposed policies will also aim to establish a federal Medicaid program in the 12 existing non-expansion states. (InsideHealthPolicy)

Also included in the bill’s markup is a review of further investment in HCBS, for which President Biden had initially requested a $400 billion investment in HCBS. A senior Democratic aide told Inside Health Policy last week that the figure included in the House proposal would be closer to $150 billion, as the House was given a $150 billion allotment for HCBS from the Senate. Another aid confirmed that Senate proponents of HCBS continue to seek a $250 billion investment in the program.

Biden Administration Unveils COVID-19 Action Plan Outlining Mandatory Vaccinations for Health Workers, Guidance on Masking, Economic Recovery and More

Last week, the Biden administration released guidance on its plan to require vaccinations for federal employees, all healthcare workers at facilities that receive Medicare and Medicaid funding, and large employers. The response plan, known as “Path Out of the Pandemic”, also covers efforts to increase access to rapid point-of-care and over-the-counter diagnostic tests, as well as access to and administration of monoclonal antibodies.

The six-point plan identifies key goals of the administration around vaccinating the unvaccinated, furthering protection for the vaccinated, increasing testing and requiring masking, improving care for those with COVID-19, keeping schools safely open, and protecting U.S. economic recovery. In accordance with the first category, CMS announced that it will take action to require COVID-19 vaccinations for the more than 17 million healthcare workers who are employed at facilities that receive Medicare or Medicaid reimbursement, including hospitals, dialysis facilities, ambulatory surgical settings and home health agencies. (InsideHealthPolicy)

Additionally, the plan will double fines for individuals who do not comply with the masking requirements for interstate travel. Mandated via executive order last January, the plan continues to direct agencies to take action and require mask-wearing in airports and on modes of public transportation. Through the administration’s plan, the Transportation Security Administration will extend its implementing orders for masking on air and ground travel through Jan. 18, 2022. (InsideHealthPolicy)

To support the goal of keeping schools safely open, HHS and CDC will continue to aid schools in accelerating the establishment of screening testing programs. The administration continues to support the FDA’s vaccine review for kids under the age of 12 and will provide the agency with any resources it needs to review the vaccines as quickly as possible, stating that officials will keep the public updated on the process so that parents can plan.

The plan also aims to protect the country’s economic recovery by further supporting small businesses. Through the plan, the Small Business Administration will increase the maximum amount of funding a small business can borrow through the COVID Economic Injury Disaster Loan program from $500,000 to $2 million. Businesses can use the additional funding to hire/retain employees, purchase inventory and equipment, and pay off higher-interest debt. (InsideHealthPolicy)

Brookings, USC Health Experts Share Framework for Categorizing Drug Pricing Policy Options

The University of Southern California Schaeffer Center for Health Policy & Economics and the Brookings Institution recently shared their analysis on categorizing lawmakers’ prescription drug pricing reform options and offering recommendations to tackle the problem of high prescription drug costs. The framework also offers insight on whether the government or an outside group should negotiate prices, how to assess prices and the value of drugs, and what to do when negotiations fail.

Democrats are hoping to use the institute’s analysis to rally support and answer key questions around their plan to direct Medicare to negotiate drug prices in their budget reconciliation bill. One concern in particular that the institute addresses is what happens in the process when negotiations around a drug’s price fail, to which the institute has offered that HHS might unilaterally set prices or could establish prices through notice and comment rulemaking, or an independent arbitrator could set prices. The institute also suggested that Congress might designate an independent arbiter and specify whether a single arbitrator or panel of arbiters would break negotiation deadlocks. (InsideHealthPolicy)

The institute also shared feedback around government price setting and assessing drug value, suggesting the government tie U.S. prices to international prices or base Medicare negotiation on the appraised value of drugs. International reference pricing might lead drug makers to delay launches or raise prices in reference countries, especially for first-in-class drugs, though these challenges can be avoided by setting price ceilings in the United States using previous drug prices from abroad. (InsideHealthPolicy)

Dentist Groups Share Concerns with Proposed W&M Dental Care Expansion for Medicare Part B

Dental groups have come forward in the past week expressing their concerns with the House Ways & Means Committee’s proposal to expand Medicare coverage to Dental care, as part of the proposed $3.5 trillion budget resolution. The committee is seeking to cover dental care under Medicare Part B instead of a new, stand-alone benefit and while beneficiary advocates are pleased with the bill, groups including the American Dental Association have said that they would like to see it extend coverage even further and provide dental benefits sooner.

The committee’s proposed bill looks to expand coverage to dental care starting in 2028 under Medicare Part B and includes preventative screenings and cleanings twice a year, dental x-rays, fluoride treatments, and so-called basic dental treatments. The ADA stated that it was disappointed with the proposal after the group has been advocating for a stand-alone Medicare dental benefit, dubbed Part T, that would be available to Medicare beneficiaries making up to 300% of the poverty level. (InsideHealthPolicy)

“It just won’t work for dentistry and dentists are going to get frustrated just phasing in the program,” said Michael Graham, Senior Vice President of Government and Public Affairs at the American Dental Association. “Even if reimbursement rates were adequate, they would have to face administrative burdens, just like the physicians do, that would make participation in the program difficult.”

Not all beneficiary advocates agree with the ADA’s criticisms, with many believing that the proposed bill “is a great starting place from which to build comprehensive dental – and vision and hearing – care.” Melissa Burroughs, associate director for strategic partnerships at Families USA, said that the bill shows that lawmakers are committed to getting these benefits passed.

HHS Unveils Drug Pricing Plan to Tackle Competition and Transparency in Response to Executive Order

HHS last week unveiled its plan to address high drug prices in response to President Biden’s July executive order on Competition in the American Economy. According to the agency, the plan focuses on competition, innovation and transparency to address overconcentration, monopolization and unfair competition in or directly affecting the American economy.

While the plan includes some reforms and directives to let Medicare negotiate Part B and D drug prices, some have criticized the agency for being non-commital on whether it would use march-in rights and its failure to mention tying U.S. drug prices to those abroad. HHS’ plan is calling on lawmakers to consider legislation that would allow Medicare to negotiate drug prices, cap beneficiaries’ annual spend on Part D drugs, and limit price hikes on existing drugs to the rate of inflation and force manufacturers to pay a greater share of beneficiaries’ catastrophic costs in Part D. (InsideHealthPolicy)

The agency’s plan also calls for further administrative actions to be taken, including having CMs test models where value-based payments may be used under Medicare Part B, therefore directly linking payment for drugs to the clinical value they hold for patients. The plan would also require CMS to collect data from insurers and pharmacy benefit managers with a focus on increasing price transparency to get a better understanding of which drugs are driving the overall increase in drug spending. (InsideHealthPolicy)

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