HealthCare Roundtable e-News – September 19, 2022


Special Announcements

The Roundtable welcomes the Central Management Services of the State of Illinois

The CMS Bureau of Benefits is the primary health care and insurance administrator for State universities, community colleges, teachers, State employees, and retirees. In addition, the Bureau of Benefits administers a wide range of other programs including the State dependent and medical care assistance program for State workers, retirees, and their qualified dependents, the State commuter savings program, the Illinois workers’ compensation program, and the State of Illinois Deferred Compensation Plan

Register Now for Roundtable Events

Wednesday: Webinar on IRA Legislation

The Public Sector HealthCare Roundtable will host a Webinar on the recently enacted Inflation Reduction Act (IRA) on Wednesday, September 22nd at 4:00 PM (EDT). The presentation will include an overview of the health care provisions of the IRA by Roundtable staff as well as a panel of Roundtable corporate members who will highlight how they expect the IRA to impact their areas of expertise and services.

Click here to register for the IRA Webinar.


Registration for our 2022 Annual Conference

After two years of virtual meetings, the Roundtable’s highly-regarded annual conference returns to an in-person event in Old Town Alexandria, Virginia on November 9-11, 2022.

The conference provides 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.  

The Agenda

We have released our preliminary agenda and look forward to sharing additional details as we continue to confirm timely speakers for each conference segment.

A Virtual Option

Since we know many of our members have appreciated the opportunity to share our conference with plan leaders and staff, we will offer a virtual option to any member that registers at least one attendee for the in-person conference. Details will be provided to registered health plan members.

Lodging Information

The Alexandrian Old Town Alexandria

$229 Room Rate

Book by October 7, 2022

Top News

House Unanimously Passes Improving Seniors’ Timely Access to Care Act

On Wednesday, the House unanimously passed the Improving Seniors’ Timely Access to Care Act, following passage by the House Energy and Commerce Health Subcommittee earlier in the day. With over 300 cosponsors, the bill reforms existing Medicare Advantage (MA) prior authorization procedures by establishing an electronic and real-time approval process and increasing data transparency. The Congressional Budget Office estimates the bill to cost $16 billion over the next decade, and expects MA payment plans to increase due to the added costs. The bill now moves to the Senate, where it may end up in a larger year-end government funding and tax extenders package.


Drug Manufacturers Exploit Patent System to Extend Monopoly on Market, Report Finds

Four pharmaceutical companies have filed hundreds of patents to keep generic competition out of the market, according to a report from the Initiative for Medicines, Access, and Knowledge (I-MAK). AbbVie, Bristol-Myers Squibb, Regeneron, and Bayer have been able to maintain higher price levels on their drugs by making small tweaks to extend their patents. Legal experts refer this as “evergreening.” According to the I-MAK report, on average, drug companies file more than 140 patent applications per drug, with two-thirds of those applications filed after the Food and Drug Administration’s (FDA) approval for market use. This summer, President Joe Biden signed the Inflation Reduction Act into law, which lowers the price of some prescription drugs for Americans on Medicaid. According to the I-MAK report, the federal government must seriously examine drug companies’ use of patents.


HHS, Labor, and Treasury Departments Release RFI on Advanced EOB and Good Faith Estimate for Covered Individuals

The Departments of Labor, Health and Human Services, and Treasury, along with the Office of Personnel Management, released a Request for Information (RFI) to inform their rulemaking for advanced explanation of benefits (AEOB) and good faith estimate (GFE) requirements of the No Surprises Act, as part of the Consolidated Appropriations Act, 2021 (CAA). This RFI seeks information and recommendations on transferring data from providers and facilities to plans, issuers, and carriers, other policy approaches, and the economic impacts of implementing these requirements. The CAA requires group health plans and health insurance issuers offering group or individual health insurance coverage, upon receiving a GFE regarding an item or service, to send a covered individual an AEOB.


NCQA Release Performance Rankings for Health Plans

The National Committee for Quality Assurance (NCQA) released their list of top-performing health plans for 2022 based on key factors including care quality, patient satisfaction, and efforts to keep improving. The ratings were released on Sept. 15, and are based on 2021 data from commercial, Medicare, Medicaid and ACA plans that reported HEDIS and CAHPS results to the NCQA, covering 203 million people. Of the 1,048 plans that received ratings, only six were rated five stars.

Administrative Action

Last Monday, President Biden signed an Executive Order (EO) (fact sheet) to launch a National Biotechnology and Biomanufacturing Initiative. The EO aims to increase innovation in the biotechnology and biomanufacturing industries and decrease prices by making vaccine and therapeutics manufacturing more efficient, which in turn could drive a major increase in funding for medical research and development. The order calls for accelerating development in disease detection and vaccine manufacturing, as well as improving the security of the biotechnology industry.

Regulatory Action

On Tuesday, the Food and Drug Administration (FDA) finalized a rule on reporting requirements for drug makers providing investigational drugs to patients through the “Right to Try” pathway. The Right to Try Act requires pharmaceutical companies that use the Right to Try Pathway for their investigational drugs to submit annual summaries to FDA on the use of the drug. The final rule clarifies the entities that are required to submit annual reports, describes content requirements, and establishes deadlines, beginning with the first annual summary report due by March 31, 2023.


CMS released a report on community-living Medicare beneficiaries use of dental, vision and hearing care services in 2019 using Medicare Current Beneficiary Survey data. CMS highlighted that 43% of all beneficiaries had at least one dental exam, 52% of beneficiaries had a vision exam, and only 7% of beneficiaries had a hearing exam. The report also incorporated data on beneficiaries’ gender, race/ethnicity, language spoken at home, income level, and dual eligibility status. Non-Hispanic Blacks had the lowest rates among the racial and ethnic groups reported, and dually eligible beneficiaries were significantly less likely than non-duals to have accessed the services.


  • CMS released a slide deck containing information on opportunities to support Medicaid unwinding efforts in states with integrated eligibility systems or workforces. States will be responsible for conducting renewals for their Medicaid enrollees once the COVID Public Health Emergency and the corresponding maintenance of eligibility requirement from the Families First Coronavirus Response Act ends. The deck covers relevant policy guidance released by CMS, including information on how to leverage Supplemental Nutrition Assistance Program (SNAP) data to help with redetermination processes, using an express lane eligibility state plan amendment (SPA) to enroll or renew children, and using a facilitated enrollment SPA to enroll or renew children and/or adults.

  • CMS announced approval of the Oregon Health Authority’s proposal to cover community-based mobile crisis intervention services in Medicaid. Through the program, Oregon will be able to connect individuals experiencing mental health or substance use crises to a behavioral specialist 24 hours per day, providing community-based stabilization services. The new Medicaid option became available to states in April 2022, and Oregon is the first state to seek and be granted approval. CMS encourages other states to expand access to crisis care services by following Oregon’s model.

  • CMS announced that people with Medicare, Medicaid, Children’s Health Insurance Program (CHIP) coverage, private insurance coverage, or no health coverage can receive COVID-19 vaccines, including the updated Moderna and Pfizer-BioNTech COVID-19 vaccines, at no cost, for as long as the federal government continues purchasing and distributing these vaccines. The FDA recently authorized the Moderna and Pfizer-BioNTech vaccines that target the original COVID-19 viral strain and two Omicron variants (BA.4/BA.5) that are currently the most prevalent in the U.S.