HealthCare Roundtable e-News – September 25, 2023

 

Top News

Commonwealth Fund Survey Reveals Financial Burdens Faced by Older Adults on Medicare

The Commonwealth Fund published the results of their Biennial Health Insurance Survey, 2022 which examined the financial burden of care that people age 65 and older with Medicare face, and how that burden differs for those with traditional Medicare and Medicare Advantage (MA). Findings showed that despite having Medicare coverage, many individuals still struggle with healthcare costs. About 1 in 5 adults with Medicare are considered “underinsured,” facing high out-of-pocket expenses relative to their income, with these issues affecting both traditional Medicare and Medicare Advantage beneficiaries. The survey suggests that while Medicare aims to provide financial security for older adults with medical needs, affordability concerns persist, impacting access to essential healthcare services and resulting in medical debt for many beneficiaries.

 

U.S. House Committee on Oversight and Accountability Holds Hearing on Inflation Reduction Act

The United States House Committee on Oversight and Accountability Subcommittee on Healthcare and Financial Services recently held a hearing titled The Inflation Reduction Act: A Year in Review. The hearing consisted of three witnesses, each with their own specialty including tax policy, health care coverage, and energy and environmental policy. Chairwoman Lisa McClain (R-MI) opened the session by emphasizing that the Inflation Reduction Act (IRA) has not delivered as Americans still struggle under the weight of inflation. Additionally, the Chairwoman described the legislative package as a $369 billion spending package that expanded the federal deficit. In opposition to the Chairwoman, Ranking Member Katie Porter (D-CA) defended the effectiveness of the IRA, referencing how it has lowered the national debt, lowered energy costs, and made healthcare more affordable. Next, the witnesses proceeded to give their testimonies with respect to their specialty, which was followed by questions from members of the subcommittee. Generally, Republicans attacked the IRA, stating that is it is spending bill aimed at fighting climate change rather than helping everyday Americans. Democrats praised the legislation, highlighting the provisions that aim to hold corporations accountable to paying their fair share in taxes and address climate change.

 

Senate Health, Education, Labor and Pensions Committee Advances Primary Care Legislation

The Senate Health, Education, Labor and Pensions Committee held a markup of the $26 billion Bipartisan Primary Care and Health Workforce Act, legislation which includes billions in funding for community health centers and to bolster the doctor, nursing and dentist workforces. The legislation advanced with 14 in favor and seven opposed. The legislative package looks to address the critical primary care crisis in the United States, including the severe shortages of nurses and primary care doctors. The legislation also aims to increase funding for essential healthcare services such as community health centers, the National Health Service Corps, and Teaching Health Centers. The committee also approved a number of amendments, including one that would codify price transparency rules for hospitals and health plans.

Administrative Action

  • The U.S. Department of Health and Human Services (HHS) through the Agency for Healthcare Research and Quality (AHRQ) announced nine grant awards of $1 million each for up to 5 years. The grants support a multitude of existing Long COVID clinics throughout the country focused on expanding access to person-centered care, particularly in underserved, rural, and minority populations. Long COVID is generally defined as signs, symptoms, and conditions that continue or develop after an initial COVID-19 infection. The AHRQ Long COVID clinics aim to expand access to care and expand multidisciplinary networks through three strategies. One of these strategies emphasizes increasing Long COVID care access by expanding in-person and virtual visit capabilities. The clinics will also add dedicated care coordination, social services, language interpretive staff, and programs for people experiencing Long COVID. Lastly, the initiative will integrate dedicated behavioral health staff and implement behavioral health support group programs. The grants are a response to the National Research Action Plan, a byproduct of the Presidential Memorandum that directed the Secretary for the Department of HHS to establish an effective response to Long COVID.
  • The Administration for Community Living (ACL) has announced four new cooperative agreements for its 2023 grant initiative, aligned with the 2022 National Strategy to Support Family Caregivers. These grants, running from September 30, 2023 to September 29, 2027, amount to over $3.6 million and are funded by Title III-E formula funds under the Older Americans Act. Notably, ACL intends to release a Notice of Funding Opportunity in October 2023 to address Goal 4 by inviting applications that enhance awareness of resources for financial and workplace security for family caregivers and identify unmet needs in this critical area.

Congressional Action

  • The House is planning to vote on legislation next week to reauthorize the SUPPORT Act, which addresses opioid dependence and drug addiction issues. This legislation, along with maternal health bills, is scheduled for quick votes under the suspension of the rules process. Additionally, the Medicaid Primary Care Improvement Act and the 9-8-8 Lifeline Cybersecurity Responsibility Act will also move forward using the same procedure. The decision to move these bills under suspension of the rules comes after the House leadership withdrew a vote on the Lower Costs, More Transparency Act. The SUPPORT Act is set to expire at the end of the month if not reauthorized. The reauthorization legislation passed by the House Energy & Commerce Committee is expected to save $3 million over 10 years.
  • The House has postponed a vote on a comprehensive health transparency bill, which was originally scheduled for Monday evening. This delay affects a bipartisan bill that has caused division among Democrats and faces an uncertain future in the Senate. The bill was under consideration with a two-thirds majority requirement, highlighting the internal disagreements among Democrats. While Frank Pallone Jr. (D-NJ), ranking member of Energy and Commerce, supported the bill, Richard E. Neal (D-MA) and Robert C. Scott (D-VA), ranking members of Ways and Means and Education and the Workforce respectively, opposed it. Currently, there is no stated reason for postponing the vote, and the bill will be closely monitored for any developments in the coming days.

Medicare

  • The Medicare Payment Advisory Commission (MedPAC) held its September public meeting to discuss a number of issues related to Medicare payment policy. Specifically, the Commission held sessions on Medicare Advantage: MedPAC workplan, Standardized benefits in Medicare Advantage plans, Improving MedPAC’s estimate of Medicare Advantage coding intensity and Medicare’s Acute Care Hospital at Home program. Healthsperien was there to cover the September MedPAC meetings.
  • The Centers for Medicare and Medicaid Services released a final rule to streamline enrollment in the Medicare Savings Programs (MSPs). This is expected to decrease the cost of coverage for 860,000 people, save older adults and people with disabilities around 19 million hours in paperwork annually, and alleviate state administrative burden. The MSPs are essential to ensuring coverage and care, but only about half of eligible people are enrolled in the MSPs. With a streamlined enrollment process, eligible individuals should have an easier time applying and enrolling. Additionally, this rule will allow data from the Medicare Part D Low Income Subsidy (LIS) or “Extra Help” program, which assists older adults and people with disabilities with prescription drug coverage, to be utilized more effectively. Considering both this rule and the President’s prescription drug law that will expand eligibility for the LIS benefit, this marks a time of great progress in making Medicare more affordable, specifically for older adults and people with disabilities. This final rule comes as the first of a two-part response to comments regarding the notice of proposed rulemaking that CMS released on August 31, 2022.

Medicaid

The National MLTSS Health Plan Association (MLTSS Association) published a report capturing emerging best practices for managed long-term services and supports (MLTSS) plans and providers to address the shortage of direct care workers (DCWs) who provide care to older adults and individuals with disabilities served by MLTSS plans. While workforce shortages have been a longstanding issue in the long-term care industry, the COVID-19 pandemic heightened the challenges and the current crisis. The MLTSS Association examined issues and innovations across five domains: recruitment; retention; data collection, monitoring and evaluation; workforce alternatives; and elevating the social value of direct care workforce’s impact. Across each of these themes, the MLTSS Association also identified policy recommendations for how state and federal lawmakers can facilitate and scale these practices more broadly, as well as opportunities to incorporate informal caregivers, technology, and flexible funding models to support innovation.

Research

A study was recently published in JAMA Internal Medicine aimed to assess the correlation between the prices hospitals publicly post online for certain medical services and the prices they provide to secret shoppers inquiring by telephone. The researchers collected cash prices for vaginal childbirth and brain MRI from representative US hospitals’ websites and compared them to the prices quoted over the phone to secret shoppers. The main findings include:

  1. Limited Availability: Not all hospitals provided both online and telephone prices for the selected procedures, with varying participation rates among top-ranked, safety-net, and non-top-ranked, non-safety-net hospitals.
  2. Wide Price Variations: The study revealed significant price variations for both procedures, with some hospitals charging drastically different amounts for the same service. Prices ranged from very low to extremely high, depending on the hospital.
  3. Poor Correlation: There was a poor correlation between the online prices and telephone quotes. In many cases, the prices differed significantly, suggesting a lack of consistency in pricing information provided by hospitals.
  4. Challenges for Patients: These findings highlight the ongoing difficulties that uninsured patients and others face when trying to compare healthcare prices. Hospitals’ inconsistent pricing practices make it challenging for consumers to make informed decisions about their healthcare.

Overall, the study underscores the challenges hospitals face in accurately communicating and maintaining consistent pricing for specific medical services. It also emphasizes the difficulties patients encounter when attempting to shop for healthcare services based on price transparency.


Registration Open for 2023 Annual Conference

The Public Sector HealthCare Roundtable 2023 Annual Conference Moves to Washington, DC

The conference features a new location, a revised format, and a great agenda!

Wednesday, Nov. 1 to Friday, Nov. 3, 2023

 

The Roundtable’s highly-regarded annual 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.

After years of successful conferences in Old Town Alexandria, we have outgrown our space at the Alexandrian Hotel. This year we will hold our conference at the historic Mayflower Hotel in Washington, DC. The new location will undoubtedly improve the overall experience for all of our attendees.

In recent years, many of our attendees have urged us to schedule more free time in the conference agenda for networking. Since we understand the importance of this networking time, we have revised this year’s agenda to incorporate longer breaks and more time before evening receptions.

This year, the conference will begin at Noon on Wednesday, November 1st and will conclude at Noon on Friday, November 3rd. By adding time on Wednesday, we have been able to add critical content, lengthen our breaks, and add free time prior to any evening activities.

Although we certainly believe the best way to experience our conference is in-person, this year’s conference will once again feature a virtual option. Any health plan that registers at least one individual to join us in Washington, will be eligible to register online attendees.

Visit the Roundtable’s website for a preliminary Agenda, a Registration Form, and the Mayflower Hotel registration link.

We will be updating the agenda and announcing specific speakers over the course of the next couple of months.