WEEKLY E-BULLETIN


Trump Issues First Executive Order To Change the Affordable Care Act

In his first executive order, President Trump on Friday evening directed government agencies to scale back as many aspects of the Affordable Care Act as possible. The one-page order (click here to read), which Mr. Trump signed in a hastily arranged Oval Office ceremony shortly before departing for the inaugural balls, gave no specifics about which aspects of the law it was targeting. But its broad language gave federal agencies wide latitude to change, delay or waive provisions of the law that they deemed overly costly for insurers, drug makers, doctors, patients or states, suggesting that it could have wide-ranging impact, and essentially allowing the dismantling of the law to begin even before Congress moves to repeal it.

What does it mean?  It does NOT take away anyone’s existing healthcare coverage. It does NOT end any specific programs or initiatives.  However, it could lead to many changes.  Click here for a NYTimes analysis.  Click here for a summary legal analysis from LegalNewz.

President Trump earlier declared that the ACA replacement will “get private insurance companies to take care of a lot of the people that can afford it.” Trump said that he was nearly finished with a plan to replace the ACA, which was being designed with the goal of “insurance for everybody,” although he declined to offer specifics. Click here to view the report. Trump said last Wednesday that he will likely pursue Medicaid block grants. To view the interview on Fox, click here.

Price Provides Peek at Health Care Agenda during Senate Hearing

HHS Secretary-nominee Tom Price had first confirmation hearing last week and Democrats grilled him. The Senate’s Health, Education, Labor and Pensions Committee held a “courtesy” hearing last week and the Senate Finance Committee has its formal hearing of Price this week.  Price signaled the incoming administration’s ACA replacement plan may include health savings accounts, high-deductible plans, association health plans and short-term market stability, but he remained vague on the future of the current law’s essential health benefits and provision allowing children to stay on their parents’ insurance until they are aged 26. Price also showed support for some provisions in the Affordable Care Act, such as 1332 waivers to provide states added flexibility for health care innovation. To watch the hearing in its entirety, click here.

  • Asked about the future of the CMS Innovation Center, Price did not commit to keep it or remove it. He said the center “has great possibility and great promise,” however he is opposed to the center mandating demos like the Comprehensive Care for Joint Replacement (CJR) model.
  • Price dodged repeatedly questions on whether he is open to letting Medicare negotiate drug prices and allowing Canadian drug imports, Price was more willing to entertain use of transparency to stem rising drug price. Click here for more on this line of questioning.

GOP Governors Go To the Hill To Discuss Medicaid

10 Governors met with both Senate Finance Committee and House Energy and Commerce Members in roundtable discussions last week and questions of coverage in expansion states were high on the list of topics; all the governors asked for more flexibility. For more on the meeting, click here. Ohio Gov. John Kasich told the Committees that states should have the option of keeping Medicaid expansion, and if Congress decides to pare back the program, it should retain expansion for people at 100 percent of the federal poverty line. For the letter to Kasich wrote to the House, click here, and for the one to the Senate, click here.

  • Senator Rand Paul (R-KY) is preparing to release an Obamacare replacement bill by the middle of this week. He’s pushing for repeal and replace to happen in Congress on the same day. One provision would allow small businesses to group together with other small businesses to act like a large group. He’s been talking about his plan with President Trump.

CMS Rule Will Phase-Out Medicaid Pass-Through Payments, Providers Will Lose Billions

CMS published a final rule that will phase-out Medicaid Managed Care pass-through payments. The final rule prevents establishment of any new pass-through payments, and precludes increases in current pass-through payments for hospitals, physicians, or skilled nursing facilities. Additionally, the rule finalizes changes to pass-through payment transition periods and the maximum amount of pass-through payments permitted annually under Medicaid managed care contracts and rate certifications. The managed care rule provided a 10-year transition period for hospitals and a five-year transition for physicians and nursing homes. To view the informational bulletin, click here. To view the January 2017 final rule, click here.

Next Gen ACO Model Applications Now Available

CMS has released the Request for Applications and Letter of Intent for organizations interested in applying to the Next Generation Accountable Care Organization (ACO) Model for 2018. The Next Gen ACO Model previously accepted organizations into the initiative for January 2016 and 2017 start date; as of January 2017, there are a total of 45 Next Generation ACOs. Letters of Intent are due by Friday, May 4, 2017. The Next Generation ACO Model’s application portal will open in March 2017; and applications will be due in May 2017. The Next Gen ACO Model is an initiative for ACOs that are experienced in coordinating care for populations of patients. Click here for the Next Gen ACO Model website.

APMs Projected to Cover 12 Million Beneficiaries in 2017

CMS announced last week that it has enrolled more than 359,000 clinicians in new payment structures in 2016. The agency states the participants in its four Alternative Payment Models (APMs) are responsible for treating roughly 12.3 million Medicare and Medicaid beneficiaries across all 50 states. Clinicians have signed up for 2017 and will take part in one of four APMs: the Medicare Shared Savings Program, Next Generation ACO Model, Comprehensive End-Stage Renal Disease Care Model (CEC) or Comprehensive Primary Care Plus Model operating under CMS’s innovation center. In 2017, there will be:

  • 572 ACOs across the Shared Savings Program, Next Generation ACO Model and CEC Model ;
  • 131 ACOs in a risk-bearing track, including in the Shared Savings Program, Next Generation ACO Model and CEC Model;
  • 2,893 primary care practices participating in CPC+.

Click here for more from CMS.

CMS Extends 2016 EHR Reporting Deadline, Announces Intention to Modify 2017 Reports

CMS has extended the deadline to March 13 for hospitals to submit data on meaningful use and the Hospital Inpatient Quality Reporting program. The previous deadline was Feb. 28. Hospitals stand to receive a 4 percent penalty in their Medicare payments if they fail to achieve meaningful use standards in data they report for 2016. CMS also announced its intention to initiate the rulemaking process regarding modifications to the eCQM requirements established in the FY 2017 Inpatient Prospective Payment System (IPPS) final rule in response to concerns raised by stakeholders.?Specifically, CMS intends to address issues raised with transitioning and upgrading to new technology. To view the announcement from CMS, click here.

Medicaid Commission Recommends Extending CHIP Funding For Five Years

The Medicaid and CHIP Payment and Access Commission sent a report to Congress last week with a package of recommendations built on the core idea that lawmakers should extend federal funding for the Children’s Health Insurance Program through fiscal 2022. CHIP insures 8.4 million children who don’t qualify for Medicaid and funding is set to expire at the end of fiscal 2017. Those children could also lose health, dental and developmental services coverage that is often unavailable under other plans. Click here for the report.

Premiums and Deductibles for Silver Plans Increased in 2017

A new study by Avalere that examined plans sold on the exchanges this year, found average premiums for silver plans increased by 12 percent, and for low-cost silver plans, premiums increased 25 percent in 2017. Meanwhile, average deductibles for services and drugs increased 20 percent for silver plans in 2017 to $3,703. Average deductibles in gold and platinum plans, however, actually went down. The study also says coinsurance for specialty drugs increased from 34 percent in 2016 to 37 percent this year. To read the study, click here.

New Study Highlights the Impacts of Repeal in Each State

A new Urban Institute project offers a breakdown of how Republicans’ plans to partially repeal the health law through budget reconciliation would play out. For instance, almost 1 million in Ohio, 588,000 in Colorado, 486,000 in Kentucky, and nearly 2.6 million Texans would lose coverage if the law was struck down through reconciliation. Click here for the interactive map to see how each state fairs.

CBO: 32 Million Could Lose Health Coverage Under GOP Bill; GOP Says Not True

A new report by CBO states that a GOP bill to repeal major parts of the Affordable Care Act would double the price of insurance premiums within a decade and 32 million people could lose their insurance. But CBO cautioned that the score doesn’t account for any plan Republicans may pursue as a replacement to the health law, this was the repeal only language. Senate Majority Leader Mitch McConnell’s office pushed back saying , “This report assumes a situation that simply doesn’t exist and that no one in Congress advocates.” To read the CBO report, click here.

FDA Releases Draft Guidance on Off-Label Communications

FDA issued draft guidance last week that gives drug and device companies more flexibility to communicate off-label information about their products and avoid charges of misbranding. The new policy allows companies to promote a drug or device with information not on the agency-approved label as long as that information is truthful and non-misleading and is “consistent” with the FDA-approved labeling. Comments on the draft are due in 60 days. Click here for the draft guidance.

HHS Revises Rule on Informing Patients of Risks in Medical Experiments

Last week, HHS issued a long-awaited revision of a rule establishing how to properly inform people enrolling in medical experiments about the risks and benefits of the research. The revision of the 1991 Common Rule dropped an earlier proposal that scientists said would have made much of their work impossible. The rule, most of which takes effect in 2018, calls for consent forms to include concise explanations of the purpose of a medical experiment, as well as the risks and benefits and alternative treatments a subject might want to consider. Click here to view the rule and here for more from HHS.

Higher Rebates on Drugs Not Always Passed On To Government or Beneficiaries: CMS

According to a new CMS report, drug companies and pharmacies are paying larger and larger rebates to benefit pharmacy managers and insurers, but that doesn’t always translate to lower costs for government health programs and their beneficiaries. Since 2010, the growth in rebates from drug makers to pharmacies has far outpaced the growth in Medicare Part D drug costs. This has helped private insurers in Part D keep costs down, but it isn’t translating to lower costs for consumers — and in some cases results in more drug costs being shifted to the government. CMS attributes the discrepancy between insurers’ savings and more costs for patients and government to a couple of factors. To read the report, click here.