December 2, 2019

The Next Three Weeks:  Congress returns to work this week on a mad dash to the Christmas recess.  The government runs out of money December 20, so the primary legislative effort will be to keep the funding flowing. (And House action on impeachment.) This is likely to include a continuation of the delay in Medicaid disproportionate share hospital (DSH) payment cuts, as well as funding for a variety of health care programs, like community health centers.  The key question now is whether Congress will pass drug pricing reform or surprise billing legislation as part of the year-end package, odds are presently against either passing this year – maybe in the first quarter of 2020.

CMS To Make Case for Price Transparency Regulation
The Centers for Medicare and Medicaid Services will hold a public conference call on Tuesday, December 3, on its final price transparency rule that requires hospitals to disclose payer-specific negotiated rates effective on January 1, 2021. The rule, released last month, would require hospitals to post their gross charges, negotiated rates, minimum and maximum negotiated rates, and discounted cash prices for 300 “shoppable” services in a consumer-friendly, machine readable way. Click here for information on the call including the CMS PowerPoint presentation.

Air Ambulance Concerns Continue Over Surprise Billing Proposals; White House Not Happy
Moody’s warned last week that proposals to end air ambulance surprise billing could lead to lower private reimbursement rates for air ambulance providers, and a decrease in private pay rates without an increase in government pay rates could threaten the entire industry due to gross underpayment for the services, click here.  Axios reports on the White House displeasure with the more than $28 million worth of anti-surprise billing advertisements paid for by private equity firms focused in states with contested Senate races, click here.

HHS OIG: Hospitals Received Over $500 Million in Excessive Outlier Payments from CMS
According to a new report from the HHS Office of the Inspector General, Medicare overpaid 60 hospitals by more than half a billion dollars over a four-year period. From fiscal years 2011 through 2014, CMS paid the 60 hospitals a net of $502 million more in outlier payments than the hospitals would have been paid if their outlier payments had been reconciled – CMS did not detect or recover these excessive outlier payments because the cost reports did not meet the 10-percentage-point threshold for reconciliation.The OIG recommended that CMS require reconciliation of all hospital cost reports with outlier payments during a cost-reporting period. CMS concurred with the recommendation and stated that it is evaluating the current outlier reconciliation criteria and will consider whether to propose any appropriate modifications to the outlier reconciliation policy in future rule making. Click here for the report.

  • Washington state’s health department sued HHS to resolve a dispute over how to calculate Medicaid payments to hospitals to reward them for adopting electronic health record systems, click here.

ACA Open Enrollment Similar To Last Year; Senators Voice Opposition To Short-Term Plans
Open enrollment through closes on Dec. 15th, and at the end of the third week, CMS showed that the numbers were about at the same pace as last year; however, the numbers are expected to dip due to the Thanksgiving holiday. Almost 2.4 million people have signed up for coverage through the first four weeks, over 703,000 people in the fourth week alone. Almost two dozen Senate Democrats sent a letter of concern over the “short-term” plans that are being offered through the ACA that are usually cheaper policies and often do not follow certain ACA requirements, including protections for pre-existing conditions. In a letter to CMS and the HHS Inspector General, the 23 Senators requested that they “identify the legal authority” the White House is using “to promote ‘junk’ plans.” Click here for the week four snapshot, and here for the Senate letter.

  • The digital tool to helps seniors navigate complicated Medicare choices is malfunctioning with alarming frequency, offering inaccurate cost estimates according to a ProPublica investigation, click here.
  • Pharmacy and supermarket chain Giant Eagle is partnering with Amazon for Giant customers to use Alexa to review and refill their prescriptions and remind them when to take their medications, click here.
  • UnitedHealthcare will open Medicare service centers in Walgreens stores in Las Vegas, Phoenix, Cleveland, Denver and Memphis markets where beneficiaries can learn more about the program, enroll in a UnitedHealthcare MA plan and learn about their individual benefits, click here.

States Taking Advantage of Change in Federal Law to Provide Medicaid Children Health Care in School
Five years ago, CMS changed a decades old rule that barred school-based clinics and providers from billing Medicaid for care provided to children on Medicaid. Recently, states have begun to take advantage of the change in law and, according to a new Pew Charitable Trusts report, more schools are billing Medicaid to help students manage chronic conditions such as asthma, diabetes and food allergies, offer mental health and addiction treatment as well as provide dental, vision, hearing and speech services. Seven states – Florida, Kentucky, Louisiana, Massachusetts, Michigan, Nevada and North Carolina – have already began billing Medicaid for health care in schools.  California and Georgia are awaiting approval to start, and Colorado and Oregon are preparing paperwork to start services. To view the full report, click here.

CDC Identifies Likely Harmful Additive in Vapes; FDA Looks at New Graphic Anti-Smoking Labels
The Centers for Disease Control and Prevention last week announced that the compound that’s been tied to lung illnesses nationwide could likely be a relatively new ingredient in THC-containing vaping products – vitamin E acetate. The agency identified vitamin E acetate as a chemical of concern through recent CDC laboratory testing of fluid samples collected from the lungs from 29 patients from 10 states. The testing found vitamin E acetate in all of the samples. Meanwhile, the FDA is looking for comments on graphic cigarette warning labels meant to dissuade people from lighting up, which European countries have been utilizing since the 1990’s. The plan depicts 13 different images in color that are meant to show not just the consequences, such as damaged lungs, but also other side effects people might not be as familiar with, such as bloody urine, erectile dysfunction, and amputated limbs. Tobacco companies would need to place the pictures on the upper half of the front and back of cigarette packs, as well as on 20% of the space on their ads. For more from the CDC on vaping, click here, and for the FDA regulation, click here.

  • The Senate Health Committee will vote on President Trump’s nominee to lead the FDA on Dec. 3, Texas oncologist Stephen Hahn, click here.

House Subcommittee to Hold Oversight Hearing on the Flu; CDC Urges Vaccine
The House Oversight and Investigations Subcommittee will hold a hearing Wednesday to examine the public preparedness for this year’s flu season and review the government’s forecast for the 2019–2020 influenza season and ongoing influenza-related research and innovation. The 2018–2019 flu season marked the longest flu season in a decade with 37–43 million flu illnesses, up to 20 million medical visits, as many as 647,000 hospitalizations, and up to 61,200 possible deaths. The CDC is urging Americans as young as 6 months and especially the elderly to get a vaccine this year to lower the rates. For more on the hearing, click here, and for more from the CDC, click here.

Birth Rates Down Seven Percent to Record Low
The CDC reports that the teen birth rate in the US has hit a record low.  In 2018the rate among those ages 15-19 was 17.4 births per 1,000 women, down 7 percent from 2017 and nearly half the 2010 rate of 34.2 births per 1,000 women. The current rate is also an almost 60 percent drop since 2007, the most recent year with high birth rates. Although the new report does not identify the reasons behind this trend, other analyses have found that recent drops in teen births can be traced back to funding for family planning programs under Title X and mandates under the ACA that expanded access to contraception. For the CDC report, click here.

Gallop Poll: 28% of Americans Weigh Over 200 Pounds
A newly released Gallop poll shows that an average of 28 percent of Americans said they weighed 200 pounds or more from 2010-2019, up from 24 percent during the prior decade. Additionally, Americans’ average self-reported weight rose to 178 pounds up from 174 pounds during the previous decade, with similar increases among men (4 pounds) and women (3 pounds). Of those polled, 54 percent stated that they wanted to lose weight, down from 59 percent in previous decade. Click here to view the poll results.

  • Five major nutrition organizations just united to form the American Nutrition Association to “unleash nutrition’s potential to reverse the crisis,” click here.

Almost 90% of Toddlers Exposed to Screen Time and Higher than Recommended Rate
A new study published in JAMA Pediatrics shows that almost 90 percent of kids 18 months to 5 years old were exposed to screens for much longer than pediatricians recommend. By 12 months old, the average child was spending about 53 minutes a day looking at TV, computer, or mobile phone screens. Researchers also found that by the age 3, kids had about two and a half hours of screen time. According to the American Academy of Pediatrics, parents should very gradually introduce infants to screens and limit screen time for kids 2 to 5 to about an hour a day at most. Click here for the study.

Just in Time for the Holidays: Eye Injuries on the Rise from Paintball and BB Guns 
According to a new study published in the Journal of American Pediatrics, eye injuries from BB and other non-powder guns have risen 30 percent. Researchers looked at data from over 360,000 children under the age of 18 between 1990-2016 and found that the rate of eye injuries from BB guns as well as pellet, paintball, and airsoft guns increased by 30 percent, even though the number of all types of injuries from these guns decreased by almost 50 percent. Additionally, the study found that BB guns accounted for more than 80 percent of all injuries, and nearly 90 percent of children injured were boys. The most common type of eye injury was a scratch on the eye’s cornea. To read the full study, click here.

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