February 3, 2020

Trump Administration Proposes Medicaid Block Grants
CMS has announced the agency’s anticipated Medicaid block grant demonstration titled the “Healthy Adult Opportunity”, details of which appear in a 56-page CMS letter to state Medicaid directors. The HAO is available to all states and will be initially approved for five years and may be renewed for up to 10 years. Demo participants can include adults under age 65 that are not eligible for Medicaid based on disability or a need for long term care and are not eligible under a state plan.  States may target a defined subset of high need individuals for HAO demonstration participation and states can migrate Medicaid enrollees from current 1115 waiver demonstrations to the HAO demonstration. Critics say this initiative will do the opposite of what it promises, by limiting opportunities for people to sign up for Medicaid and drastically cutting the threshold of eligibility for Medicaid. However, some states are already jumping on the chance for the demo with Oklahoma’s Governor announcing that they will now expand Medicaid under the new formula. For the letter, click here, and for the factsheet, click here. For Administrator Verma’s remarks on the plan, click here.
  • House Democratic leaders announced they will vote on a resolution of disapproval of the proposed demonstration this week, click here.

Major Groups Oppose MFAR Proposal:  US Chamber Joins Hospitals, Long-Term Care in Opposition
The comment period on the other major proposed regulatory change to Medicaid – the Medicaid Fiscal Accountability Regulation (MFAR) – closed February 1 and numerous major organizations announced their opposition to CMS’ MFAR proposal.  More than 2,800 comments were submitted.  The U.S. Chamber joined a few thousand hospitals and long term care facilities in opposing the rule.  The Chamber said the “proposed rule could: have detrimental economic ramifications on communities across the country; put patient access to critical services in jeopardy, exacerbate cost-shifting onto privately insured communities; and violate state sovereignty and ability to manage state programs and populations by providing CMS unprecedented discretion over its evaluation of state financing and payment approaches.”  Click here to review all comments.

  • For MACPAC’s comments, click here.

CMS Identifies 786 Hospitals Penalized for HACs
The Centers for Medicare & Medicaid Services last week identified 786 hospitals that will receive lower payments for a year under the Hospital-Acquired Conditions Reduction Program, a creation of the Affordable Care Act. The penalties are designed to encourage better care without taking the extreme step of tossing a hospital out of the Medicare and Medicaid programs, which would drive most hospitals out of business. Click here to find your hospital.

CMS Says 228 Hospitals Have One Star in Latest Ratings
CMS updated its Overall Hospital Quality Star Ratings last week, recognizing 228 hospitals with one star. CMS’ Hospital Compare website reports on quality measures for more than 4,500 hospitals nationwide. The American Hospital Association was critical of the update saying the methodology had not been improved. Here is a breakdown of the updated star ratings: One star: 228 hospitals; Two stars: 710 hospitals; Three stars: 1,191 hospitals; Four stars: 1,136 hospitals; Five stars: 407 hospitals.  Click here to find your hospital.

GAO Continues Probe of 340B Rx Program
The Government Accountability Office has issued a second report on the 340B Program. The report reviewed “duplicate discounts” in which drugs provided to Medicaid beneficiaries are subject to both 340B Program discounted prices and Medicaid rebates. GAO suggests that HRSA and CMS do not do enough to prevent drug makers from paying duplicate discounts under Medicaid and the 340B drug discount program and should increase its efforts. However, HRSA responded (page 44 of the report) that it, “does not have the regulatory authority related to the prevention of duplicate discounts for covered entities.”  Also, that it has requested this authority from Congress since the President’s FY 2017 budget. Click here for the report.
CMS Issues 2021 Exchange Rule with Numerous Changes
CMS is proposing to pull tax credits from consumers who pay zero dollars in premiums for their exchange plans if they are auto-reenrolled but don’t update their income, arguing in the 2021 proposed exchange rule released Friday that the plan complies with a provision tucked into the 2019 spending bill that demands HHS maintain auto-reenrollment in 2021.  The 2021 draft Notice of Benefit and Payment Parameters was released after a longer-than-usual delay that has left insurers wondering whether there would be enough time to implement policy changes before submitting applications. The rule proposes regulatory updates in several areas — including the out-of-pocket maximum and premium contributions, risk adjustment program and other policies — which CMS says will drive down premiums and improve program integrity. Click here for details from CMS.  Click here for the draft notice to insurers.
Insurers Believe Proposed Price Transparency Rule Costs Too Much
Insurance groups say the Trump Administration’s proposed price transparency rule for insurers will cost 26 times more than previously estimated. The rule, proposed by the Treasury, Labor and Health and Human Services departments late last year, would mandate insurers to disclose negotiated rates for in-network providers and allowed amounts for out-of-network care. In addition to the high costs, insurers worry that they would have to share an overwhelming amount of data. To read more, click here. Transparency rules for hospitals take effect January 1, 2021.
Coronavirus: a Global Health Emergency, a Public Health Emergency in U.S. 
The World Health Organization has declared the Coronavirus outbreak to be a global health emergency. The viral outbreak extends beyond its country of origin, China, and poses an international threat. As of the formal announcement, on January 30, there are 7711 confirmed and 12167 suspected cases throughout the China. Of the confirmed cases, 1370 are severe, 170 people have died, and 124 people have recovered and been discharged from hospital.  Outside of China, there have been 83 cases in 18 countries. Of those cases, 7 had no history of travel in China, only 1 was severe, and there have been no deaths.  For the WHO announcement, click here.   For the latest from the CDC, click here.
  • HHS Secretary Alex Azar has declared a public health emergency in the United States as well, click here.
New Systems to Simplify Prior Authorization 
The Insurance Industry association AHIP and CMS announced last week that they are each rolling out new programs to ease prior authorizations. AHIP, along with SureScripts and Availity, plans to provide a new program called Fast Path within the next 60-90 days for about six months. Fast Path is a portal for providers to access patient’s pharmacy benefits, view medications that require prior authorization, and view what procedures require it based on patient’s health insurance. CMS is developing a Documentation Requirement Lookup Service to inform providers at the point of care if the patients have any prior authorization requirements. These solutions to simplify the process are promising. Click here to read more.
Maine, New Mexico, West Virginia Docs Rated Worst; New Jersey, Idaho, North Carolina Rated Best
The people in Maine rate their doctors as the worst in the country, according to a new study. The state’s physicians received the lowest average score across the nation in the 2020 Patient Sentiment Report, an analysis of feedback from 8.4 million health care consumers by the Medical Group Management Association and provider rating website Healthgrades. The study examined quantitative and qualitative data from the ratings patients gave their doctors, and then scored them on six attributes: bedside manner, communication, skill and care quality, staff, length of office visits, and waiting time for office visits. Click here for the complete report.
Shorter Hospital Stays After Cardiac Surgery May Not Increase Risk
Patients undergoing cardiac surgery may have shorter in-hospital recovery periods than previously thought, according to a new study presented at the 56th Annual Meeting of the Society of Thoracic Surgeons. The results of the study revealed that patients may leave as little as three days after surgery without any increased risk of complications. It is anticipated that the first cardiac enhanced recovery after surgery program to improve overall patient outcomes will be developed. To read more, click here.
Health Care Costs Greatest for Lower-Income Households
Families in the bottom fifth of income groups pay nearly a third of their income towards health care a new RAND Corporation study found. Meanwhile, households in the highest income group pay 16 percent of their income towards health care costs. Although higher-income households finance health care the most, the burden of payments is greatest among lower-income households. Click here to read the full report.
Report Finds U.S. Has the Highest Suicide Rate Among Wealthy Nations
The U.S. has the highest suicide rate, at 14 per 100,000 people,according to a new report, from the Commonwealth Fund. Other key findings included that in 2018, the U.S. spent the most on health care (16.9 percent of GDP), which totaled over $10,000 per person. Despite these costs, the U.S. was found to have the lowest life expectancy, 78.6 years, which is two years lower than the average for other wealthy countries. From their findings, the report concluded with recommendations for the U.S. to reduce health care costs, promote preventative incentives, and to invest in primary care. For the full report, click here.
U.S. Life Expectancy Rises for the First Time in Four Years
CDC’s National Center for Disease Statistics says that the United States has increased life expectancy for the first time in four years. Life expectancy increased to a peak of 78.9 years in 2014 and gradually declined by 0.4 years between 2014 and 2017. However, there was a 0.1 year increase from 78.6 years in 2017 to 78.7 years in 2018. The report also shows a decline in drug overdose deaths that most likely influenced the incline in life expectancy rates. Six of the 10 leading causes of death in the United States declined in 2018: heart disease by 0.8 percent, cancer by 2.2 percent, unintentional injuries by 2.8 percent, lower respiratory diseases by 2.9 percent, stroke by 1.3 percent, and Alzheimer’s by 1.6 percent. However, two leading causes of death, influenza/pneumonia and suicide have increased. For the CDC report, click here.
FDA Issues Warning Letter for Purell to Remove False Claims
The makers of Purell sanitizer products, GOJO Industries Inc., received a letter from the Food and Drug Administration regarding the mislabeling of their products that state unproven claims that Purell can prevent diseases such as the flu, norovirus, and the Ebola virus. The letter said the company’s marketing of the products violates the Federal Food, Drug, and Cosmetic Act as the current labeling advertises Purell as a new drug to be used for treatment, when in fact, it is unapproved. The warning letter stated that GOJO Industries has 15 working days to notify the FDA about steps they have taken to correct the violations before legal actions are taken. Click here for the warning letter.
FDA OKs First Peanut Allergy Treatment
The Food and Drug Administration on Friday approved the first treatment for peanut allergy, providing a new option for the growing number of children and their families dealing with the life-threatening condition. The new treatment, named Palforzia from Aimmune Therapeutics Inc., is designed to work by exposing patients to the very substance they had been taught to avoid. The drug is derived from peanut powder, and doses contain the equivalent of small amounts of peanuts. Click here for the report.
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