November 13, 2017

Ways and Means Passes Tax Bill that Kills Widely-Used Hospital Bonds;

Dozens of Groups Oppose Bond Provision

The House Ways and Means Committee last week passed along party lines the GOP tax reform bill that contains several provisions negatively impacting not-for-profit hospitals.  The full House is expected to vote on the bill this week.  Click here for the plain-language summary of the House’s bond provisions.  The Senate tax bill does NOT contain the same provision.  Click here for the Senate version summary.  The Senate Finance Committee could pass its version this week.  Dozens of organizations that would be impacted by the elimination of these private activity bonds are actively engaged in opposing this provision.  Click here to see their opposition letter.

  • Neither bill contains the repeal of the health care law’s individual mandate from their tax bills, however Republicans in both chambers want to see it happen. The Senate tax bill keeps medical deductions, the House tax bill eliminates that deduction. A coalition of health care groups sent at letter to Congressional leaders calling for them to retain the medical expense deduction. Click here for the letter.
  • Law firm Akin Gump released an good analysis of how the Senate’s tax reform proposal differs from the House bill. Click here for the analysis.

Big 340B Fight Gearing Up 

Legislation is expected to be introduced this week by Rep. David McKinley (R-WV) that would negate a CMS rule to reimburse hospitals for Part B drugs at a rate of average sales price minus 22.5 percent, a cut from the current reimbursement rate for Part B drugs to 340B hospitals of average sales price plus 6 percent. Rural Sole Community Hospitals, PPS-exempt Cancer Hospitals, and Children’s Hospitals are exempt from this policy for CY 2018. CMS states it may revisit these policies for CY 2019 and is especially interested in exploring policies addressing the needs of safety net hospitals.   Click here for a review of the fight between hospitals and big pharma.

  • A lawsuit against the CMS rule by several hospitals, backed by major trade associations, is expected to be introduced this week.  Hospitals are also likely to seek a restraining order on the regulation’s implementation.  If it goes forward, the new rule would take effect January 1.


CBO: Repealing Individual Mandate Increases Uninsured by 13 Million Repealing the requirement that most Americans purchase health insurance coverage would reduce the federal deficit by $338 billion over a decade, an analysis by the nonpartisan Congressional Budget Office shows. Additionally, the CBO estimate projects that  the number of uninsured people will increase by 4 million in 2019 and 13 million in 2027. While the repeal is not currently in the tax reform drafts, republicans are still considering including a repeal in the legislation (HR 1). Those savings are less than the $416 billion over 10 years that CBO projected last December but would still be a sizable offset to the tax cuts Republicans are seeking. Click here for the CBO’s full report.


Record Number Sign Up for Obamacare in First Few Days

More than 600,000 Americans signed up for insurance coverage under the Affordable Care Act during the first four days of the new enrollment season, according to federal figures that signal a brisk start despite Republicans’ efforts to dismantle the law. Some 601,462 Americans chose a health plan from Nov. 1-4 in states relying on the federal exchange, the figures released late last week by CMS.  Click here for a backgrounder on what may be driving the sign-up.


Administration Will Support Medicaid Work Requirements The nation’s top Medicaid official indicated last week that the Trump Administration would allow states to impose work requirements on some adults in the health care program for low-income Americans. Conservatives have long championed work requirements for non-disabled adults on Medicaid, while critics argue such a move would result in people losing health care coverage. The move is a marked shift in federal policy from the Obama Administration that refused to approve state Medicaid proposals that included work requirements.  The new direction was outlined by CMS Administrator Seema Verma. Click here for her speech.

  • Medicaid is fast becoming the focal point in the debate over the future of American health care policy.  Click hereto review the issues.

OIG Says Ohio, Kansas Must Pay Back $47M in CHIP Funds

Two states received millions of dollars’ worth of unallowable bonus payments that are meant to offset the cost of enrolling children in Medicaid.  The HHS Office of Inspector General says CMS overpaid Ohio by $29.5 million and overpaid Kansas by $17.8 million. The OIG notes that this isn’t the first time it has found overpayments tied to the provision in the Children’s Health Insurance Program, which allows states to receive bonus payments if they enroll more children in Medicaid than a CMS-specified baseline.  The OIG recommended that each state refund the federal government the amount it was overpaid. Both Kansas and Ohio, however, disputed the agency’s findings and the suggestion that they return the funds. Click here for the OIG’s Ohio report.  Click here for the Kansas report.


Healthcare Prices Growth Rate Slows Substantially

Healthcare prices rose just 1.1% year-over-year through September, representing the lowest price growth rate in roughly two years, according to a new report from Altarum. That growth rate was just slightly higher than the all-time low growth rate of 0.9% in December 2015. The figure has fluctuated between 1.2% and 2.3% over the past year. The small increase in healthcare prices was likely due in large part to a decline in prescription drug prices, according to the report. Price growth for prescription drugs dropped to 1.4% in September from 2.7% in August. Click here for the Altarum report.


FDA: Withdrawn Opioid Could Make Comeback The head of the Food and Drug Administration last week suggested that the agency is concerned about reports that an opioid painkiller it pulled from the market earlier this year could make a comeback in a different form. In June, the FDA ordered Endo Pharmaceuticals to pull its drug Opana ER from the market, citing its abuse potential and involvement in an HIV/AIDS outbreak among needle users in Indiana who were altering the drug to inject it. The drug was introduced in 2012, with its manufacturers claiming it had properties that would make it harder to abuse. It replaced an earlier version of Opana that didn’t have those properties. As it turned out, the changes made it more susceptible to manipulation. To read Dr. Gottlieb’s remarks, click here. Doctors Ask House Panel for More Technical Help, Less Reporting Physician groups told Congress they need more assistance and less data reporting to help them succeed under Medicare’s new payment system. In the hearing last week, the Energy & Commerce Subcommittee sought information regarding the development of new payment models for doctors under the Medicare Access and CHIP Reauthorization Act of 2015 which overhauled the way Medicare pays doctors into on of two tracks — the Merit-based Payment Incentive System (MIPS) or Advanced Alternative Payment Models (APMs). Click here to view the hearing and read the written testimony.

Hospital Sues Leapfrog over Patient Safety Score

A Chicago hospital has sued the Leapfrog Group, alleging that the organization used inaccurate information when lowering its score in its patient safety grades released last week. Saint Anthony Hospital, a safety-net facility, filed a complaint in Cook County, Illinois Circuit Court, seeking to have the court force Leapfrog to retract its grade. The hospital said in the filing that the group lowered its grade from an “A” to a “C” using information it knew to be inaccurate. The hospital asked Leapfrog not to publish its score, according to a court filing dated Oct. 30.  Click here to read the legal complaint.  Click here to see the provisions sought in the restraining order.

27% of Nurses Say They Plan to Retire in a YearThe percentage of registered nurses who plan to retire in less than a year is up significantly, a finding that indicates the long-predicted wave of retirements among baby boomer nurses is already underway, according to a new survey. The 2017 survey of 3,347 nurses shows that 27% of the nurses who say they are planning to retire intend to do so in less than a year. In 2015, only 16% of nurses reported they planned to retire in less than a year. The survey found that 9% of RNs plan to retire in one year, more than twice the number from 2015. Click here to download the AMN survey.

CMS Failed to Track Seniors at Risk for Opioid Abuse: GAO

According to a new GAO report, CMS failed to identify hundreds of thousands of seniors using prescription painkillers who are risk of becoming addicted to the pills. The report, requested by Sens. Pat Toomey (R-PA) and Tim Kaine (D-VA), states that the criteria CMS uses to track Medicare recipients who are at risk of addiction “misses some who could be at risk of harm.” CMS flagged 33,223 Medicare beneficiaries at high risk for opioid abuse based on the agency’s criteria in 2015, but about 727,016 were actually at risk of receiving high doses of the drugs. CMS flags beneficiaries who are prescribed high doses of opioids, those who receive prescriptions from four or more providers and those who fill the prescriptions at four or more pharmacies. To read the full report, click here.

House Passes Veterans Health BillsThe House last week passed a number of veterans bills including five that would impact veterans health care.  Two will allow better access to organ transplants for veterans, others that will study crises lines and increase mental health services, and another to support telehealth services for veterans. The bills:

  • H.R. 4173: The Veterans Crisis Line Study Act of 2017, click here
  • H.R. 918: The Veteran Urgent Access to Mental Healthcare Act, click here
  • H.R. 1133: Veterans Transplant Coverage Act, click here
  • H.R. 2123: Veterans E-Health and Telemedicine Support Act (VETS) Act of 2017, click here
  • H.R. 2601: Veterans Increased Choice for Transplanted Organs and Recovery (VICTOR) Act, click here

Congress Likely To Overhaul Veterans Choice Program, Focus Is on Rural Areas

Congress is still considering a bill to overhaul the Veterans Choice Program. Streamlining the administrative processes and adding more providers into the regional networks is crucial to ensuring the program’s effectiveness in serving Veterans in rural communities, click here for an depth look at the rural communities from the Minneapolis Star Tribune.

  • The CAH Coalition represents Critical Access Hospitals interests in the Veterans Choice Program. Learn more about the CAH Coalition here. The CAH Coalition is hosting a webinar on the Veterans Choice Program Tuesday, November 14th, click here to register.

More Than One Million Seniors Now Have High Out-of-Pocket Costs in Part D 

The number of Medicare Part D enrollees with high out-of-pocket drug costs has more than doubled to over one million in 2015 since 2007, according to a new Kaiser analysis. 3.6 million enrollees had total drug spending above the catastrophic threshold in 2015, though 2.6 million were shielded by federal low-income subsidies. After that, one million enrollees are shown to be paying significantly higher costs. While they made up just 2 percent of the Medicare Part D population, they are 20 percent of the total $15 billion in out-of-pocket drug spending by Part D enrollees that year. On average, these seniors paid $3,000 out-of-pocket for prescriptions, $1,215 of which was above the catastrophic threshold. Click here for the report.


FDA Encourages Competition Through New Guidance

FDA last week released guidance to help make it easier for makers of brand-name drugs and generics to collaborate on mandated safety programs known as REMS — a move that should make it harder for brand drug companies to use REMS to prevent competition.  FDA prefers that brand and generic companies have one REMS system per product to reduce the burden on doctors and the pharmacy system. However, brand-name drug makers sometimes make it difficult for the generic company to join their safety plan as a way to forestall competition. Click here for the FDA guidance.

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