October 2, 2017

October 2, 2017



Who Will Replace Price at HHS?

Tom Price resigned his position as HHS Secretary Friday, following a week-long stretch of negative media stories about his use of chartered and military aircraft.  Click here to read his resignation letter.  Speculation about his successor is already intense.  On the short list of replacements:  CMS Administrator Seema Verma, FDA Commissioner Scott Gottlieb and VA Secretary David Shulkin.  There are also several physician members of Congress who may be interested in the job.  Click here for the possibilities from the NYTimes.

  • Don Wright is named Acting Secretary at HHS. Click here to learn more about him.
  • The Senate’s 2018 budget resolution released Friday won’t allow for full repeal of the Affordable Care Act, but it is the vehicle they plan to use to move massive tax cuts.  Click here for details.
  • Price’s exit complicates the GOP effort to repeal and replace the Affordable Care Act.  Click here for the report.
  • Despite the setbacks, the sponsors of the recently failed Graham-Cassidy repeal and replace bill vow to press on.  Click here.

Congress Moving Significant Health Care Legislation

The House and Senate are both moving some major health care bills that are generally favorable to providers.  The legislation is not attracting attention, particularly from major media, and therefore is more likely not to be stalled by partisan fighting.  Click here for an excellent summary, with links, from our policy team.


A Majority of the House Sends Letter to CMS to Drop 340B Proposal

A bipartisan group of 228 House lawmakers urged CMS last week to scrap proposed cuts to hospitals’ reimbursement for 340B drugs because they say it isn’t clear the proposal would reduce drug costs for Medicare beneficiaries and it could hurt hospitals. A senate letter is still gathering senators’ signatures.  Hospital groups have argued since it was proposed that CMS doesn’t have the authority to cut the pay for 340B drugs, while community oncologists support the proposed cuts and drug makers say the proposal could spur a needed overhaul of the drug-discount program.  CMS has not responded to the congressional request, but the agency’s intentions should be made known within the next 4 to 6 weeks.  To see who signed on to the letter, click here.


221 House Members Urge Leadership To Pass Delay in Medicaid DSH Cuts

More than half of the House of Representatives, 221, are urging their leadership to pass legislation that would delay at least for two more years cuts to hospitals that serve a disproportionate share of Medicaid and uninsured patients. The cut takes effect October 1, 2017. Unless the law changes, hospitals’ DSH payments will be cut by $2 billion in FY 2018. Click here for the letter and to see who signed on.


ACA Provision Expected To Hit Hospitals’ Medicare Reimbursement

A little-known element of the Affordable Care Act could leave some hospitals strapped for cash. The ACA allows Medicare to adjust reimbursements based on workers’ productivity, meaning reimbursement rates decrease as productivity grows in the economy, according to an article from The Wall Street Journal (click here). The Congressional Budget Office projected last year (click here) that this section of the law would cause reimbursement rates to grow at 2.2% each year between 2012 and 2025, a decrease from 3% growth.


MA and Part D Premiums To Decrease Next Year

Premiums for Medicare Advantage and Part D prescription drug plans will decrease slightly next year, CMS has announced. The average monthly premium for a Medicare Advantage plan will be $30 in 2018, a 6-percent decline from this year. CMS expects 20.4 million Medicare beneficiaries — just over a third of all enrollees — to choose private plans for next year. The average premium for prescription drug coverage in 2018 will be $33.50 — down from $34.70 this year. It’s the first time that premiums have declined since 2012.  Medicare open enrollment runs from Oct. 15 to Dec. 7. Click here for more from CMS.


Senate Committee to Have Hearing on Opioid Crisis
Senate HELP Committee is scheduled to review the Federal government’s response to the opioid epidemic on Thursday. The panel will review the implementation of last year’s 21st Century Cures Act, which included $1 billion over two years to help states combat the drug epidemic. The Trump Administration this year has been steadily announcing awards to states from that funding. To view the hearing on the Committee’s website, click here.


Rural American Towns Struggle with Funding While Battling the Opioid Crisis  Budgets in small-towns have been turned upside down with the rapid increase in use of local resources as they combat the opioid crisis. With overdose antidotes, busy jails and courtrooms, and increased autopsies, these communities are spending at historic rates to fight the epidemic. The CAH Coalition in Washington, D.C. advocates for rural hospitals providing crucial aide in these communities. Click here for more on the CAH Coalition. Click here for more on the impacts of the opioid crisis on rural communities.
PhRMA Supports Opioid Prescription Limit

The nation’s largest drug company association, PhRMA, has signaled its support for limiting opioid prescriptions to seven days amid the national drug abuse epidemic. “Our companies are prepared to collaborate, break down silos and really move the needle,” said PhRMA president and CEO Steve Ubl while testifying before the president’s opioid commission in Washington. CVS last week became the first national retail pharmacy chain to announce it will restrict opioid prescriptions to seven days for certain conditions, following guidelines released by CDC last year. Click here for more from PhRMA.


FDA Targets 500+ Websites Illegally Selling Prescription Drugs

The FDA has targeted more than 500 websites it said were illegally selling unapproved versions of prescription medications, including opioids, antibiotics and injectable epinephrine products, according to the agency. The action was part of a global operation called Pangea X, led by the international police organization Interpol. That group said the international enforcement effort occurred Sept. 12 to 19.  This year’s crackdown involved police, customs and regulatory officials from 123 countries and resulted in the seizure of millions of doses of dietary supplements, pain reduction pills, epilepsy medication, erectile dysfunction pills and antipsychotic medication. Click here for the story.


Poll Shows Americans Want Congress to Focus on Drug Prices

Americans think Congress should prioritize combating high prescription drug prices for the remainder of the year, according to a new poll. Digging into how the problem should be handled there’s little consensus. Nearly 9 in 10 of those polled stated that they support allowing the federal government to negotiate cost with pharmaceutical companies for Medicare. But when they are told that doing so could lead some drug-makers refusing to sell certain prescription drugs to Medicare beneficiaries, support for that idea plummeted to 38 percent. Click here for more.

  • A federal judge rejected a request by a generic drug trade group to block Maryland’s law targeting price gouging from taking effect. The law gives the state attorney general the authority to go after pharmaceutical companies that raise the price of a generic drug to an “unconscionable” level.  Click here.

House Committee to Examine Making Experimental Drugs Available to Terminally Ill

FDA Commissioner Scott Gottlieb is set to testify Oct. 3 at a House Energy and Commerce Committee hearing on pending “right-to-try” legislation. H.R. 1020, the Compassionate Freedom of Choice Act of 2017 and S. 204, the Senate’s companion bill, would allow terminally ill patients to seek access to experimental medicines outside of the FDA’s established system for such requests. Click here for hearing information.
Senate Passes CHRONIC Care Act

The Senate last week passed a bipartisan bill that aims to improve the way Medicare handles chronically ill patients. The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Act –

  • Extends the Independence at Home demonstration program;
  • Modifies provisions regarding access to home dialysis therapy under Medicare and special needs plans under Medicare Advantage (MA);
  • Expands testing of the MA Value-Based Insurance Design test model;
  • Allows an MA plan to provide additional telehealth benefits to enrollees and, to chronically ill enrollees, certain supplemental health care benefits;
  • Modifies other provisions regarding the use of telehealth services;
  • Allow prospective, voluntary assignment of Medicare fee-for-service beneficiaries to accountable care organizations (ACOs); and
  • Allow ACOs to operate beneficiary incentive programs.

It is uncertain whether the House will pass this bill this year. Click here for more on the bill.
New VA Reg Dramatically Expands Telehealth

The Department of Veterans Affairs has issued a proposed rule that would allow VA providers to treat patients in any state via telehealth, regardless of where they are licensed to practice. The proposed rule would override state licensing restrictions that the agency says are limiting its telehealth program and allow VA physicians to treat patients anywhere in the country using the VA’s telehealth technology.  Click here for the rule.


2017’s Last Quarterly MIPS Reporting Period Starts Now

As we move into the final quarter of the calendar year, CMS is reminding clinicians – if you are required to participate in the Merit-based Incentive Payment System (MIPS), today is the day practices should begin data collection to report 90 consecutive days of data for the transition year. For example: If a practitioner is planning to submit 90 days or more of quality data via claims, they would need to begin adding the applicable quality data codes to their claims no later than October 2nd. If clinicians submit data for at least 90 days, they avoid the negative payment adjustment, and may be eligible for a positive payment adjustment. Click here for the CMS MIPS overview.


CMS Won’t Update Hospital Star Ratings this Month

CMS will not update its Overall Hospital Quality Star Ratings in October, despite previous announcements it would do so. The star ratings released last December will remain on the Hospital Compare website until the next update.  Click here for the AHA News report.


HHS OIG – $51 Million in Medicare Payments for Outpatient Services for Inpatients of Other Facilities

The Office of the Inspective General at HHS found over $51 million in inappropriate Medicare payments for outpatient services provided to inpatients of other facilities. Generally, Medicare should not pay an acute-care hospital for outpatient services provided to an inpatient of another facility. Instead, the services should be provided under arrangements between the two facilities, and Medicare should pay the inpatient facility for all services provided. The OIG recommends that CMS recover overpayments and instruct those hospitals to refund beneficiaries for incorrect deductibles and coinsurance and that Medicare contractors educate hospitals on this policy. To read the report, click here.


House Committee to Vote on CHIP Reauthorization Bill This Week

The House Energy and Commerce Committee is scheduled to mark up a bill this week to renew federal funding for the Children’s Health Insurance Program and other health programs, after funding for the program expired on Saturday. The announcement did not unveil official bill text for the program that provides funding for a program that covers about 9 million children nationwide. The Senate has introduced legislation to reauthorize CHIP, S. 1827, for five years without addressing other issues like health center funding. The Senate Finance Committee has yet to schedule a markup. Click here for the Committee announcement

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