Health Care Policy Update – Weekly Wrap-up and What’s Ahead


 Weekly Wrap-Up: Notable Health Care Developments From Last Week

 116th Congress –

  • On November 14, Senate Republicans reelected Sen. McConnell (R-KY) to serve as Senate Majority Leader, and Senate Democrats also reelected Sen. Schumer (D-NY) to serve as Senate Minority leader for the 116th Press releases: http://bit.ly/2qUvUBK and http://bit.ly/2qOJvL8
  • Also on November 14, Rep. McCarthy (R-CA) was elected as the House Minority Leader. House democrats have yet to hold their leadership elections. Press release: http://bit.ly/2qUGVmW
  • On November 16, Senate Judiciary Chair Grassley (R-IA) announced his intention to lead the Senate Finance Committee, of which he is currently a member. Sen. Grassley Statement: http://bit.ly/2r15PRX Senate Finance Committee Chair Hatch (R-UT) statement: http://bit.ly/2qUruLq

 Legislative Activity –

  • On November 14, Sen. Kennedy (R-LA) introduced S. 3629, which would require state agencies to use federal tax return information to verify income eligibility for Medicaid, the Temporary Assistance for Needy Families program, and the Supplemental Nutrition Assistance Program. Press release: http://bit.ly/2FGAvCb
  • On November 15, Sens. Collins (R-ME) and Cantwell (D-WA) introduced S. 3621, which would amend the Internal Revenue Code of 1986 to provide for a permanent extension of the lower threshold for the medical expense deduction. Press release: http://bit.ly/2FuggHG

 ACA and Individual Insurance Markets –

  • On November 7, CMS released a Weekly Enrollment Snapshot from the second week of the 2019 Open Enrollment period, showing that 804,556 individuals selected plans using the HealthCare.gov platform, for a total of 1.18 million. Fact sheet: https://go.cms.gov/2FrRO9R

  • On November 15, CMS released an evaluation of the EDGE Data submissions for the 2018 benefit year, which is used to determine which states will receive 2018 benefit year interim risk adjustment summary reports in March, which issuers will receive the 2018 benefit year interim transfer reports, and which issuers will be included in final risk adjustment transfer calculations. Report: https://go.cms.gov/2FoZb1E
  • On November 16, Senate Finance Committee Ranking Member Wyden (D-OR), Senate HELP Committee Ranking Member Murray (D-WA), Senate Aging Committee Ranking Member Casey (D-PA), House Energy & Commerce Committee Ranking Member Pallone (D-NJ), House Ways & Means Committee Ranking Member Neal (D-MA), and House Education and the Workforce Committee Ranking Member Scott (D-VA) sent a letter to HHS Secretary Azar, CMS Administrator Verma, and Treasury Secretary Mnuchin expressing concern that the Administration’s new guidance on section 1332 of the ACA is inconsistent with congressional intent, will raise costs for consumers, and will undermine protections for individuals with pre-existing conditions. Press release: http://bit.ly/2qQVsQe Letter: http://bit.ly/2qTeE04

 Medicare and Medicaid –

  • On November 13, CMS announced a new section 1115 waiver opportunity for states to provide community-based services for adults with a serious mental illness or children with a serious emotional disturbance. Press release: https://go.cms.gov/2PWnurW State Medicaid Director letter: http://bit.ly/2Q2jWUY
  • On November 15, CMS announced it had achieved improper payment rate reductions in Medicare fee-for-service, Medicare Advantage, Medicare Part D, Medicaid, and the CHIP program. Press release: https://go.cms.gov/2FDHJXA
  • On November 15, Arkansas announced that an additional 3,815 beneficiaries have been disenrolled from Medicaid coverage for failure to meet the state’s work requirements. More than 12,000 beneficiaries have been removed from coverage since the work requirement was put in place. Report: http://bit.ly/2qSyWqc
  • On November 16, CMS posted a fact sheet highlighting information for the 2019 Medicare electronic health record incentive program payment adjustment for hospitals. Fact sheet: https://go.cms.gov/2Fr9DpC

 Payment and Delivery System Reform –

  • On November 16, CMS released a document listing quality measures performance percentiles for the Comprehensive Care for Joint Replacement Model. Document: http://bit.ly/2FsS74b
  • Also on November 16, CMS posted the participation agreement document for the Bundled Payments for Care Improvement Advanced model. Agreement: http://bit.ly/2FtitD3
  • Also on November 16, CMS posted the final year two and preliminary year three savings report for the Financial Alignment Initiative for Medicare-Medicaid Enrollees in Washington State. Report: http://bit.ly/2FvAuAK
  • Also on November 16, CMS announced a proposed Artificial Intelligence Health Outcomes Challenge, which will explore how to harness AI to predict health outcomes in current payment and service delivery models. More information will be posted in 2019. Summary: http://bit.ly/2FubMkk

 Drug Prices and Regulation –

  • On November 16, incoming Senate Finance Chair Grassley (R-IA) and Sen. Durbin (D-IL) sent a letter to HHS Secretary Azar supporting the finalization of proposed regulations requiring pharmaceutical companies to list prices of their prescription drugs in direct-to-consumer advertisements. Press release: http://bit.ly/2FtN9Ea Letter: http://bit.ly/2FsT0tx
  • Also on November 16, Food and Drug Administration (FDA) Commissioner Gottlieb released a statement on the FDA’s efforts to hold industry accountable for fulfilling critical post-marketing studies of the benefits and safety of new drugs. Statement: http://bit.ly/2FsWCf5
  • On November 18, Sens. Portman (R-OH) and Carper (D-DE) released a report finding that the manufacturer of the naloxone drug Evzio increased its price by more than 600 percent from 2015 to 2016. Press release: http://bit.ly/2Qb0gyc  Report: http://bit.ly/2Qb0ple

Mental Health and Substance Use –

  • On November 13, U.S. Government Accountability Office (GAO) released a report describing leading practices for state programs to certify peer support specialists. Summary with link to report: http://bit.ly/2qTBZ1p
  • On November 15, HHS released a report finding that from 2013-2015, there was an average of one substance-related inpatient stay annually for every 100 people in the U.S. Summary with link to report: http://bit.ly/2Fw1kc9
  • Also on November 15, Centers for Disease Control and Prevention released a report finding that the suicide rate among the U.S. working age population increased 34 percent from 2000-2016. Summary with link to report: http://bit.ly/2qSu0BK
  • Also on November 15, FDA released new findings from the National Youth Tobacco Survey showing that more than 3.6 million middle and high school students were current e-cigarette users in 2018, an increase of 1.5 million from 2017. Additionally, FDA announced new steps to protect youth by preventing access to flavored tobacco products and banning menthol in cigarettes. Report: http://bit.ly/2FreNSb FDA Commissioner Gottlieb Statement: http://bit.ly/2FrP24k

 Military & Veterans’ Health –

  • On November 13, GAO released a report finding that while the Veterans Health Administration conducts regular inspections of the settings in which patients receive health care services, it should establish set goals and measures to enable improved oversight of the facilities. Summary with link to report: http://bit.ly/2qTfAl6
  • Also on November 13, VA announced updates to its website to provide veterans with an enhanced digital customer experience. Press release: http://bit.ly/2FuFV2Z

 Health IT –

  • On November 15, CMS released a report on the use of telehealth in the Medicare and Medicaid programs, including the activities by the Innovation Center, describing the use of telehealth services in models and barriers that might prevent the expansion of telehealth. Report: https://go.cms.gov/2qQasxW

Misc. –

  • On November 15, HHS posted a blog highlighting its policy-oriented research on the health challenges of rural communities. Blog: http://bit.ly/2FubbiA
  • On November 16, HHS Office of Inspector General (OIG) released its 2018 Top Management and Performance Challenges, which include preventing and treatment opioid misuse, and ensuring program integrity in Medicare and Medicaid. Summary with link to report: http://bit.ly/2FsQAer
  • Also on November 16, U.S. Preventive Services Task Force released the 8th Annual Report to Congress on High-Priority Evidence Gaps for Clinical Preventive Services, including areas such as cancer prevention and cardiovascular health. Summary with link to report: http://bit.ly/2FDDbjA