What’s Ahead: This Week


  • Tuesday, January 24
    • Senate Finance Committee, “Hearing to Consider the Anticipated Nomination of the Honorable Tom Price (R-GA) to be Secretary of Health and Human Services.”
    • House Budget Committee, “The Failures of Obamacare: Harmful Effects and Broken Promises.”
    • House Ways and Means Committee, Oversight Subcommittee, “Hearing on Examining the Effectiveness of the Individual Mandate under the Affordable Care Act.” 

Notable Policy Events

  • Wednesday, January 25
    • National Coalition on Health Care, “The Progress and Future of Value-Based Care.” Additional information: http://bit.ly/2jDAthR
  • Thursday, January 26
    • Medicare and CHIP Payment and Access Commission (MACPAC), “January Public Meeting.” Additional information: http://bit.ly/2jy5S32
    • CATO Institute, “The Economics of Health Insurance Reform.” Additional information: http://bit.ly/2kgY60H

Weekly Wrap Up: Notable Health Care Developments From Last Week


On January 19, HHS posted its HHS Presidential Transition Agency Landing Team Book, which provides a comprehensive overview of HHS and highlights key issues expected to come before the new Secretary in the near-term. Book: http://bit.ly/2kh4HIa

ACA Repeal/Replace Legislative Activity

  • On January 17, Congressional Budget Office (CBO) released a report finding that H.R. 3762 – which was passed by Congress last year before being vetoed by the President, and would repeal the ACA without a replacement – would increase premiums by 20 to 25 percent and 18 million people would lose coverage the first new plan year following enactment. Report: http://bit.ly/2kh2cWA
  • On January 20, President Trump signed an Executive Order instructing federal agencies to “waive, defer, and grant exempt provisions from, or delay the implementation of any provision or requirement of, the [ACA] that would impose a fiscal burden on any State or a cost, fee, penalty, or regulatory burden.”

Other Legislative Activity

  • On January 17, Senate Majority Leader McConnell (R-KY) introduced the Helping Ensure Long-term Protection (HELP) for Coal Miner Health Care Act (S. 176), which would amend the Surface Mining Control and Reclamation Act of 1977 to transfer certain funds to the Multiemployer Health Benefit Plan, which would provide a permanent extension of health care benefits for retired coal miners and their dependents. The same day, Sen. Manchin (D-WV) and 19 bipartisan cosponsors introduced a similar measure (S. 175). Majority Leader McConnell’s press release: http://bit.ly/2jIx15V Manchin’s press release: http://bit.ly/2jy9KRH
  • Also on January 17, Sen. Rubio (R-TX) and four Republican cosponsors introduced the Obamacare Taxpayer Bailout Prevention Act (S. 147), which would immediately prevent the Administration from making risk corridor payments that are owed to health insurers for the 2014, 2015 and 2016 plan years. Press release: http://bit.ly/2jIKRoG

ACA Implementation

On January 17, CMS wrote letters to Alaska and California, informing them that their Section 1332 State Innovation Waiver applications have been deemed complete. California subsequently announced it was withdrawing its request; comments on Alaska’s waiver are due by February 16.  CMS letters: http://go.cms.gov/2jJ0Fb3 and http://go.cms.gov/2jIOpXT CA withdrawal letter: http://bit.ly/2kgUlbq


  • On January 18, CMS released an updated Open Enrollment Snapshot showing that as of January 14, 8.8 million individuals signed up for 2017 coverage through Healthcare.gov. Fact sheet: http://go.cms.gov/2jDoNMn
  • Also on January 18, HHS released a report finding that consumers responded to changes in net or gross premiums when making health plan choices in the Marketplaces. Report: http://bit.ly/2jtEBP5
  • Also on January 18, the Internal Revenue Service released a notice outlining a new hardship exemption from the individual mandate for individuals who were eligible for the health coverage tax credit but did not enroll in a plan through the Marketplaces from July 2016 through December 2016, which can be claimed in a 2016 federal income tax return. Notice: http://bit.ly/2jy5NMQ


  • On January 17, CMS released a data brief detailing a sharp reduction in avoidable hospitalization among long-term care facility residents between 2010 and 2015. Blog post: http://bit.ly/2jtprtn
  • Also on January 17, CMS announced an extension of the 2016 reporting deadline from February 28 to March 13 for hospitals participating in the Hospital Inpatient Quality Reporting and/or the Medicare Electronic Health Record Incentive Programs. Blog post: http://bit.ly/2jDuYQy
  • Also on January 17, CMS updated its Open Payments dataset to reflect changes to the data , including updates from disputes and other data corrections, that have occurred since June 30, 2016. Data: http://bit.ly/2jTrfye
  • On January 19, CMS released a fact sheet finding an increasing disparity between gross Part D drug costs and net Part D drug costs. Fact sheet: http://go.cms.gov/2jDN9oX
  • Also on January 19, U.S. Government Accountability Office (GAO) released a report finding that CMS does not fully validate Medicare Advantage encounter data for completeness and accuracy. Summary with link to report: http://bit.ly/2jDNIiN


  • On January 17, CMS released a final rule limiting states, providers and health plans from making any new Medicaid payments under a “pass-through” reimbursement system. Rule: http://bit.ly/2jDU29Z
  • Also on January 17, CMS released guidance on state flexibility to facilitate timely access to drug therapy by expanding the scope of practice and services that can be provided by pharmacists using standing orders, collaborative practice agreements, and other protocols. Guidance: http://bit.ly/2jtoYHn
  • Also on January 17, CMS released a toolkit to help states in applying mental health and substance use disorder parity requirements to their Medicaid and CHIP programs. Toolkit: http://bit.ly/2jDULYL
  • Also on January 17, HHS released a report finding that safety net hospitals in states that expanded Medicaid are treating more insured and fewer uninsured patients in 2016 than in 2013. Report: http://bit.ly/2jttSUK
  • Also on January 17, MACPAC released a report to Congress on the future of CHIP and children’s coverage, recommending Congress extend federal funding for CHIP through fiscal year 2022. Report: http://bit.ly/2jIGFFu
  • On January 18, HHS released a literature review of Medicaid expansion’s impact on insurance coverage and access to care. Report: http://bit.ly/2jDGE5C
  • Also on January 18, CMS released Frequently Asked Questions (FAQ) on funding for services provided to Medicaid-eligible American Indians and Alaska Natives and received through the Indian Health Service or a Tribal Facility. FAQ: http://bit.ly/2jIo2RU
  • On January 19, Senate Finance Committee Democrats sent a letter to all governors asking for their input on the impact of proposals to block grant or cap Medicaid on state programs and budgets. Responses are due by February 15. Press release: http://bit.ly/2jJ2CUN Letter: http://bit.ly/2jIQkvS
  • Also on January 19, CMS released a report outlining the role of the Medicaid and CHIP programs in providing coverage to children and families and highlighting the programs’ accomplishments in providing community care, fostering innovation, and strengthening benefits and access to care. Report: http://bit.ly/2kgQcEy

New Payment and Delivery System Models

  • On January 17, CMS released the first annual report for the Maryland all-payer model. Report: http://bit.ly/2jtrqO4
  • On January 18, CMS announced that over 359,000 clinicians are confirmed to participate in four of CMS’ alternative payment models in 2017. Press release: http://go.cms.gov/2jtkgJB
  • Also on January 18, CMS released a list of participants for Performance Year 2 of the Comprehensive ESRD Care Model. List: http://bit.ly/2jDDC1f
  • Also on January 18, CMS released a list of the first round of practice participants for the Comprehensive Primary Care Plus (CPC+) Model. List: http://bit.ly/2jDBoih
  • Also on January 18, CMS released a list of participants for the second round of the Next Generation ACO Model. One day later, CMS released a Request for Applications (RFA) and Letter of Intent (LOI) for organizations interested in participating in the model in 2018. LOIs are due by May 4. Participant list: http://bit.ly/2jtmB7n RFA and LOI: http://bit.ly/2kgTZS0 and http://bit.ly/2kgYe0f
  • On January 19, CMS released corrected Performance Year 2 results for the Independence at Home (IAH) Demonstration, finding that during Performance Year 2, IAH practices saved $7.8 million in aggregate rather than approximately $10.6 million in aggregate as previously announced. Fact sheet: http://go.cms.gov/2jtgJel 

Health IT

  • On January 17, CMS and Office of the National Coordinator on Health IT (ONC) released a blog post highlighting the progress that has been made in sharing electronic health data. Blog post: http://bit.ly/2jIIlyH
  • On January 18, HHS released a report on use of interoperable electronic health care records (EHR), finding that there has been substantial progress in the adoption of EHR among provider populations eligible for incentive payments. Report: http://bit.ly/2jDGnzO
  • Also on January 18, ONC released a blog post on using public-private partnerships to expand interoperability. Blog post: http://bit.ly/2jISBas


  • On January 17, U.S. Government Accountability Office (GAO) released a report finding that the Food and Drug Administration (FDA) has improved its Foreign Drug Inspection Program, but that it needs to improve the effectiveness and staffing of its foreign offices. Summary with link to report: http://bit.ly/2jDS759
  • Also on January 17, HHS released a report examining the non-medical use of opioids among women of childbearing age. Press release: http://bit.ly/2jtwMci Report: http://bit.ly/2jts4eD
  • Also on January 17, FDA released draft guidance outlining the criteria companies must meet for biologics to be deemed interchangeable with existing brand biologics. Comments are due by March 20. Guidance: http://bit.ly/2jTB5Ah
  • Also on January 17, House Committee on Energy & Commerce Chair Walden (R-OR) and Oversight and Investigations Chair Murphy (R-PA) sent a letter to the Centers for Disease Control and Prevention (CDC) requesting more information on a series of lab incidents involving dangerous pathogens that cause anthrax, Ebola, and the plague, among others. Press release: http://bit.ly/2jTq5CW Letter: http://bit.ly/2jTnl8p
  • On January 18, HHS and 15 other federal agencies issued a final rule to update regulations that safeguard individuals who participate in research, also known as the Common Rule. Press release: http://bit.ly/2jxYNj3 Rule: http://bit.ly/2jxQlA1
  • Also on January 18, GAO released a report analyzing federal government spending on kidney disease treatment and research. Summary with link to report: http://bit.ly/2jtis3n
  • Also on January 18, CMS announced the award of $66.1 million in funding to health departments in American Samoa, Puerto Rico, the U.S. Virgin Islands, and Florida to help combat the Zika virus. Press release: http://go.cms.gov/2jtpPIa
  • Also on January 18, CMS and the National Committee on Quality Assurance released a toolkit aimed at improving care for minorities and at-risk populations through the use of culturally and linguistically appropriate services standards. Toolkit: http://go.cms.gov/2jyjN9a
  • Also on January 18, HHS announced that the Health Care Fraud and Abuse Control Program has helped to recover over $3.3 billion in fiscal year, returning $5 for each dollar invested. Fact sheet: http://go.cms.gov/2jDDUp7 Report: http://bit.ly/2jtrUDO
  • Also on January 18, FDA released draft guidance outlining how drug companies can communicate with payers about cost-effectiveness and other information without violating marketing restrictions. Comments are due by April 17. Guidance: http://bit.ly/2jTnQ2h
  • Also on January 18, FDA released draft guidance describing how drug companies can communicate certain off-label information and avoid charges of misbranding. Comments are due by April 17. Guidance: http://bit.ly/2jJaELc