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Multicancer Early Detection (MCED) Consortium Releases Initial Position Paper | Healthsperien Summary: Inflation Reduction Act of 2022: Drug Pricing and Other Health Care Provisions | CMS Published Updated Medicare, Medicaid, and CHIP Enrollment | CMS Invests Nearly $100 Million in Health Care Navigators | CMS Delays Radiation Oncology Model Indefinitely | CMS Delays Radiation Oncology Model Indefinitely |CMS Release Medicaid LTSS Utilization Report | Administration Action | Congressional Action | Medicare | Medicaid | Marketplace | Litigation
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Multicancer Early Detection (MCED) Consortium Releases Initial Position Paper
The MCED Consortium released their first position paper, Evaluating Multicancer Early Detection Technologies for Clinical Use, which explores the landscape of emerging technologies that could allow clinicians to screen and detect multiple cancers at early stages and establishes their role in the development of guidance for use of, and education about, these tools.
Healthsperien Summary: Inflation Reduction Act of 2022: Drug Pricing and Other Health Care Provisions
Last week, President Biden signed into law the Inflation Reduction Act of 2022, a legislative package to fight inflation, lower prescription costs for seniors, invest in domestic energy production and manufacturing, and reduce carbon emissions by roughly 40 percent by 2030. This landmark legislation directs the Secretary of Health and Human Services to negotiate the price of prescription drugs, establishes a $35 monthly cap on Insulin beginning in 2023, eliminates out-of-pocket costs for adult vaccine coverage, and extends the enhanced premium subsidies for those who access their health care through the Affordable Care Act through 2025.
Healthsperien has provided a detailed summary of the health care provisions of the legislation, which can be accessed here.
CMS Published Updated Medicare, Medicaid, and CHIP Enrollment Data
Today, the Centers for Medicare and Medicaid Services (CMS) released enrollment data showing growth in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) programs in May 2022. Medicare enrollment has grown to 64.5 million people, with 34.9 million enrolled in Original Medicare, 29.7 million enrolled in Medicare Advantage and other health plans, and 50 million enrolled in Medicare Part D. Medicaid enrollment grew to 81.9 million people and enrollment in CHIP enrollment grew to 7.07 million individuals.During the COVID-19 Public Health Emergency (PHE), CMS instituted continuous enrollment for Medicaid and CHIP programs, to preserve individuals’ access to healthcare. After the PHE declaration expires, CMS expects States to resume redeterminations, and an estimated 15 million individuals could be disenrolled from Medicaid and CHIP programs.
CMS Invests Nearly $100 Million in Health Care Navigators
Today, CMS announced that they are investing $98.9 million in grant funding to 59 returning Navigator organizations for the 2023 open enrollment period to help consumers navigate enrollment through the Marketplace, Medicaid, and the Children’s Health Insurance Program. These awards are intended to enable Navigator organizations to retain staff and add to the 1,500 existing Navigators who were trained during the 2022 open enrollment period. Navigators help consumers prepare applications to establish eligibility and enroll in coverage through the Marketplaces and potentially qualify for an insurance affordability program as well as provide outreach and education to raise awareness about the Marketplaces and refer consumers to a health insurance ombudsman and consumer assistance programs when necessary.
The Navigator awardees will continue to focus on outreach to particularly underserved communities, such as those who identify as racial and ethnic minorities, people in rural communities, the LGBTQ+ community, American Indians and Alaska Natives, refugee and immigrant communities, low-income families, pregnant women and new mothers, people with transportation or language barriers or lacking internet access, veterans, and small business owners. Marketplace Open Enrollment for 2023 starts November 1, 2022 and ends January 15, 2023.
CMS Delays Radiation Oncology Model Indefinitely
Yesterday, CMS announced its final decision to indefinitely delay the Radiation Oncology model to work with interested parties and the Agency to craft a better model. CMS will give at least a 6-month notice before the future start date. CMS noted that in response to commenters’ feedback, they will consider a January 1, 2024, start date.
CMS stated the new model, once launched, will address long-standing concerns about the delivery and payment of radiation treatment and will also help providers and suppliers because of the demonstration’s focus on financial predictability through prospective, site-neutral, episode-based payment and care improvement by linking payment to quality. In response to CMS’ decision, the American Society for Radiation Oncology, the largest radiation oncology society, indicated that they are developing a new radiation oncology alternative payment model that will emphasize episodic payments and address disparities in radiation treatment access by economically and socially marginalized communities.
CMS Releases Medicaid LTSS Utilization Report
Today, CMS released a report on the use of Long-Term Supports and Services (LTSS) by Medicaid beneficiaries. The report examines the use of LTSS across different home- and community-based services (HCBS) during 2019. The report found that 11 million Medicaid beneficiaries across 50 states and the District of Columbia received LTSS through fee-for-service or managed care delivery systems in 2019. Of these, 1.6 million beneficiaries (18.4 percent) received institutional services, 7.5 million (85.0 percent) received HCBS, and 0.3 million (3.5 percent) received both. The report provides data to support States and other stakeholders in making determinations about HCBS utilization, responding to rebalancing trends, and planning for future growth in HCBS. The full report can be found here.
Administration Action
- The U.S. Departments of Health and Human Services, Labor, and the Treasury (the Departments) released a new resource to assist in determining whether the Federal IDR process or a specified state law (SSL) or All-Payer Model Agreement (APMA) applies for determining out-of-network (OON) rates. The resource is intended to serve as a tool for certified IDR entities to determine whether a payment dispute is subject to the Federal IDR process and to assist disputing parties as they submit or evaluate disputes.
- CMS announced they awarded approximately $25 million in planning grants to five new states and territories to expand access to home and community-based services (HCBS) through Medicaid’s Money Follows the Person (MFP) demonstration program. Awards of up to $5 million are being announced for Illinois, Kansas, and New Hampshire, as well as for American Samoa and Puerto Rico. With these awards, 41 states and territories will now participate in MFP. Funding will support the early planning phase of their MFP programs.
- Last Friday, the Departments of Labor, Health and Human Services (HHS), and the Treasury issued final rules (fact sheet here) concerning standards related to the arbitration process implementing the No Surprises Act (NSA). The bipartisan law, which went into effect this past January, protects consumers against surprise medical bills. The update addresses certain provisions of the July 2021 and October 2021 interim final rules that are relevant to the operation of the federal independent dispute resolution (IDR) process and revise certain provisions in light of two recent federal court cases.
Congressional Action
- Last week, Chair Ron Wyden sent letters requesting 15 state insurance commissioners and state health insurance assistance programs provide information on Medicare Advantage and Part D plans’ marketing practices. Recently, CMS and the National Association of Insurance Commissioners both reported receiving more complaints about false and misleading advertising from these plans. In his letter, Chair Wyden askes states to report any complaints or misleading marketing data, examples, or trends among the plans, third-party marketing organizations, or other related organizations by September 16th.
Medicare
- Analysis published by the Kaiser Family Foundation today predicts that if current growth trends continue, over half of Medicare beneficiaries will access their care through Medicare Advantage (MA) plans as soon as next year. Currently 48% of Medicare beneficiaries are enrolled in MA, an increase of 2.2 million beneficiaries or 8% from the previous year. The majority of MA enrollees participate in plans that offer benefits not covered by traditional Medicare (including eye and hearing exams, glasses, or hearing aids) and offer some prescription drug benefits. With this growth in enrollment MA plans may face increasing scrutiny of patient experience and outcomes, health disparities, and overall expenditures.
Medicaid
- CMS published a bulletin outlining financial incentives states could employ to promote nursing home safety and quality, in alignment with the Biden Administration’s nursing home reform action plan. States are encouraged to use current Medicaid authorities and submit State Plan Amendments to implement value-based purchasing programs, incorporate quality data into their oversight activities, direct a proportion of future nursing home rate increases to direct care worker compensation, and implement new emergency preparedness requirements. CMS also plans to initiate programs in Medicare and Medicaid to reduce room crowding, strengthen the Skilled Nursing Facility Value-Based Purchasing program, expand financial penalties and enforcement sanctions, increasing scrutiny of poorest performing facilities and chain owners, and new minimum staffing requirements.
Marketplace
- Last week, the Commonwealth Fund published a review of rates paid to healthcare providers across the health insurance market, and compared how they may relate to beneficiaries’ access to care, health equity, and overall healthcare costs. Medicaid fee-for-service (FFS) physician service rates were 30% lower than Medicare, and commercial insurance were 30% higher. Hospital rates are less directly comparable due to the supplemental Medicaid payments, but the FFS Medicaid payments were 22% lower than Medicare and commercial rates were nearly 90% higher. With new Medicaid access rules forthcoming, these payment disparities should be considered as potential drivers of health disparities, barriers to accessing care, and barriers to provider participation in Medicaid programs.
Litigation
- This week, a federal judge blocked the U.S. Department of Health and Human Services (HHS’) guidance, which cites the Emergency Medical Treatment and Active Labor Act (EMTALA). The guidance would have directed healthcare providers who are required to provide emergency care to pregnant patients to also provide abortion services in situations where the life and health of the mother is at risk. The guidance was initially issued by HHS on July 11 following the Dobbs ruling and was subsequently challenged by Texas Attorney General Ken Paxton, who claimed that the guidance forced providers to commit crimes and risk their licensure under current Texas law.