Weekly Roundup: March 3, 2023

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Biden Administration Reiterates Its Commitment to Advancing Health Equity

Yesterday, the Biden-Harris Administration signed a new executive order, Further Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, reaffirming the administration’s commitment to advancing equity and support initiatives across federal agencies.

The new executive order mandates:

  • Launching a new annual process for each agency to produce an annual public equity action plan to assess barriers underserved communities face and actions to address these barriers.
  • Empowering Federal equity leaders by requiring agencies to build and resource Equity Teams to implement the mandate.
  • Strengthening community partnerships and engagement by requiring agencies to improve the quality, frequency, and accessibility of their community engagement.
  • Investing in underserved communities with the goal of increasing the share of federal contracting dollars awarded to small, disadvantaged businesses (SDBs) by 50 percent by 2025, and expanding procurement opportunities for SDBs through federal, state, and local grants.
  • Improving economic opportunity in rural and urban communities by directing agencies to spur equitable economic growth in rural and urban areas through locally-led development.
  • Addressing emerging civil rights risks by focusing their civil rights authorities and offices on emerging threats, such as algorithmic discrimination in automated technology. It also seeks to improve accessibility for people with disabilities.
  • Promoting data equity and transparency by instructing the Interagency Working Group on Equitable Data to facilitate better collection, analysis, and use of demographic data to advance equity, and to regularly report on progress to the White House and the American public.

The new executive order builds on a previous executive order signed by the Biden-Harris Administration two years ago, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, which instituted a mandate for all federal agencies to launch a whole-of-government approach to equity.

Senate Committee Hearing Addresses PBM Accountability and Transparency

Yesterday, the Senate Committee on Commerce, Science, and Transportation held a full committee hearing on “Bringing Transparency and Accountability to Pharmacy Benefit Managers” (hearing summary here). Committee members and witnesses discussed the role of pharmacy benefit managers (PBMs) in determining drug prices and their impact on patients. The hearing specifically addressed how S.127 – Pharmacy Benefit Manager Transparency Act of 2023, reintroduced by Senate Commerce Chair Maria Cantwell (D-WA) and Sen. Chuck Grassley (R-IA), proposes to bring transparency into PBM business practices. The bill would prohibit PBMs from using ‘deceptive and unfair pricing schemes,’ from imposing arbitrary claw back payments made to pharmacies, and would require them to report to the Federal Trade Commission (FTC) how much money they make through spread pricing and pharmacy fees.

During the hearing, witnesses and committee members discussed concerns about the market power that PBMs possess because of consolidation and how independent pharmacies are struggling in the existing system. Members of the committee expressed support for reforms of the industry on a bipartisan basis.

Execution Action
  • On Thursday, Politico shared that the Biden Administration is developing plans to preserve free access to COVID-19 tests, treatments, and vaccines for individuals who are uninsured after the end of the national public health emergency (PHE). The Administration anticipates that after the PHE ends on May 11th, COVID-19 care will begin commercializing in the latter half of the year. Individuals with private insurance, Medicare, and Medicaid will likely continue to be able to access care and an existing federal program will continue providing free vaccinations to uninsured children. While the plan is still in development, Administration officials anticipate they will be able to use existing COVID-19 response funding to continue providing care into 2024, giving the Administration time to develop longer-term solutions.
Administrative Action
  • On Monday, the Department of Health and Human Services (HHS) hosted a call to discuss the end of the public health emergency (PHE). Based on current data, HHS is expecting that this will be the last renewal of the PHE and it will end on May 11, 2023. The call included representatives from the Office of the Secretary, Centers for Medicare & Medicaid Services (CMS), Food and Drug Administration (FDA), Centers for Disease Control and Prevention, and Substance Use and Mental Health Services Administration (SAMHSA)to discuss the impact of the end of the COVID-19 PHE on current flexibilities and policies.
  • Recently, the Department of Health and Human Services (HHS) stated (subscription required) that they chose six organizations to begin developing qualified health information networks to facilitate patient healthcare data sharing nationwide. The six organizations: Epic, CommonWell Health Alliance, Health Gorilla, Kno2, eHealth Exchange, and KONZA, will begin pre-production testing and project planning with HHS, but each pledged to go live as qualified networks later this year. To become qualified networks, each of the organizations must meet the Trusted Exchange Framework and Common Agreement (TEFCA) standards HHS finalized last year. If successful, this initiative will allow providers and public health agencies to quickly send and receive health information, which HHS believes will lead to better patient care and outcomes.
  • On Monday, the Department of Health and Human Services (HHS) issued a proposed rule (proposed rule, fact sheet) that would require nursing homes to disclose to the Centers for Medicare and Medicaid (CMS) and states additional ownership and management information. In addition, the rule would provide definitions of “private equity company” and “real estate investment trust,” which would assist nursing homes in reporting data and lead to the disclosure of nursing home owners who are private equity companies or real estate investment trusts. This rule marks a continuation of President Biden’s initiative to improve the quality and care available at nursing homes. HHS asserts that through transparent facility ownership and oversight, nursing home residents and their families can make informed decisions related to care.
  • On Tuesday, CMS announced that the Secretary of the Department of Health and Human Services (HHS) has selected three new models for testing by the CMS Innovation Center. The announcement of the new models is in response to President Biden’s Executive Order 14087, “Lowering Prescription Drug Costs for Americans.” In a report, Secretary Becerra detailed how the three models addressed the themes outlined in the executive order and meet the criteria for affordability, accessibility, and feasibility of implementation. These models include the Medicare High-Value Drug List Model, The Cell and Gene Therapy Access Model, and The Accelerating Clinical Evidence Model.
  • CMS released a proposed National Coverage Determination (NCD) to expand coverage for power seat elevation equipment on certain power wheelchairs to Medicare individuals. If finalized, the equipment would be covered by Medicare for individuals with a Group 3 power wheelchair, which are designed to meet the needs severely disabled Medicare beneficiaries. The proposed NCD is open for public comment for 30 days and closing on March 17, 2023.
  • On Wednesday, Sellers Dorsey in collaboration with Medicaid Health Plans of America (MHPA) and the Association for Community Affiliated Plans, released their 2022 State of Medicaid Managed Care Report. The report details the evolution of the Medicaid Managed Care industry from its inception to the present, highlighting key legislative and regulatory changes, case studies from innovative states and individual plans, and data on enrollment, growth and beneficiary outcomes. The report also notes that enrollment has continued to grow through the COVID-19 public health emergency and maintenance of eligibility requirement.
  • Last Friday, CMS announced that effective immediately, certified Independent Dispute Resolution (IDR) entities should not issue any new, out-of-network surprise billing payment determinations until further guidance is issued. Certified IDR entities have also been instructed to recall any payment determinations issued after February 6, 2023. CMS noted this comes as a direct result of a court ruling in Texas Medical Association, et al. v. United States Department of Health and Human Services, which vacated certain portions of the Federal IDR process applicable to all surprise billing payment disputes. The Departments will provide specific directions to certified IDR entities for resuming the issuance of payment determinations that are consistent with the court’s judgment and order.
  • On Tuesday, the Consumer Financial Protection Bureau (CFPB) released a report showing a significant reduction in the number of Americans with medical debt on their credit report. From the first quarter of 2020 to the first quarter of 2022, 8.2 million individuals eliminated medical debt on their credit reports. The Biden Administration pointed to efforts to strengthen the Affordable Care Act, lower health care costs as drivers of the decrease, as well as the CFPB’s actions to highlight inaccurate reporting of debt in collections. The CFPB report also shows that while progress has been made in reducing medical debt for Americans, it still accounts for more than 50% of debt in collections exceeding the number of debt collections from all other sources combined.
  • The National Academies of Science, Engineering, and Medicine published a new report titled, “Advancing Antiracism, Diversity, Equity, and Inclusion in STEMM Organizations: Beyond Broadening Participation.” The report, published on Tuesday, stresses that higher education and scientific institutions must go beyond increasing the number of people from underrepresented racial and ethnic groups in clinical trials, and in addition, change their culture. The authors argue that cultural changes are necessary to create an environment where students, scientists, and clinicians from various backgrounds feel included and welcomed. The report includes a multitude of broad recommendations, including different frameworks to approach culture change and steps that can be taken at the individual, group, and organization levels.
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