Weekly Roundup: October 28, 2022

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CMS Finalizes Rule to Reduce Barriers to Coverage, Simplify Medicare Enrollment, and Expand Access
CMS released a final rule implementing sections of the Consolidated Appropriations Act to simplify Medicare enrollment rules and extend coverage of immunosuppressive drugs for certain beneficiaries. Beginning January 1, 2023, Medicare coverage will become effective the month after enrollment for individuals in the last three months of their Initial Enrollment Period (IEP) or in the General Enrollment Period (GEP). Currently, coverage can take multiple months to begin if an individual enrolls in either of these enrollment periods. CMS also finalized several Special Enrollment Periods (SEPs):
  • An SEP for individuals impacted by an emergency or disaster
  • An SEP for health plan or employer error
  • An SEP for formerly incarcerated individuals
  • An SEP to coordinate with termination of Medicaid coverage
  • An SEP for other exceptional conditions
The rule also finalizes an extension of coverage of immunosuppressive drugs for certain beneficiaries. An individual who does not have other health insurance coverage would be eligible to enroll in Part B beyond the 36-month post-transplant period for the limited purpose of getting Part B coverage for immunosuppressive drugs. The benefit would begin as early as January 1, 2023.
NIH Funds First Psychedelics Research Study in Decades 
For the first time in five decades, the National Institutes of Health (NIH) has funded psychedelic research. Researchers from Johns Hopkins University, New York University, and the University of Alabama will assess whether psilocybin, a psychoactive compound in mushrooms, can help people quit smoking. The study marks a shift in federal research attitudes towards psychedelics and greater curiosity in its applications in treating other mental health disorders such as depression and anxiety.
Tracking OUD “Cascade of Care” to Address Opioid Crisis
In light of the data gaps on opioid use disorder (OUD) treatment data across the U.S., The Pew Charitable Trusts held an expert panel to identify core OUD treatment measures to improve outcomes through the “cascade of care,” which tracks key data from the diagnosis, treatment, and recovery for chronic diseases. By tracking crucial information like the percentage of people diagnosed with an OUD or the percentage of those who start treatment within two weeks of diagnosis, states can be held accountable for how they address the opioid crisis, target OUD efforts, and funding, and uncover OUD-related health inequities.
Administration Action
  • To address the lack of nursing preceptors, the U.S. Department of Health and Human Services (HHS) is investing $13 million in nursing education and training, with $8.4 million to the Clinical Faculty and Preceptor Academies Program and another $4.75 million to the Registered Nurse Training Program. Currently, the U.S. has a shortage of healthcare professionals that can deliver high-quality, culturally competent care, with nurses, like many other healthcare providers, suffering from burnout. There are also not enough nursing preceptors, or experienced clinicians that can supervise nursing students during their clinical rotations.
  • Earlier this month, the National Association of Insurance Commissioners (NAIC) submitted comments on the proposed 1557 rule which restores and strengthens civil rights protections for patients and consumers in certain federally funded health programs and HHS programs after the 2020 version of the rule limited its scope and power to cover fewer programs and services. NAIC highlighted concerns over how the rule applies to all of a carrier’s operations if they receive federal assistance, including operations in markets where the carrier does not receive federal assistance. The NAIC notes that this interpretation goes beyond the intent of Congress and Section 1557 of the Affordable Care Act. Others report (subscription required) that this could in turn create issues of uneven markets where some carriers abide by certain rules and others do not. America’s Health Insurance Plans (AHIP) echoes this concern in its comment letter.
Congressional Action
  • Last week, a group of women’s health organizations sent a letter (subscription required) to the House Energy & Commerce Committee to ask the committee to mark up a bill authorizing an increase in funding for uterine fibroids research. The organizations signing onto the letter include the Black Women’s Health Imperative, the Society for Women’s Health Research, The American College of Obstetricians and Gynecologists, and others. The Stephanie Tubbs Jones Uterine Fibroid Research and Education Act (H.R. 2007) would authorize $30 million per year for the U.S. Department of Health and Human Services to study uterine fibroids from FY2022 through FY2026.
  • On Monday, the American Hospital Association (AHA) sent a letter to Congress outlining the organization’s end-of-year priorities as Congress considers its agenda for the closing months of the year. The letter notes that hospitals continue to face financial hardships from the COVID-19 PHE and record-setting inflation impacting staffing and overhead costs. The letter breaks down the requests into two categories, those that address the workforce shortage and those that provide financial relief to hospitals.
  • The American Hospital Association (AHA), American Medical Association (AMA), and other provider groups submitted two amicus briefs backing the Texas Medical Association (TMA) in another legal dispute over the Surprise Billing Law’s use of qualifying payment amounts (QPAs) in independent dispute resolution processes. The TMA and other providers argue that the arbitration process still favors insurers by preferencing QPAs, giving insurers leverage over physicians in contract and rate negotiations. The AMA and AHA’s amicus brief can be found here, and the amicus brief submitted by the American Association of Neurological Surgeons and a host of other groups can be found here.
  • The Kaiser Family Foundation (KFF) released two reports related to Medicaid spending, enrollment, and priorities during the fallout from the COVID-19 pandemic. The first report analyzes state Medicaid enrollment and spending trends for Fiscal Years (FY) 2022 and 2023. The KFF report found a slowdown of enrollment growth during 2022 and projects a decline in 2023. The second report summarizes policy priority results from an annual Medicaid Budget survey for states during fiscal years 2022-2023. Most states are in a strong fiscal position entering FY 2023, but identified uncertainty in their long term fiscal outlook due to economic (wage pressures, inflation, slowing revenue growth) and political (midterm results) factors.
  • Under the Biden-Harris Administration and the American Rescue Plan (ARP), twenty-six states and D.C. have now expanded Medicaid and Children’s Health Insurance Program (CHIP) coverage for twelve months postpartum to cover a total of 418,000 people. Prior to the ARP’s new state plan authority, the minimum postpartum Medicaid and CHIP coverage period was only sixty days. This effort builds on the Administration’s current efforts to address maternal health crisis and the criticality of the postpartum period: one-third of pregnancy-related deaths occur within a year after childbirth. The Biden-Harris Administration has published a Blueprint for Addressing the Maternal Health Crisis while the Centers for Medicare and Medicaid Services have released a Maternity Care Action Plan.
  • Ahead of the annual Marketplace Open Enrollment Period on November 1st, the Biden-Harris Administration announced that consumers now can preview detailed information about their health plan options for 2023. To help consumers navigate the offerings, the Administration has also invested nearly $100 million into the Navigators program, which helps enroll eligible consumers and assist them in qualifying for insurance affordability programs. HHS also released a report of Marketplace enrollment, which found enrollments for all racial and ethnic groups has increased from 2020 to 2022, with Black and Latino populations seeing 49% and 53% increases, respectively.
  • A new budgetary analysis, commissioned by Alzheimer’s Impact Movement (AIM) and conducted by Healthsperien, concludes that the proposed Dementia Care Management (DCM) program could generate nearly $9.2 billion in Medicare and $11.7 billion in federal Medicaid spending over 10 years. The Dementia Care Management program targets patients based on care pathways rather than clinical disease, and theorizes that using evidence based care coordination techniques would reduce adverse health events (including hospitalization and emergency room use) over time. The Alzheimer’s Impact Movement supports legislation that identifies and implements better care for those with dementia, including the Comprehensive Care for Alzheimer’s Act (S. 1125 / H.R. 2517).
  • The 2022 Kaiser Family Foundation Employer Health Benefits Survey reported that nearly half of large employers surveyed had increasing mental health demands from their employees. Although 80% of employers had sufficient primary care providers in their network, only 44% had sufficient behavioral health providers, highlighting behavioral workforce shortages. The survey found that 81% of large firms use third-party mental health services and 44% provide self-care apps. Employers are also concerned about increasing healthcare premium costs, which were similar to last year’s – where employees pay $1,327 for single coverage and employers pay $7,911 – but are expected to rise in response to inflation and higher labor costs.
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