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Foundation for Social Connection to Host End Social Isolation & Loneliness Action Forum | CMS Releases 2023 Medicare Advantage and Part D Star Ratings | Medicare Payment Advisory Commission (MedPAC) Holds September Meeting | Senate Republicans Introduce Bill to Repeal Medicare Drug Pricing Provisions in Inflation Reduction Act | Executive Action| Administration Action | Congressional Action | Medicare | Marketplace | Research |
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Foundation for Social Connection to Host End Social Isolation & Loneliness Action Forum
CMS Releases 2023 Medicare Advantage and Part D Star Ratings
- For 2023, only about half of the plans will have at least a four-star rating, whereas nearly 70 percent of plans earned four stars in 2022.
- The overall weighted average of Star Ratings for MA-PD contracts decreased from 4.37 in 2022 to 4.15 in 2023. For PDPs, the average decreased from 3.70 in 2022 to 3.25 in 2023.
- Diabetes Care — Blood Sugar Controlled and Osteoporosis Management in Women Who Had a Fracture measures show larger increases.
- Improving Bladder Control and Reducing the Risk of Falling, the measure Call Center — Foreign Language Interpreter and TTY Availability, and the measure Members Choosing to Leave the Plan show larger declines.
- Several COVID-19 flexibilities were phased out, and the only adjustment for the impact of the COVID-19 PHE is the three HEDIS measures derived from the 2021 Health Outcomes Survey.
- Patient experience and access Star Ratings (e.g., CAHPs measures) increased in weight from 2 to 4.
- As finalized in the previous rulemaking, Controlling Blood Pressure (Part C) was transitioned into the 2023 Star Ratings as a new measure. The Rheumatoid Arthritis Management (Part C) measure was retired and an updated Statin Use in Persons with Diabetes (Part D) measure weighting category was implemented.
- New guardrails restricting upward and downward movement of a measure’s cut points for certain measures were implemented.
Medicare Payment Advisory Commission (MedPAC) Holds September Meeting
- Supporting safety-net clinicians
- Mandated report: Evaluation of a prototype design for a post-acute care prospective payment system
- Nursing facility staffing
- Mandated report: Study on the expansion of telehealth
- Congressional request: Medicare and inpatient psychiatric facility care
- Analysis of Part D data on drug rebates and discounts
Senate Republicans Introduce Bill to Repeal Medicare Drug Pricing Provisions in Inflation Reduction Act
- Under Executive Order 14031, the President’s Advisory Commission on Asian Americans, Native Hawaiians, and Pacific Islanders (AA and NHPI) was established to address equity, justice, and opportunity disparities within AA and NHPI communities. The commission recently released its first inaugural report across six key issue areas including belonging, inclusion, anti-Asian hate, and discrimination, data disaggregation, language access, economic equity, health equity, and immigration and citizenship status.
- The White House released a document titled, “Blueprint for an AI Bill of Rights,” which outlines what consumers can expect from safe and equitable use of AI in fields including healthcare. The guidance explains that there should be extra protections for sensitive types of data that AI and algorithms may collect, including data about pregnancy and abortion care and other types of harm. U.S. Department of Health and Human Services (HHS) of Health Secretary Becerra explained that HHS needs to be prepared to use every tool at its disposal to address health crises, including AI, but should ensure such tools operate in a way that promotes safety and equity.
- The U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra announced the expansion of the pool of providers who can administer Food and Drug Administration (FDA) approved or authorized monkeypox vaccines and therapies while being protected from liability under the Public Readiness and Emergency Preparedness (PREP) Act. The PREP Act declaration comes nearly two months after Secretary Becerra declared a public health emergency for monkeypox on Aug. 4. He has since issued two 564 declarations allowing the FDA to authorize monkeypox vaccines and tests for use during the public health emergency.
- The Biden-Harris Administration held a White House Conference on Hunger, Nutrition, and Health. Healthsperien has developed a detailed summary of the event, which can be found here. Of note, President Biden underscored three principles to strengthen food security efforts to support his goal of ending hunger and increasing healthy eating and physical activity by 2030. The three principles are focused on (1) increasing healthy food access, (2) educating and providing Americans with healthy food options, and (3) boosting Americans’ physical activity. In addition, U.S. Secretary of Agriculture Tom Vilsack outlined the conference’s five pillars to address food insecurity and proposed permanent expanded child tax credit, a pilot Medicaid program to cover healthy meals, and updated Supplemental Nutrition Assistance Program (SNAP) benefits.
- To address the lack of coordination and quality information across health care directories, the Centers for Medicare & Medicaid Services’ (CMS) latest Request for Information (RFI) proposes a centralized, public database of health care providers and services, or a National Directory of Healthcare Providers and Services (NDH). In addition to helping patients access care more easily, CMS aims to reduce administrative burden for payors and providers as well as promote health data exchange and interoperability. These infrastructural improvements have the potential to dramatically improve patients’ health care experiences and bolster public health reporting. CMS is requesting input from stakeholders on NDH priorities, data elements, risks, and suggested actions by December 6, 2022.
- The House passed the Mental Health Matters Act (H.R. 7780), which aims to address mental health issues among students, families, and educators whose mental health concerns have been aggravated by the pandemic. The legislation would provide grants to establish a pipeline for school-based mental health service professionals, grow the number of school mental health experts in high-need locations, and establish a grant program to bolster access for students to evidence-based trauma support. Finally, the bill mandates that disability accommodations be available to incoming students at institutions of higher education if they have documents outlining their disability. The legislation has now moved to the Senate for consideration.
- A recent Health Affairs article conducted an analysis from a physician’s perspective on the first set of 10 drugs that will be listed for negotiation in September 2023 under the Medicare drug pricing provisions of the Inflation Reduction Act (IRA). The legislation requires the Secretary of Health and Human Services (HHS) to regulate certain drugs in Medicare Part D based on biologic and business factors including small-molecule drugs approved 7 or more years ago, or biologics approved 11 or more years ago, single-source drugs with no approved and marketed generics or biosimilars, and drugs that are not a small biotechnology manufacturer’s only major agent. Drugs identified were mainly blood thinners, diabetes treatments, and cancer drugs and accounted for $34.7 billion in Medicare Part D spending in 2020.
- Optum and Change Healthcare completed their $7.8 billion merger, combining data and analytics capabilities allowing Optum access to data from 85 million patients across the U.S. health care continuum and thousands of providers. The merger, recently cleared by a federal judge to proceed, aims to connect and simplify clinical, administrative, and payment processes for health care providers and payers.
- A Kaiser Family Foundation/CNN latest mental health survey reveals that nine in ten of Americans believe that there is a mental health crisis in the U.S. today, with most people saying the opioid epidemic, youth mental health issues, and severe mental illness are at a crisis level. For many, the cost, stigma, and lack of diverse mental health resources are mental health barriers, with Black and Hispanic adults facing significant obstacles. In addition, while 85% of Americans are open to leveraging the 988-suicide hotline in times of mental health crisis, the survey found 56% to not have heard of the hotline at all.