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Inside CMS - 06/22/2017

  • CMS Proposes 'Slow Ramp-Up' Of Physician Payment System

    CMS proposed Tuesday (June 20) to exempt more doctors from the performance measures of Medicare's new physician pay rule, delay measuring doctor performance on cost, allow doctors in small and rural practices to form "virtual groups," award bonus points to the performance scores of doctors in small practices and delay a required upgrade to physicians' electronic health record systems. CMS estimates about 94 percent of doctors will avoid penalties from the Merit-Based Incentive Payment System during the program's second year.

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  • Senate May Have To Handle ACHA Stability Funding, Cost-Sharing Subsidies In CHIP Bill

    Lawmakers are considering shifting stability funding and cost-sharing subsidies from the American Health Care Act to legislation that funds the Children's Health Insurance Program, which would jeopardize the reauthorization of CHIP funding, because the Senate parliamentarian is leaning against allowing those measures in the AHCA, lobbyists say. The latest development is an example of the unexpected ways that CHIP funding is becoming ensnared in the politics of the House-passed American Health Care Act, despite broad bipartisan support for the children's insurance program.

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  • 'Discussion Draft' Of AHCA Coming Thursday; Vote Expected Next Week

    Senate GOP leadership will release a draft of its version of the American Health Care Act on Thursday (June 22) with the goal of a vote next week, Senate Majority Leader Mitch McConnell (R-KY) confirmed Thursday amid mounting frustration among key moderate and conservative lawmakers that they haven't seen the bill and that their asks have not been incorporated.

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  • GOP Signals House Budget Committee Considering Additional Medicaid Changes

    The House Republican Conference on Monday (June 19) emailed a survey asking for the public's take on the future of Medicaid, and in the email signaled the House Budget Committee is considering additional Medicaid reforms. A spokesperson for the committee says any further changes will "reflect the principles" that House Budget Chair Diane Black (R-TN) laid out in an op-ed last month, which advocated changes to Medicaid financing beyond those included in the House-passed American Health Care Act as well as mandatory work requirements.

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  • Cummings, Welch: Trump Is About To Betray His Voters On Rx Prices

    House Democrats who met with the president in the spring to discuss drug-price policies are urging him to take aggressive action to curb price increases in an anticipated executive order. However, news reports indicate President Donald Trump is considering measures that are friendly to the drug industry.

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  • Bipartisan Coalition Of Governors Urge McConnell To Stabilize Markets

    Seven Republican and Democratic governors are calling on Senate Majority Leader Mitch McConnell (R-KY) to work with them to help stabilize endangered state exchanges, and their priority is making plans affordable.

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  • Murray, Grassley Worry Administration Restricting Oversight Requests

    HHS Secretary Tom Price said he has instructed his agency to respond to requests for information from all members of Congress, despite what Sen. Patty Murray (D-WA) called a "disturbing" memo from the Justice Department's Office of Legal Counsel that says the executive branch should only consider requests from committee chairs or full committee requests as oversight.

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  • GOP Senators Home In On How Per-Capita Caps Will Impact Their States

    Senate Republicans are debating where and how they can adjust the Medicaid portion of the House AHCA to make sure their states get equitable treatment under the per-capita caps system, senators said Thursday (June 15). As lawmakers get more familiar with the intricacies of Medicaid financing and how per-capita caps might affect their states, talks are shifting toward whether states should have different annual growth rates for their per-capita caps and receive different disproportionate share hospital (DSH) payments.

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  • Senate Eyes Deeper Medicaid Cuts As McConnell Pushes For AHCA Vote

    Senate Republican leadership plans to hold the vote on its version of the American Health Care Act next week, senior Senate aides told Inside Health Policy, even though Republicans remain divided on key aspects of the emerging bill. The Medicaid funding caps are expected to be even more stringent than in the House bill, and potentially include a carve out for kids with high costs.

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  • House Pulls Medical Malpractice Bill Over Concerns About States' Rights

    House Republicans postponed a floor vote on medical malpractice legislation because some conservatives are worried about imposing federal standards on states, according to Freedom Caucus Chair Mark Meadows (R-NC). Tort reform is one of many issues that House Republicans had wanted to address in the American Health Care Act but were forced to deal with separately because of budget rules. The president's 2018 budget request also calls for medical malpractice reform.

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  • Executive Order On Rx Prices Could Have CMS Test Value-Based Designs

    President Donald Trump could use an executive order to direct the CMS innovation center to waive rules that would make it easier for drug companies and insurance companies to use value-based contracts, said Paul Howard, director and senior fellow at the Manhattan Institute. Drug industry representatives met with administration officials Friday (June 16) to discuss policies aimed at curbing drug price increases, and drug industry lobbyists said news reports about a soon-to-be-released executive order aimed at encouraging value-based contracts are true.

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  • Price Said He Hadn't Seen Senate GOP's Health Bill

    HHS Secretary Tom Price told senators Thursday (June 15) that he had not seen legislative language for the Senate GOP's health care overhaul, though his staff has provided lawmakers with some technical assistance. When pressed by Democrats at a Senate Appropriations subcommittee hearing about the lack of transparency around the upper chamber's health care efforts, Price said it was not his place to critique the legislative process.

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  • Nursing Homes To Price: Delay Enforcing Conditions Of Participation Rule

    Nursing homes are hanging their hopes on HHS to delay or amend parts of the Obama administration's three-part rule laying out updated requirements for long-term care facilities -- mostly nursing homes -- to receive Medicaid and Medicare money. People in the industry say the rule was well intentioned but difficult and expensive to implement on the time line given and as HHS Secretary Tom Price signals he will lift burdensome regulations they are looking to him for relief.

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  • Alexander: Administration Should Pay CSRs At Least Through 2018

    Sen. Lamar Alexander (R-TN) on Thursday (June 15) became the second congressional GOP chair to recommended the administration fund cost-sharing reduction payments at least through 2018, and he said it would be preferable for the subsidies to run through 2019. Alexander told HHS Secretary Tom Price at a Senate Appropriations subcommittee hearing that the CSR payments would keep many people from having no options to buy insurance in 2018.

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  • HHS Pays June CSRs But Still Weighs Future Payments

    HHS tells Inside Health Policy it has paid insurers the ACA's cost-sharing reduction payments for June, but is still deciding whether to make the payments going forward as the administration urges Congress to pass the American Health Care Act. Insurers had until Wednesday (June 21) to file rates for next year.

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  • Gingrich Tells GOP To Hit The Brakes On ACA Repeal Efforts

    Former House Speaker Newt Gingrich (R) penned an op-ed Monday urging his fellow Republicans to slow down their push to repeal and replace the Affordable Care Act because it is being branded as hurting elderly individuals and will hurt the party politically in the midterms. Gingrich, who informally advised Donald Trump during the presidential transition, said GOP lawmakers should stabilize the market and fund the ACA's cost-sharing reduction payments through 2018 before working on a long-term health care overhaul.

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  • Sen. Collins Considers Using Medicare Part D To Stop REMS Abuses

    Sen. Susan Collins (R-ME) is considering using Medicare Part D as leverage to stop brand drug makers from gaming FDA drug-safety policy to thwart generic competition. At issue is brand makers' use of Risk Evaluation and Mitigation Strategies to withhold drug samples from potential generic competitors, and Collins suggests brand makers be contractually required to provide such samples as a precondition for inclusion in Part D formularies.

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  • E&C Reschedules CHIP Hearing For June 23

    The House Energy & Commerce health subcommittee rescheduled its planned hearing on funding for the Children's Health Insurance Program for Friday (June 23). The hearing was initially scheduled for Wednesday (June 14) but was postponed after House Majority Whip Steve Scalise (R-LA) was shot that morning.

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  • Former GOP Aide Says Dems Would Likely Use NFIB Against Medicaid Caps

    Democrats would likely use the Supreme Court ruling against mandatory Medicaid expansion to fight federal Medicaid funding caps, a former Senate Republican staffer said, but legal scholars doubt that suit would be a good precedent to use against Medicaid funding caps. Even if Democrats did not prevail in a lawsuit against per capita caps, the suit would keep the American Health Care Act in the news for a long time, which would likely help Democrats in the next election, a legal scholar said.

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  • NASHP Launches Center For State Rx Drug Pricing

    The National Academy for State Health Policy launched the Center for State Rx Drug Pricing to provide actuarial, legal and financial support to states trying to control drug spending as they take the lead on curbing drug price increases. NASHP also is requesting proposals from states on how to contain the costs of prescription drugs as part of the center's launch.

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  • Cassidy Still Pushes Auto-Enrollment As Senate Health Reform Vote Nears

    Sen. Bill Cassidy (R-LA) is still advocating for passive enrollment and touting his Patient Freedom Act bill with moderate Sen. Susan Collins (R-ME) even as a vote on the emerging Senate health care bill is expected next week.

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  • First Phase Of SEP Pre-Enrollment Verification Process Kicks In June 23

    CMS is set to roll out its new pre-enrollment verification process for special enrollment periods in two phases, with the first slated to start June 23 for two categories -- a permanent move and loss of minimal essential coverage -- and the second phase starting in August for additional categories -- marriage, adoption, birth, and denial of Medicaid or CHIP. The agency has been holding webinars to introduce the process to insurance enrollment assisters, agents and brokers as well as consumers advocates, some of whom tell Inside Health Policy they worry the process will be too confusing for many people.

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  • Anthem To Pull Out of Indiana, Wisconsin Exchanges

    Anthem announced Wednesday (June 21) that it will pull out of the health insurance exchanges in Wisconsin and Indiana for 2018, citing difficulty in planning for Affordable Care Act requirements when federal policy is so uncertain.

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  • Trump Not Keen On Changing CMS' Biosimilar Pay Policies, Sources Say

    Changing CMS' controversial policy of lumping biosimilars that reference the same biologic under a single same billing code is not a high priority for the Trump administration, two sources in touch with the White House said Tuesday (June 13). One source predicted that the administration won't reexamine the existing policies until more biosimilars, and particularly interchangeables, come to market. However, one industry expert argued that companies likely won't pursue developing interchangeable products -- those seen as offering the biggest potential savings -- until CMS tweaks its policies.

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  • Experts Tout Value-Based Contracts, RWE, Patent Reform As Pricing Fixes

    Academics and policy experts said that value-based contracts, real-world evidence and drug repurposing for off-patent and on-patent drugs could help to spur competition and lower drug prices. One expert also discussed the negative effect that President Donald Trump's proposal to increase FDA user fees would have on the generic drug industry while a former senator said the agency has plenty of money and simply needs a culture change to institute new approval policies.

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  • SCOTUS To Hear Case Challenging PTO Process For Overturning Patents

    The U.S. Supreme Court agreed last week take up a case that will determine the constitutionality of the patent office's inter partes review process -- an administrative procedure for challenging patents that some drug industry stakeholders have said undermines the drug pipeline and unfairly uses a lower standard for reviewing patents than that used by a district court.

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  • FDA Launches Plan For Post-Market Regulation Of Digital Medical Devices

    FDA Commissioner Scott Gottlieb announced Thursday (June 15) that the agency plans to pilot an entirely new approach for regulating digital health tools, such as mobile apps and fitness trackers. The agency is considering creating a third-party certification program so that lower-risk digital health products can be marketed without pre-market review, and higher risk products can be marketed with a streamlined pre-market review. An industry group representing clinical decision support software makers applauded the move, saying it seems industry and FDA are "singing off of the same page."

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