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Inside CMS - 12/14/2017

  • Collins, Alexander Confident CSR, Reinsurance Funding Bills Will Pass

    After huddling with Vice President Mike Pence outside the GOP Conference lunch Tuesday, Sens. Susan Collins (R-ME) and Lamar Alexander (R-TN) expressed confidence that market stabilization bills to fund the ACA's cost-sharing reduction payments and set up reinsurance funding would be included in must-pass legislation before the end of the year.

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  • Lawmakers Hope To Fund CHIP This Month, But Timing Is Uncertain

    Lawmakers still hope to fund the Children's Health Insurance Program by year's end, even though the omnibus appropriations bill on which lobbyists thought CHIP would ride seems to be slipping into next year. House Republicans on Wednesday (Dec. 13) added the CHIP bill that they already passed, including its partisan offsets, to a short-term government-funding bill, but a Senate Democratic aide said negotiations over government spending legislation, of which CHIP is a part, are unresolved.

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  • 340B Policies In The Mix For Possible Inclusion In End-Of-Year Legislation

    A bipartisan group of six senators recently urged the upper chamber's leadership to include a provision to prevent a cut to hospital reimbursement for 340B drugs in an end-of-the-year package -- though it is unclear what legislation lawmakers may look to pass once the current continuing resolution runs out Dec. 22. A hospital lobbyist says that some type of spending bill will need to move once the short-term government funding runs out, and hospitals hope a moratorium on the cuts to 340B hospital pay will be attached to that vehicle.

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  • House E&C Might Hold Another Rx-Price Hearing Soon

    Representatives of the drug-distribution sectors argued over the causes of drug prices at a House Energy & Commerce health subcommittee hearing Wednesday (Dec. 13), but lawmakers were left with unanswered questions and the committee Chair Greg Walden (R-OR) said the subcommittee will likely hold another hearing on drug prices early next year.

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  • LePage Doubles Down On Fight Against Maine Medicaid Expansion

    Maine Gov. Paul LePage (R) on Monday (Dec. 11) sent the state legislature a list of demands he says must be met before the state expands Medicaid, as called for by Mainers in the Nov. 7 election. The legislature's budget committee is scheduled to discuss funding for the expansion on Wednesday (Dec. 13).

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  • Labs Sue Govt. Over Exclusion Of Hospital-Lab Rates From Fee Schedule

    Clinical laboratories on Monday (Dec. 11) sued the government over the fee schedule for tests. The American Clinical Laboratory Association said CMS illegally exempted nearly all hospital laboratories from the requirement to report private-payer rates on which the new reimbursements will be based, and that lowers those rates. However, a firm that follows the lab industry says it's doubtful that ACLA will win.

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  • PhRMA Challenges Constitutionality Of Calif. Drug-Price Transparency Law

    Brand drug makers on Friday (Dec. 8) challenged the constitutionality of a California drug-price transparency law. The lawsuit by the Pharmaceutical Research and Manufacturers of America argues the law violates numerous constitutional provisions, including the Commerce Clause, the First Amendment and the Fourteenth Amendment's Due Process Clause, and it raises concerns the law would set national pricing policy.

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  • MedPAC To Vote Next Month On Replacing MIPS With Voluntary Approach

    Congress' Medicare pay advisers plan to vote in January on a draft recommendation to eliminate and replace the Merit-based Incentive Payment System, which Commissioner David Grabowski said belongs in the "bad pay for performance hall of fame."

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  • Physician Groups Ask HHS Not To Link Medicaid Coverage To Work

    Six physician groups on Friday (Dec. 8) wrote to Acting HHS Secretary Eric Hargan and and CMS Administrator Seema Verma asking them not to use Medicaid waivers to place limits and barriers on coverage, such as by conditioning coverage on work. The groups also ask the Trump administration to ensure that 1115 waivers help people maintain affordable coverage.

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  • Paul Proposes Letting Rx Makers Vary Discounts To Undermine Rebates

    Sen. Rand Paul (R-KY) on Tuesday (Dec. 12) proposed letting drug companies offer varying up-front discounts because doing so would move industry away from rebates that are blamed for obscuring business deals many lobbyists and policy analysts say contribute to price increases. Paul said allowing discounts directly from the manufacturer is a way to achieve price transparency without mandating it.

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  • Tax Bill Deal Repeals Individual Mandate, Keeps Medical Expense Deduction

    The preliminary tax deal hammered out by House and Senate GOP leaders includes the Senate provision to repeal the ACA's individual mandate, and is expected to lower the medical expense deduction threshold to 7.5 percent of income as proposed by the Senate, whereas the House would have scrapped the deduction.

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  • Activists, Dems Call On GOP To Pause Tax Vote After Jones Win

    Health care activists and Democrats are calling on the GOP Senate to hold off a vote on the tax bill, which is expected to include a repeal of the Affordable Care Act's individual mandate, until Alabama's Democratic Senator-elect Doug Jones is seated in the upper chamber. But a GOP consultant says the preliminary win by Jones that further narrows an already thin GOP majority, and which GOP opponent Roy Moore is challenging, just lit a fire under the GOP to get the tax bill out by the end of the week.

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  • MedPAC Discusses Interim Blended Pay Systems For Post Acute Providers

    Congressional Medicare advisers outlined a potential post-acute care pay system that CMS could use until a unified system is put into place. The interim system would redistribute pay across conditions within each post acute sector while keeping total payments to each setting at set levels, staff said at the commission's meeting last Thursday (Dec. 8).

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  • Gottlieb: CMS To Cover Diagnostic Tests That Voluntarily Gain FDA Approval

    FDA and CMS will increasingly work together on simultaneous diagnostic test reviews, a move that FDA Commissioner Scott Gottlieb told lawmakers Thursday (Dec. 7) could serve as "a powerful incentive" for more sponsors of diagnostic tests to voluntarily go through the FDA approval process.

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  • MedPAC Sets Out To Revamp Medicare Advantage Star Ratings

    Congressional Medicare advisers said Friday (Dec. 8) they plan to look into overhauling the Medicare Advantage star-rating system, and they're particularly bothered by an insurance industry practice that games bonuses. In the past five years, that practice has moved 20 percent of MA enrollees, who benefit from the bonuses, into plans that receive bonuses, despite not deserving them.

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  • HHS To Distribute Opioid Funds Based On Population, Not Need, In 2018

    Next year the administration will continue to divvy up set-aside funds for states to fight the opioid epidemic based on a state's population, rather than need, Assistant Secretary for Mental Health and Substance Use Elinore McCance-Katz told senators Wednesday (Dec. 13). Lawmakers from both sides of the aisle have been pushing the administration to change the policy next year when the second year of 21st Century Cures funding kicks in so that states disproportionately affected by the epidemic could better respond, but McCance-Katz said changing funding methods could place extra burdens on states.

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  • PhRMA Throws Support Behind Opioid Prescribing Limits, Education

    Drug industry lobby group Pharmaceutical Research and Manufacturers of America (PhRMA) on Monday (Dec. 11) threw its support behind a number of policy proposals to tackle the opioid crisis, including limits on prescribing, a ban on prescribing of Schedule II opioids in an office setting, ongoing prescriber training, expanded access to addiction treatment options, and development of abuse-deterrent formulations (ADFs) of opioids.

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  • Wyden, Murray Call On CMS To Extend ACA Open Enrollment Period

    Three days before the 2018 Affordable Care Act open enrollment period comes to an end, the ranking Democrats on the Senate Finance and Health committees are asking the Trump administration to extend the Affordable Care Act's open enrollment period to Jan. 31 amid speculation among Washington insiders that an extension or grace period isn't forthcoming. A bipartisan group of Virginia lawmakers, led by Sens. Tim Kaine (D) and Mark Warner (D) and Rep. Tom Garrett (R), also recently asked HHS to extend the open enrollment period, which they said would also give Congress more time to pass legislation aimed at stabilizing the market.

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  • W&M Bills Would Reduce, Delay ACA Taxes; Pause Employer Mandate

    House Ways & Means Republicans on Tuesday (Dec. 12) introduced a package of bills that would delay the Affordable Care Act's medical device tax by five years, reduce the tax on health issuers that are able to rebate consumers in 2018 and provide full relief to all issuers in 2019, stop implementation of the employer mandate, push the start date for the controversial Cadillac tax by one year to 2021, and freeze for two years the ban on using consumer-directed accounts to purchase over- the-counter medications.

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  • Alexander Cites Avalere Study In Press For CSR, Reinsurance Funding

    Senate health committee Chairman Lamar Alexander (R-TN) cited Avalere research, which found cost-sharing reduction and reinsurance funding could lower premiums by as much as 18 percent in 2019, on the Senate floor Thursday (Dec. 7) in a press for Congress to pass the Alexander-Murray CSR deal and $10 billion in reinsurance funding by year's end.

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  • Enrollment Surges As Dems Call For Extended Open Enrollment Period

    More than 1 million Americans selected plans from Dec. 3 through Dec. 9, the sixth week of open enrollment that ends on Friday (Dec. 15), and nearly 4.7 million have signed up for coverage since Nov. 1, CMS announced Wednesday (Dec. 13). Also on Wednesday, at least one additional Democrat joined the bipartisan chorus calling on the administration to extend the open enrollment period through Jan. 31.

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  • CMS Expected To Eliminate Grace Periods For 'In-Line' Enrollees

    Stakeholders expect CMS to shut out potential enrollees attempting to register for a plan on healthcare.gov as the clock strikes midnight on Dec. 15 and not afford them a grace period for sign-ups as the agency has done in years past -- and the agency wouldn't deny that might be the case when asked about it by Inside Health Policy.

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  • IRS Guidance Lays Out Mandate Exemptions In Areas With No Bronze Plans

    The IRS in recent guidance explains that individuals living in areas in which no bronze-level plans are offered can request a hardship exemption from the Affordable Care Act's individual mandate if the lowest cost plan in that region, which would generally be a silver-level plan, is unaffordable. The Affordable Care Act requires Americans to either purchase coverage or pay a penalty, but allows people to claim an exemption if the lowest cost plan in their service is more than a certain percentage of income, or 8.16 percent for 2017.

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  • FDA Plans Meeting On 'Unprecedented' Steps To Combat Opioid Crisis

    FDA will hold a meeting Jan. 30 weighing a number of steps FDA Commissioner Scott Gottlieb called unprecedented to deal with the opioid crisis, including requiring sponsors create nationwide Prescription Drug Monitoring Programs (PDMPs). Other proposals to be aired at the meeting include mandating additional prescriber documentation when prescribing opioids above a certain threshold, potentially imposing additional measures to improve patient storage and handling of opioids, and the possibility of requiring sponsors create mandatory opioid take-back programs.

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