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Inside CMS - 02/16/2017

  • Doctors Hope MACRA Advisory Panel Becomes More Prominent Under Price

    Physician groups are hoping the panel that advises CMS on alternative pay models will have more influence with Tom Price as the head of HHS, and they're pushing anew for lessening the financial risk that alternative pay models must accept in return for the 5 percent bonus under the new physician pay system.

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  • GOP Weighing Revisions To Medicaid Federal Match System

    House GOP leadership may revise the federal matching system for states' Medicaid programs in the first budget reconciliation that is likely to be voted on in April, an industry executive close to the talks told Inside Health Policy.

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  • Stakeholders Call For CMMI Reforms, Look To How Price Will Handle Program

    The Healthcare Leaders for Accountable Innovation in Medicare is calling for HHS Secretary Tom Price to stop CMS' innovation center from requiring providers to participate in demonstrations, and a spokesperson for the House Ways & Means Committee says Chair Kevin Brady (R-TX) wants to work with Price on guardrails for demonstrations that test reforms. Republican have tried to kill mandatory demos, but it could be a challenge to pull back the mandatory hip and knee replacement bundle that is already underway, according to some following the issue.

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  • House GOP Promises Medicaid Reform In Reconciliation But No Details Yet

    Reps. Michael Burgess (R-TX) and Brett Guthrie (R-KY) chaired a Feb. 14 meeting with House Republican lawmakers to outline for their Republican colleagues the differences between per-capita caps and block grants as the GOP plans to include Medicaid changes within their first budget reconciliation.

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  • GOP Lawmakers See Price's Takeover Of HHS As Opportunity To Change ACA

    Some GOP lawmakers are looking to newly confirmed HHS Secretary Tom Price to administratively get the ball rolling on an Affordable Care Act overhaul following a party-line Senate vote early Friday morning (Feb. 10) that ended a contentious nomination process which included Democratic boycotts of committee votes. Republican lawmakers looking to chart an ACA replacement path expect Price will tap into the law's flexibility to immediately start making changes while also taking taking steps to shore up the markets, and produce a legislative ACA overhaul plan the president promised would be unveiled when the new CMS chief took over.

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  • Bipartisan Senate Trio Asks Price To Allow Limited Drug Imports

    A bipartisan group of three senators, including Senate Finance member Charles Grassley (R-IA), is urging HHS Secretary Tom Price to allow imports of less-costly versions of expensive off-patent prescription drugs that lack competition, but only if the imported drugs are produced abroad by brand companies that invented the drugs or by well-known generic companies that commonly sells drugs in the United States. Price sidestepped questions during a confirmation hearing about whether he would advocate drug imports, a policy pushed by Donald Trump while on the campaign trail.

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  • Judge Rejects HHS' Call To Dismiss Medicare Observation Status Suit

    A federal district court judge rejected an HHS call for dismissal of a lawsuit filed by Medicare beneficiaries calling for a right to appeal placement in observation status during hospital care. The judge will allow the beneficiary advocates' case to proceed, but dismissed requests from both the advocates and HHS to make an immediate decision in the case.

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  • Grassley Hopes Price More Responsive To Congress, Increases Oversight

    Senate Judiciary Chair Charles Grassley (R-IA) said he hopes newly confirmed HHS Secretary Tom Price will be more responsive to lawmakers' concerns than was the Obama administration, particularly around Medicaid drug rebates and misclassifications. He previously said he planned to question CMS chief-nominee Seema Verma about drug pricing at her confirmation hearing, which is scheduled for Feb. 16.

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  • Stakeholders Push To Protect Medicaid Expansion, Lift IMD Restrictions

    Advocates pressed members of the Senate Appropriations Committee's HHS subcommittee to protect the Medicaid program -- including expansion -- at a hearing on mental health on Wednesday (Feb. 15), and also pushed for more community health center funding. As part of a long list of recommendations to improve mental health care, they asked lawmakers to maintain protections for those with pre-existing conditions included in the Affordable Care Act, as well.

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  • PBMs Launch Campaigns To Ward Off Threat Of Rx Price Measures

    As attention turns to drug distribution middlemen in the debate over rising drug prices, pharmacy benefit managers have launched another coalition, and the industry’s trade group rolled out a series of new videos in its campaign to emphasize the work that pharmacy benefit managers do to lower drug prices.

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  • Verma Offers Medicaid Critique From 2013 To Shore Up Qualifications

    CMS Administrator-designate Seema Verma offered her 2013 public-record testimony, "The Need for Medicaid Reform: A State Perspective," as the main policy statement in the completed questionnaire she submitted to the Senate Finance Committee outlining her qualifications for the job. The questionnaire, obtained by Inside Health Policy, is among the documents cabinet and sub-cabinet nominees have to submit to the Senate committees ahead of their confirmation hearings.

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  • Safety-Net Hospitals Say GOP Repeal Plan Will Cost Them Billions

    The Republican 2015 reconciliation bill that repealed parts of the Affordable Care Act would lead to $16.8 billion in losses for safety-net hospitals from 2018 to 2026, America's Essential Hospitals said. If the full ACA is repealed without a replacement, it could cost the hospitals more than $40 billion, according to the group.

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  • MHPA To Price: Push Medicaid Managed Care Design Vs. ACO Waivers

    HHS under new Secretary Tom Price should partner with states to improve Medicaid managed care design rather than encourage state-wide accountable care organization pilots as in Massachusetts, Jeff Myers, president and CEO of Medicaid Health Plans of America, told Inside Health Policy.

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  • NGA To Price: Streamline 1115s, 1332s; Let States Share Savings On Duals

    Governors are hopeful newly confirmed HHS Secretary Tom Price will let states make successful 1115 Medicaid waivers permanent, simplify 1332 and 1115 waiver processes, and let states collect on some of the federal Medicaid savings accrued when they lower their spending on dual-eligible beneficiaries, a National Governors Association official said.

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  • Rx-Spend Growth Slows But Remains One Of The Fastest Growing Sectors

    Drug spending growth slowed from 9 percent in 2015 to 6 percent last year due to a drop in use of hepatitis C drugs, according to 2016 projections that the CMS actuary's office reported Wednesday (Feb. 15). The actuaries' projections of health-spending growth overall are slightly slower than they were last year, even though spending in Medicare and Medicaid is expected to speed up a bit, and the Independent Payment Advisory Board is still projected to be triggered this year.

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  • AdvaMed Lobbies For Repeal Of Medical Device Tax In 1st Reconciliation Bill

    The Advanced Medical Technology Association (AdvaMed) has a full-court press underway to convince lawmakers to repeal the Affordable Care Act's medical device tax as part of the upcoming reconciliation bill, identifying the issue as the trade group's number one priority.

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  • Court Rules That CMS Must Pay Moda Risk Corridor Payments

    U.S. Court of Claims Judge Thomas Wheeler ruled Thursday (Feb. 9) that the government failed to abide by a promise made to issuers when it didn't provide ACA risk corridor payments and must pay Oregon-based Moda Health $214 million the company was owned for 2015 and 2015. The ruling, the first win on the merits of issuers suing the government to get the payments, could spur other insurers to sue CMS, prod settlement talks with the Department of Justice, and potentially result in a series of appeals to the federal court and potentially the Supreme Court.

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  • Centene To Expand In 2018 As Other Issuers Await Market Fixes

    Centene CEO Michael Neidorff told investors in an earnings call Tuesday (Feb. 7) that the company expects to be profitable with its exchange products, and revealed it aims to expand into at least two counties in 2018.

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  • Ways & Means Progressing On Reconciliation Package

    The House Ways & Means Committee is still discussing what policies to include in the reconciliation package that would provide relief to individuals hurt by the Affordable Cart Act and allow more flexibility for states and individuals.

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  • Brady: Tax Credits To Be Age-Adjusted, Offer Less Funding Than ACA

    House Ways & Means Committee Chair Kevin Brady (R-TX) said the Republican alternative to the Affordable Care Act will not provide the same level of funding for beneficiary subsidies as in the current law, but will provide tax credits that are universal and increase by age as in Speaker Paul Ryan's (R-WI) Better Way proposal.

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  • 'Age 26' Provision Not Priority For Insurers, Freedom Caucus Chair

    Republicans have vowed to keep consumer protections in the Affordable Care Act that cover people regardless of their health status and allow children to stay on their parent's plan until age 26, but there has been some chatter that the provision could be stripped or altered in an effort to get more young, healthy adults to enroll in the exchanges.

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  • Mike Lee: Don't Include CSRs, Tax Credits In Reconciliation Bill

    Sen. Mike Lee (R-UT) said it is a bad idea to include tax credits and cost-sharing reduction payments in the upcoming reconciliation package because he said the Affordable Care Act should be repealed before determining what it is replaced with.

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  • HHS Exempts Cybersecurity From Trump's Federal Hiring Freeze

    HHS acting Deputy Secretary Collen Barros told program heads to exclude cybersecurity operations, among other exemptions, from President Donald Trump's federal hiring freeze.

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  • Barrasso: Republicans Meeting With Insurance Chiefs On Tax Credits

    Wyoming Senator John Barrasso (R) tells Inside Health Policy that Republican lawmakers are meeting with insurance commissioners to discuss how to approach ACA tax credits in the upcoming reconciliation bill.

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  • Reps. Meadows & Jordan, Sen. Lee: Repeal/Replace ACA In 2-3 Months

    Conservative Republicans are lighting a fire under their fellow colleagues to repeal the Affordable Care Act within two to three months at the latest and replace the health care law on the same day.

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  • Meadows' Preexisting Condition Plan: HSAs, Risk Pools, Catastrophic Limits

    House Freedom Caucus Chair Mark Meadows (R-NC) said lawmakers are talking about using health savings accounts, high-risk pools and catastrophic coverage plans to cover those with pre-existing conditions.

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  • Meadows: Republicans Planning Meetings To Discuss HSAs

    House Freedom Caucus Chair Mark Meadows (R-NC) said at a Heritage Foundation event on Wednesday (Feb. 8) that House Majority Whip Steve Scalise (LA) has scheduled meetings to discuss expanding the use of health savings accounts, a policy on which GOP members reportedly are united.

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  • Appeals Court Stays Injunction That Would Have Pulled Biologic Off Market

    The court of appeals for the Federal Circuit on Wednesday (Feb. 8) suspended an injunction in a patent dispute that would have pulled one of the two biologics in a new category of cholesterol medications from the market. The defendants had argued that the injunction violated Supreme Court precedent and would harm patients by requiring them to switch between non-interchangeable biologics.

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  • GPhA Becomes 'Association For Accessible Medicines'

    The generic drug trade association is the latest group to launch a campaign touting its industry as the solution to lowering drug prices, but it is also using its new campaign to push back against certain drug pricing proposals it sees as bad for the generic market. The Generic Pharmaceutical Association (GPhA) announced Tuesday (Feb. 14) that it will become the Association for Accessible Medicines (AAM) and will launch an advertising campaign both touting generics as a means to increase access to medicines, and opposing drug pricing proposals that would regulate the generic industry in the same way as the brand industry.

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  • Senators Probe Price Hike Of Kaléo's Naloxone

    A group of 31 senators led by Judiciary Committee ranking Democrat Patrick Leahy (VT) is asking Kaléo Pharmaceuticals to justify the price hike of its opioid reversal product, a naloxone auto injector called Evzio, from $690 in 2014 to a current wholesale acquisition cost (WAC) of over $4,000. This is not the first time that Kaléo has come under scrutiny by Congress for the price of its naloxone product -- top members of the Senate Aging Committee wrote to five companies, including Kaléo, in June 2016 requesting an explanation of price changes for various naloxone products.

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  • Sanders, Cummings Allege Orphan Drug Program Abuses

    Potential abuses of FDA's orphan drug program are facing more scrutiny on Capitol Hill following Marathon Pharmaceuticals' decision to charge nearly $90,000 for its corticosteroid Emfalza (deflazacort) approved by FDA Feb. 9 to treat Duchenne muscular dystrophy. Former presidential candidate Bernie Sanders (I-VT) and House Oversight ranking Democrat Elijah Cummings (MD) on Monday alleged Marathon abused the program, just days after Senate Judiciary Chairman Chuck Grassley (R-IA) announced a more general probe of the orphan drug program.

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  • Doctor Groups Recommend Physician Pay System Changes To Price

    Physician groups recommend that CMS simplify Medicare's system for measuring doctor performance, lower the amount of risk doctors must meet to get a 5 percent bump in pay, seriously consider advice from the panel that advises CMS on alternative pay models and cut regulations on electronic health records. The Medical Group Management Association also wants to make major legislative changes to anti-kickback laws, and the trade group wants to reduce reporting burdens in the Health Insurance Portability and Accountability Act data security law.

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  • Market Stabilization Reg Aligns With Industry, Spurs Strong Reactions

    The insurance industry quickly commended the Trump administration Wednesday for proposing a highly anticipated marketplace stabilization rule that includes a series of policies closely aligned with industry wish lists, although some stakeholders said the changes don't go far enough. Republicans praised the rule as a needed step forward to shore up troubled Obamacare marketplaces as the GOP pursues an ACA replacement, but Democrats, consumer advocates and ACA supporters said the rule goes too far and will hurt consumers while only marginally benefiting issuers.

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