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Inside CMS - 10/19/2017

  • ACOs Across Demos, Program Save Medicare $70.6M In 2016

    Accountable care organizations in the Medicare Shared Savings Program and three ACO demonstrations collectively saved Medicare $70.6 million in 2016 after ACO bonuses are taken into account, a CMS spokesperson said. The performance results show that ACOs are improving both on financial and quality-of-care measures, industry sources said, and they emphasized that although the savings appear small, they don't account for the positive spillover effects in the private market.

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  • Alexander-Murray Deal Faces Uncertain Path

    Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA), in their just-released market stabilization bill that funds the cost-sharing reduction payments for two years, agreed to amend 1332 statute to fast-track the waiver process, broaden the budget neutrality requirements, and set up the pass-through funding structure Alaska recently used for its reinsurance waiver.

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  • Researchers Suggest Congress Focus On 340B Transparency, Eligibility

    Congress should make hospitals report revenue generated by 340B drug discounts and change the criteria that determines which hospitals get those discounts, according to researchers from Vanderbilt University and the University of Chicago. Lawmakers expressed interest in both of those areas at a recent hearing.

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  • Bipartisan CHIP-Offset Talks Fall Apart In The House

    House Republicans and Democrats can’t agree on how to pay for a five-year funding extension of the Children’s Health Insurance Program, which provider lobbyists say means the House GOP will likely have to accept CHIP legislation that Republican and Democratic senators are negotiating.

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  • Meadows Says House GOP Could Pass CHIP Without Dems

    House Freedom Caucus Chair Mark Meadows (R-NC) said he thinks House Republicans could pass CHIP funding extension legislation without support from Democrats.

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  • Dems Urge Use Of Bush Waivers For Evacuees' Medicaid, CHIP Coverage

    House Energy & Commerce Democrats are urging CMS to use waivers that the Bush administration developed after Hurricane Katrina to make it easier for evacuees to maintain Medicaid and CHIP coverage or enroll in those programs, but a consumer advocate said the administration has shown no interest in using those waivers.

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  • Health Committee Chair Alexander Questions Merit Of Drug Rebates

    Senate health committee Chair Lamar Alexander (R-TN) questioned the merit of drug rebates at a hearing Tuesday (Oct. 17) on drug prices.

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  • PhRMA Doesn't Take Position On Trump Executive Order

    The executive order that the president signed last week could drive healthy people to buy short-term and association health plans that are not required to cover drugs, but Pharmaceutical Research and Manufacturers of America Executive Vice President Lori Reilly declined Tuesday (Oct. 17) to take a position on the policy.

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  • Democracy Forward Sues OMB For Information On 340B Penalties Rule Delay

    Watchdog group Democracy Forward sued the White House Office of Management and Budget for information on the role OMB Associate Director of Health Programs Joseph Grogan played in the delays of the Obama administration's 340B drug ceiling price and manufacturer penalty rule.

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  • Democratic AGs Suit Argues Administration Legally Required To Pay CSRs

    The suit that 19 Democratic attorneys general filed Friday (Oct. 13) to block President Donald Trump from cutting off the Affordable Care Act's cost-sharing reduction payments argues that the law requires the government to pay those subsidies. Insurance companies also might have legal recourse, though it's not clear yet whether they'll also sue the administration.

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  • Generic, Hospital, PBM, Insurer Groups To Congress: Probe Allergan IPR Deal

    A coalition that includes the trade groups for the generic, hospital, health insurance and pharmacy benefit manager industries are the latest to call on Congress to investigate Allergan's deal with a Mohawk tribe to skirt inter partes review of its patents.

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  • Advocates Hope WV Substance Use Disorder 1115 Waiver Could Start A Trend

    West Virginia's substance use disorder 1115 waiver removes a statutory hurdle that keeps Medicaid funds from going to institutions of mental disease (IMD) for substance abuse treatments, and advocates are hopeful that the administration’s approval of the waiver could lead to similar waivers in other states.

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  • Wyden Asks HHS, Treasury To Explain Not Approving Reinsurance Waivers

    Senate Finance Committee Ranking Democrat Ron Wyden (OR) on Tuesday (Oct. 10) sent a letter to then-HHS Acting Secretary Don Wright and Treasury Secretary Steven Mnuchin requesting more information about why the Trump administration did not approve Oklahoma's 1332 reinsurance waiver, and he asks whether other states will face similar delays when applying for reinsurance waivers.

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  • Avalere Says CSR Loss Deals $1B Blow To Issuers; Dems Demand Docs

    The Trump administration's decision to stop cost-sharing reduction payments will result in a significant fourth-quarter financial blow to health insurance plans, with issuers in Florida, California, Texas, North Carolina and Virginia facing the largest hit, a new Avalere study finds. President Trump announced he would cut off the funding last Thursday, saying that a Department of Justice review of the payments concluded they were unconstitutional since they lacked a congressional appropriation. Meanwhile, key House and Senate Democrats are demanding to see the documents DOJ used as a basis for its findings.

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  • Trump Flip Flops On Short-Term Market Fix After Ending CSR Payments

    Throughout the day Monday, the president declared the Affordable Care Act "dead" and claimed his move to abruptly end the law's reimbursements to insurers for reducing out-of-pocket costs sparked bipartisan work on a short-term market fix that he said he supported -- however, Trump has so far changed his public stance on the deal several times.

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  • Trump Administration Sparks Controversy By Scrapping CSRs

    The White House late Thursday announced it would immediately stop providing insurers the Affordable Care Act's cost-sharing reduction payments, prompting backlash from Democratic lawmakers and a lawsuit from the Democratic Attorneys General Association. The move could lead to some insurers pulling out of the individual markets, which may be allowed under the "exit clauses" for insurers in states using healthcare.gov, however many insurers priced their products under the assumption the CSRs would not be funded this year and it is still possible for Congress to act.

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  • PA Insurance Office Approves Higher Rates After CSRs Axed

    Pennsylvania's insurance commissioner on Monday (Oct. 16) announced it has approved rate increases that average 30.6 percent, or 23 percent more than the 7.6 increase issuers sought under the assumption the cost-sharing reductions would be paid. Like several other states, Pennsylvania also asked issuers to limit the hikes to the silver-level plans, which will increase the amount of the tax credits available for eligible consumers since the subsidies are linked to the those plan costs.

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  • Hatch, Wyden Question CMS On Nursing Home Emergency Preparedness

    Senate Finance Committee Chair Orrin Hatch (R-UT) and ranking Democrat Ron Wyden (OR) are pushing officials from CMS and states affected by hurricanes earlier this year to explain what federal protections were in place, and whether those regulations are adequate.

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  • Trump Signs Order Calling For Association Health Plans, HRAs

    President Donald Trump Thursday signed an executive order that asks HHS, Labor and Treasury to expand health care coverage options by allowing cross-state association health plans (AHPs), extending the duration of short-term plans and boosting healthcare reimbursement arrangements. Some health experts worry the order will undermine consumer protections and destabilize the market, while others back the idea of creating more choices.

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  • Draft Bill Would Protect Basic Health Funding In 1332s

    Basic Health Program (BHP) funding would be held harmless from any reductions in projected funding under the state innovation waivers as part of the bipartisan market stabilization legislation unveiled Tuesday, a reaction to the administration's decision that is slated to cost Minnesota about $369 million if not reversed.

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  • Sen. Johnson Lays Out Principals For Alternative ACA Market Fix

    Sen. Ron Johnson (R-WI) is working on an alternative fix to the Affordable Care Act that follows five principals, including improved transparency, expanded insurance choices, strengthened consumer-directed plans, and lower premiums in exchange for cost-sharing reduction funding.

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  • Source: Former Lilly President, HHS Veteran Interviewed For HHS Secretary

    A source tells Inside Health Policy that rumored potential HHS secretary nominee, former Lilly president and HHS official Alex Azar, has been interviewed for the job and wants it with conditions -- but those conditions remain unknown as of press time. Another industry source close to the potential nominee tells IHP that Azar, an Indiana native, has been longtime friends with Vice President Mike Pence and has been advising the administration since the election.

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  • E&C Urges HHS To Learn From EPA, Commerce, Energy On Cutting Waste

    House Energy & Commerce Chair Greg Walden (R-OR) in an Oct. 18 letter asked HHS Acting Secretary Eric Hargan to look at how the Environmental Protection Agency and the departments of Commerce and Energy are working to cut down on administrative waste.

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