MA in the News
February 23, 2015

Governors Meet with Burwell, Obama

Insurers Weigh MA Pay Proposal; HHS Scraps Exchange Auto-Enrollment Plan

Governors met with HHS Secretary Sylvia Burwell over the weekend and President Barack Obama Monday (Feb. 23) as states weigh how to expand Medicaid with an alternative private market approach and how to prepare for the possibility that the Supreme Court rules against insurance subsidies in federally facilitated exchanges. Also, stakeholders are pouring through Medicare Advantage and exchange rules proposed by HHS Friday, and some health plans said Monday the MA proposal amounts to a pay cut so they oppose it. And consumer advocates are happy thatHHS scrapped the idea of letting consumers opt to be automatically enrolled in plans with the lowest premiums because such plans could be more expensive in other ways.

Burwell speaks early this week at the American Medical Association’s National Advocacy Conference, and then she testifies Thursday at a House Energy & Commerce health subcommittee hearing on HHS’ budget. Also Thursday, the Medicaid and CHIP Payment and Access Commission begins a two-day meeting.

Colorado Gov. John Hickenlooper (D) said over the weekend that the National Governors Association is still pushing its Medicaid recommendations from last year. Governors want HHS to let states keep federal savings generated from state health care initiatives, and they want CMS to approve permanent changes to state Medicaid programs, instead of making states repeatedly ask permission for waivers.

“Governors have been working with the department to make these recommendations a reality,” Hickenlooper said at the NGA conference.

The 2016 Advance Notice and draft Call Letter released by HHS near close of business Friday would result in an average pay cut to MA plans of 0.9 percent, but CMS officials expect MA plans to more than offset that pay reduction with coding tactics. CMS did not propose access standards for preferred pharmacy networks, opting instead to work with plans that market preferred pharmacy networks but don’t provide convenient access to those pharmacies with lower cost sharing. CMS also proposed going easier on the star ratings of MA plans that serve a large number of dually eligible beneficiaries. (story to come.)

America’s Health Insurance Plans is still reviewing the regulations, AHIP Director of Communications Clare Krusing said Monday, but the insurance industry-backed group Better Medicare Alliance, which includes some beneficiary and provider groups, criticized the pay cuts.

“These new cuts would add to the deep cuts to Medicare Advantage implemented each year since 2012,” Better Medicare Alliance Interim Executive Director Krista Drobac said.

DeGette Emphasizes Patient Safety In Meeting With Advocates, Doesn’t Back All ‘Cures’ Policies

Rep. Diana DeGette (D-CO) did not attach her name to the draft 21st Century Cures bill because she did not want to give the “misimpression” that she endorsed all of the legislation’s policy ideas, and she has been reaffirming her commitment to patient safety in meetings with groups, a congressional aide familiar with the topic told Inside Health Policy. A key patient advocate said that DeGette met recently with members of the Patient, Consumer, and Public Health Coalition where she expressed concerns about patient safety and sought their input.

The draft 21st Century Cures bill’s provisions on revamping and streamlining clinical trials have been a concern for FDA and some consumer advocates, with one research advocate saying the draft bill reflects the goals of venture capitalists and pharmaceutical companies rather than the goals of medical health experts and public health experts.

And as the ‘Cures’ bill pushes rare disease initiatives, the number of orphan drug designation requests, granted designations and approvals broke records in 2014, with a 53 percent increase for orphan drug approvals over 2013, according to data compiled by FDA Law Blog.

CMS Delays Final Rule On Collecting Medicare Overpayments To 2016

CMS’ recent decision to push back a final rule on collecting Medicare overpayments could be a positive sign for some providers concerned about how the agency structured the original proposed rule, though one attorney noted that providers’ obligations around returning overpayments continue.

One provider lobbyist said the one-year delay — which means four years will have passed between the proposed and final rule — is necessary for CMS to carefully put together the final rule, as providers gave the agencies many recommendations to consider. The timeline for the rule was extended to Feb. 16, 2016.

Finance Presses HHS On King Contingencies As GOP, Stakeholders Eye Fixes

Senate Finance Republicans are the latest to press the administration on how it would deal with the fallout if the Supreme Court rules that subsidies cannot flow through exchanges established by the federal government, coming as GOP lawmakers and stakeholders increasingly focus on potential legislative and administrative fixes should such a ruling surface. Key GOP lawmakers say their top priority is to create a pathway for states using to continue offering enrollees’ assistance, potentially without an insurance mandate, in the wake of such a ruling, and health care stakeholders are floating several potential fallback options.

House Majority Leader Kevin McCarthy (R-CA) recently tasked Ways & Means Chair Paul Ryan (R-WI), as well as his fellow chairs of the committees of jurisdiction, to come up with a Kingcontingency plan in addition to a developing an ACA “replacement” bill. Ryan suggested that effort is taking precedence over Medicare physician payment reform legislation, even though the current “doc fix” is scheduled to expire at the end of March.

The administration has consistently expressed confidence that the court will rule in its favor and provided no other insights, leaving stakeholders to speculate on potential paths forward if that does not happen.

FDA Reopens Comment Period, Plans Public Hearing On Generic Drug Labeling Rule

As FDA recently promised it would do in budget materials prepared for congressional appropriators, the agency formally announced last Tuesday (Feb. 17) that it is reopening the comment period for the contentious generic drug labeling proposed rule and will hold a public meeting next month to address concerns with the rule and possible alternatives.

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