Healthcare Today | September 8, 2023

House Ways and Means Requests Stakeholder Input on Addressing Rural and Underserved Community Healthcare Access. On Thursday, the House Ways and Means Committee Chairman Jason Smith (R-MO) released a letter requesting public comment on health disparities in rural and underserved communities across the nation. Highlighted in the Chairman’s statements were travel times and cost for basic services in certain regions, closures of rural pharmacies and hospitals, and health care workforce shortages. Though appropriations negotiations are likely to dominate both headlines and Congressional calendars in the upcoming September work period, those wishing to respond can email comments to WMAccessRFI@mail.house.gov by October 5th.

House Budget Committee Launches Healthcare Task Force, Issues RFI. After publishing an article on government healthcare spending over the August recess, House Budget Committee Chairman Jodey Arrington (R-TX) and Rep. Michael C. Burgess, M.D. (R-TX) announced a new Budget Committee Health Care Task Force. According to the Committee’s RFI statement the group of legislators will “examin[e] key drivers of health care costs to the federal budget and proposals to improve outcomes while reducing health care spending.” The panel will also analyze the Congressional Budget Office’s modeling process when providing cost estimates on potential programs. Comments on government health spending issues can be submitted to the Committee via hbcr.health@mail.house.gov by October 15th.

House GOP Releases Multi-Committee Discussion Draft on Healthcare Transparency, PBMs. The House Ways and Means, Energy and Commerce, and Education and the Workforce Committees released draft healthcare transparency legislation Wednesday that includes contract and reporting requirements for pharmacy benefit managers. The legislation, titled the Lower Cost, More Transparency Act, specifically bans the use of spread pricing by PBMs that contract with MCOs, requires PBMs and other third-party administrators to disclose health plan fiduciaries information related to their compensation, and requires PBMs provide detailed prescription drug spending data to employers on a semi-annual basis. House Energy and Commerce Ranking Member Frank Pallone (D-NJ) released a statement expressing support for the extenders provisions in the bill but suggested the bill would need to be strengthened before receiving his support.

CMS Announces New Model to Revamp Regional Healthcare Delivery. The Centers for Medicare and Medicaid Services announced Tuesday the unveiling of their new “States Advancing All-Payer Health Equity Approaches and Development Model”, or AHEAD Model. The model aims to better address chronic disease and behavioral health, among other medical conditions. CMS states in the announcement: “Participating states will be better equipped to promote health equity, increase access to primary care services, set health care expenditures on a more sustainable trajectory, and lower health care costs for patients”. The model is voluntary – more information on the model and the application process is available here.

While Congress Was in Recess… Some Major Healthcare Announcements:

CMS Long Term Care Staffing Ratio Proposed Rule. On September 1st , CMS issued a long-awaited proposal to establish new federal minimum staffing standards for long-term care facilities. According to CMS proposed rules, all facilities would be required to maintain a Registered Nurse on-site 24 hours per day, 7 days per week; at least .55 RN hours per resident per day; and at least 2.45 Nurse Aide hours per resident per day. Analysts state nearly 75% of current nursing home facilities are currently below these standards. Public comments on the proposed rules are due to the Federal Register by November 6th.

Biden Administration Announces First Ten Drugs for Negotiation under New Inflation Reduction Act Policy. Despite a slate of ongoing pharma-backed lawsuits against the Biden Administration’s new law allowing Medicare to directly negotiate drug prices with manufacturers, CMS unveiled the first 10 drugs subject to price negotiations beginning in 2026. The full list includes Fiasp and NovoLog insulin products, Farxiga, Entresto, and three Johnson & Johnson medications. The new policy is expected to save the U.S. government billions by 2030, and drug companies producing the 10 selected drugs have until October 1st to either agree to price negotiations, pay large fines, or withdraw their products from Medicare and Medicaid. These enforcement measures are the subject of eight current lawsuits, as drugmakers argue they violate of the Fifth Amendment and the excessive fines clause of the Eighth Amendment.

Medicare’s Accountable Care Organizations (ACOs) Produces Large Savings for Ninth Straight Year. On August 24, CMS announced Medicare’s Shared Savings Program saved Medicare $4.3 billion in 2022, which totaled $1.8 billion after accounting for shared savings and losses. In the last decade, ACOs have generated more than $21 billion in gross savings for Medicare, while continuing to provide high-quality care. Medicare’s ACOs are the largest alternative payment model in Medicare – utilized by more than 700,000 providers to care for more than 13 million beneficiaries. Highlights included in the data released by CMS also report that in 2022, ACOs saved $416 per beneficiary and 63% of ACOs nationwide (304 out of 482) earned at least some portion of shared savings. The $1.8 billion saved by the Medicare Shared Savings Program in 2022 represents the second-highest annual savings since the program’s inception.

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