{"id":2002,"date":"2020-10-19T17:09:28","date_gmt":"2020-10-19T17:09:28","guid":{"rendered":"https:\/\/thornrun.com\/health-policy-report-10-19\/"},"modified":"2023-08-08T21:25:24","modified_gmt":"2023-08-08T21:25:24","slug":"health-policy-report-10-19","status":"publish","type":"post","link":"https:\/\/thornrun.com\/health-policy-report-10-19\/","title":{"rendered":"Health Policy Report (10\/19)"},"content":{"rendered":"\n

Capitol Hill Update<\/strong><\/p>\n\n\n\n

The Senate is poised to take up another targeted pandemic relief bill when the chamber convenes for votes today, Senate Majority Leader Mitch McConnell (R-KY) said last week. The forthcoming package is largely expected to mirror the previous Senate GOP “skinny relief” effort, including business liability provisions and allocating roughly $500 billion toward unemployment insurance, health care, education, and small businesses. Much like the previous attempt to clear this measure last month, it is expected that all Senate Democrats, and possibly a few Senate Republicans, will vote against a motion to consider the legislation. Meanwhile, broader relief talks between Speaker Nancy Pelosi (D-CA) and White House officials remain at a standstill, as outlined in a recent “Dear Colleague”\u00a0letter<\/a>\u00a0from the Speaker over the weekend. <\/p>\n\n\n\n\n\n\n\n

‘Most Favored Nations’\nRulemaking Could Come Post-Election<\/strong><\/p>\n\n\n\n

In conversations with\nsources in the administration, on Capitol Hill, and beyond, TRP has learned\nthat formal rulemaking on the Trump administration’s proposed “most\nfavored nations” (MFN) policy for prescription drugs under Medicare Parts\nB is not expected to come until sometime after the election. While rumors had\ncirculated recently that publication of an interim final rule on the Part B\nportion of the MFN rulemaking might be imminent, more recent intel suggests\nthat the Department of Justice (DOJ) has stepped in to block the idea of jumping\nstraight to an interim final rule \u2014 so instead, a proposed rule is the\nanticipated next step. <\/p>\n\n\n\n

The delay comes as the\nCenters for Medicare and Medicaid Services (CMS) is prioritizing the\nimplementation of a demonstration to distribute $200 \u201cdiscount cards<\/a>\u201d to be\nused to offset prescription drug copays. TRP\u2019s sources and various press\nreports have indicated the timing of that project is being driven by the\nupcoming presidential election. Democratic leaders of congressional health care\ncommittees sent a letter to the Government Accountability Office to quickly\nreview the legality of the \u201cdiscount cards\u201d on October 13, noting that they\n\u201care further concerned about the legality and propriety of these actions,\nparticularly in light of recent press reports indicating that the timing of\nthis project is being driven by the upcoming presidential election.\u201d House\nEnergy & Commerce Chairman Frank Pallone (D-NJ), House Ways & Means\nChairman Richard Neal (D-MA) and Senate Finance Ranking Member Ron Wyden (OR)\nasked that the GAO respond by October 19. Meanwhile, separate rulemaking on MFN\nfor Part D is expected to take even longer for the agency to produce. For more\non the MFN executive order (EO), read TRP’s summary<\/a> of the order as\nwell as our special report<\/a> on how\nthe MFN EO could be implemented. <\/p>\n\n\n\n

Judge Barrett Offers\nHealth Care Perspectives During Confirmation Hearings<\/strong><\/p>\n\n\n\n

Seventh Circuit Court\nJudge Amy Coney Barrett faced questions from members of the Senate Judiciary\nCommittee last week as she seeks confirmation to the Supreme Court. Committee\nDemocrats focused much of their questioning on the potential consequences of\nJudge Barrett\u2019s elevation to the Court on the Affordable Care Act (ACA),\nwarning that she would be a decisive vote to overturn the 2010 law. They\nhighlighted her criticism of Chief Justice John Roberts\u2019 opinion in NFIB v.\nSebelius<\/em> which allowed the ACA to stand by designating the individual\nmandate a tax.<\/p>\n\n\n\n

Judge Barrett, for her\npart, said that she is \u201cnot here on a mission to destroy the Affordable Care\nAct\u201d and said that her writings on the case are immaterial to the current case\nbefore the Supreme Court. Rather, she said, the current case hinges on\nseverability. Judge Barrett told Senators that in general, courts should not\nunduly undo legislators\u2019 work. \u201cThe presumption is always in favor of\nseverability,\u201d said Judge Barrett. \u201cThe doctrine of severability serves a\nvaluable function of trying not to undo your work when you wouldn\u2019t want a\ncourt to undo your work.\u201d The question of whether the Affordable Care Act will\nbe allowed to stand may hinge on the severability of the individual mandate\nfrom the rest of the law. If found to be inseverable from the rest of the law,\nthe entire ACA may be struck down after the Court hears the case California\nv. Texas<\/em> in November. She also denied that she has spoken to the White\nHouse about the case. President Trump has repeatedly signaled that he expects\nJudge Barrett to supply a vote to overturn the law.<\/p>\n\n\n\n

Republicans sought to\nsimultaneously criticize the ACA and reassure the public that a Justice Barrett\nwould not vote to axe the law, with Judiciary Committee Chairman Lindsey Graham\n(R-SC) saying that if it were up to him, \u201cbureaucrats would not be administering\nhealth care from Washington, people in South Carolina would be running health\ncare.\u201d Senator Mike Crapo (R-ID) mentioned a moot court exercise in which Judge\nBarrett concluded that the ACA\u2019s individual mandate was unconstitutional but\nwas severable from the rest of the law. Judge Barrett, however, reminded\nSenators to not assume a legal position based on a moot court exercise.\nFollowing the conclusion of the confirmation hearing, the Judiciary Committee\nis set to vote on Judge Barrett’s nomination on Oct. 22. A vote in the full\nSenate is expected during the week of Oct. 26.<\/p>\n\n\n\n

CMS Announces 11 New\nMedicare Telehealth Services<\/strong><\/p>\n\n\n\n

Last Wednesday, the\nCenters for Medicare and Medicaid Services (CMS) announced an expansion of its\ntelehealth services list during the COVID-19 pandemic (telehealth list<\/a>, press release<\/a>). CMS\nadded 11 new services to its telehealth list, allowing for a number of\nrehabilitation services and neurostimulator analysis. The telehealth list now\nincludes 249 different codes, including 146 that have temporarily been added\nfor the duration of the public health emergency (PHE). These codes account for\n144 total services eligible to be paid when provided via telehealth. Near the\nbeginning of the COVID-19 pandemic, CMS added a wide variety of services to its\nlist of payable telehealth services. In May, it also created a new process<\/a> for adding\nor removing services from the telehealth list during the PHE, allowing the\nagency to modify the list through guidance rather than through rulemaking. Last\nweek\u2019s additions were the first made using the new process.<\/p>\n\n\n\n

Telehealth services on\nthe list are eligible for Medicare fee-for-service (FFS) payment, and the new\ncodes are eligible for payment effective immediately. The services are paid at\nthe same rate as they would be if they were provided in a facility. CMS notes\nthat between mid-March and mid-August, over 12.1 million Medicare beneficiaries\nwith FFS coverage have received a telehealth service. That number comprises\nover 36 percent of total FFS enrollment.<\/p>\n\n\n\n

CMS also released a \u201cdata snapshot<\/a>\u201d Wednesday\non telehealth use in Medicaid and CHIP during the PHE. According to CMS,\nMedicaid and CHIP beneficiaries received over 34.5 million telehealth services\nbetween March and June 2020, more than a 2,600 percent increase over the\nprevious year. CMS also released a supplement to its COVID-19 Medicaid and CHIP toolkit<\/a>\nfor states, prompting them to identify services that can be accessed through\ntelehealth and which services can continue to be reimbursed under what\ncircumstances after the end of the PHE.<\/p>\n\n\n\n

CMS Approves Georgia\u2019s\nMedicaid Work Requirements Demonstration Program<\/strong><\/p>\n\n\n\n

The Centers for\nMedicare and Medicaid Services (CMS) last Thursday announced<\/a> its approval\nof the State of Georgia\u2019s 1115 demonstration request to expand coverage to\nlow-income Georgia adults who meet \u201ccommunity engagement\u201d requirements. The\n\u201cPathways to Coverage\u201d demonstration applies to individuals between the age of\n19 and 64, with income up to and including 100 percent of poverty. CMS\nAdministrator Seema Verma stated that the \u201ccomprehensive state-led reform will\nhelp thousands of working adults in Georgia gain access to coverage for the\nfirst time in a way that addresses both their health and socio-economic needs.\u201d\n<\/p>\n\n\n\n

Georgia is the second\nof the so-called \u201cnon-expansion states\u201d to pair eligibility for coverage for\nadults with the community engagement requirements outlined in CMS\u2019 Healthy Adult Opportunity (HAO)<\/a>\nguidance released earlier this year. The state estimates that over 30,000\nindividuals will receive Medicaid coverage during the first year of the\ndemonstration and that 65,000 are projected to enroll in Medicaid or receive\nMedicaid premium assistance for coverage through Employer Sponsored Insurance\n(ESI) over the five-year demonstration. The state plans to begin implementation\nJuly 1, 2021. Notable in the approval of Georgia\u2019s 1115 demonstration is that\nCMS is denying the state\u2019s request for enhanced federal match for this\ndemonstration population. Instead the agency writes that it will continue the\nexisting policy of providing the enhanced federal match rate when the state\ncovers the entire adult expansion group, which includes adults with income up\nto 133 percent of the federal poverty level (FPL).<\/p>\n\n\n\n

Leading up to the\nNovember elections, this approval demonstrates CMS\u2019s commitment to approve\ncontroversial Medicaid programs with work requirements. It also allows the\nAdministration to tout policies designed to promote pathways to coverage and\nfinancial sustainability for low income adults. Similar to other state Medicaid\nwork requirement initiatives, stakeholder concerns are likely to land this\ndemonstration program in the courts. Regarding next steps with Georgia\u2019s\nprogram, CMS is continuing to work with the state to finalize its other pending\nrequest \u2014 complementary reforms of its individual health insurance market\nthrough a section 1332 State Relief and Empowerment Waiver. <\/p>\n\n\n\n

White House Officials\nPromote Herd Immunity Declaration <\/strong><\/p>\n\n\n\n

In a phone call last\nMonday, White House officials cited the Great Barrington Declaration<\/a>,\narguing that the government should push for herd immunity with additional\nCOVID-19 infections among the young and healthy populations. The declaration\nwas authored by a small group of doctors and has been used to push back against\n\u201clockdowns\u201d during the public health emergency, despite investigative reporting\nfinding that many of the signatures were fake names. The three doctors behind\nthe declaration met with Department of Health and Human Services Secretary Alex\nAzar last week to discuss the declaration which has been embraced by Scott\nAtlas \u2014 neuroradiologist and adviser to President Trump. Dr. Anthony Fauci criticized\nthe White House\u2019s support for the declaration last week, calling it \u201cnonsense\u201d\nand \u201cridiculous.\u201d He explained that \u201canybody who has any experience in\nepidemiology and infectious diseases will tell you that that is risky, and\nyou’ll wind up with many more infections of vulnerable people, which will lead\nto hospitalizations and deaths.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Capitol Hill Update The Senate is poised to take up another targeted pandemic relief bill when the chamber convenes for votes today, Senate Majority Leader Mitch McConnell (R-KY) said last week. The forthcoming package is largely expected to mirror the previous Senate GOP “skinny relief” effort, including business liability provisions and allocating roughly $500 billion […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,7],"tags":[],"acf":[],"yoast_head":"\nHealth Policy Report (10\/19) - thornrun<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/thornrun.com\/health-policy-report-10-19\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Health Policy Report (10\/19) - thornrun\" \/>\n<meta property=\"og:description\" content=\"Capitol Hill Update The Senate is poised to take up another targeted pandemic relief bill when the chamber convenes for votes today, Senate Majority Leader Mitch McConnell (R-KY) said last week. 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