Issues for the week ending April 27

Transcription

1 Issues for the week ending April 27 Federal and National Issues Legislative Congress Begins Committee Markups of Opioid Bills Bill Would Add Reporting Requirements for 340B Hospitals Federal Legislative Efforts to Align Health Care Privacy Provisions Senators Release Draft PAHPA Reauthorization Bill for Comment House Hearing Examines Health Care Innovation and Technology Regulatory CMS Issues Proposed Rule to Empower Patients, Remove Hospital Burdens in Annual Medicare IPPS and LTCH Rule CMS Releases Proposed Rule for Inpatient Psychiatric Facility PPS for FY 2019 CMS Issues IRF, SNF and Hospice Proposed Rules for 2019 CMS Issues Notice for Payment Adjustment Extensions for Low-Volume and Medicare-Dependent Hospitals CMS Accepting Applications for Meaningful Use Hardship Exceptions CMS Unveils New Strategy to Fuel Data-driven Patient Care, Transparency State Issues Delaware Legislative Pennsylvania Legislative Legislation Introduced Mandating Coverage for Treatment of Pediatric Autoimmune Neuropsychiatric Disorders House Public Hearing Held on Bill Banning Insurance Benefit Changes Mid- Year Governor Vetoes Workers Compensation Formulary Measure, Creates Alternative Regulatory PID Announces New Autism Benefit Coverage Cap Insurance Commissioner Issues Warning About the Proposed Short-Term, Limited-Duration Rule Industry Trends Provider / Delivery System Trends AHA, AARP CEOs Highlight Exorbitantly-priced Drugs in Hill OpEd Highmark Inc

2 ProMedica to Acquire HCR ManorCare Insurance / Market Trends Humana Launches Hospital Quality Incentive Program Humana, Others to Buy Hospice Operator Curo Health for $1.4 Billion Federal and National Issues Legislative Issues Congress Begins Committee Markups of Opioid Bills The Senate HELP Committee and the House Energy and Commerce Subcommittee on Health have approved dozens of legislative provisions on opioid-related issues. Additional action is planned by these and other committees this summer in hopes of clearing a broad-based opioid package this year that will follow up on 2016 s Comprehensive Addiction and Recovery Act (CARA). On Tuesday, April 24, the HELP Committee approved an amended version of S. 2680, the Opioid Crisis Response Act, by a vote of The bill includes more than 40 legislative provisions addressing a broad range of opioid-related issues, including $1.5 billion in federal funding for State Targeted Response Grants over the next three years. Other provisions focus on the development of non-addictive pain medications, support for opioid recovery centers, packaging and safe disposal options for opioids, the detection and seizure of illegal drugs, education and awareness campaigns, data sharing between states and local governments, and the health care workforce. The bill also includes provisions that require the Secretary of Health and Human Services to: (1) develop best practices for prominently displaying a patient s history of opioid abuse in his/her medical records, when requested by the patient; and (2) identify model programs for training health care providers, patients, and their families on issues relating to the protection and appropriate disclosure of confidential substance use disorder medical records. In addition, the House Energy and Commerce Subcommittee on Health cleared 57 separate bills that will ultimately be crafted into a House package. The many proposals in the House package include several bills aimed at addressing the crisis in Medicare and Medicaid, such as electronic health records incentive payments for behavioral health, streamlining use of telehealth to treat opioid use, and mandatory lock-in programs for at-risk beneficiaries in Medicare Part D. Bill Would Add Reporting Requirements for 340B Hospitals Representative Earl Buddy Carter (R-GA) has introduced a bill that would require hospitals participating in the 340B drug savings program to report their low-income utilization rate for outpatient services. The new reporting requirement is modeled after the current Medicaid disproportionate share hospital program low-income utilization rate (LIUR) reporting requirement, which is based on inpatient data. Currently, state Medicaid programs are required to report to the Centers for Medicare & Medicaid Services through the Medicaid DSH audit and reporting process the LIUR for hospitals receiving Medicaid DSH payments. Carter s bill would require 340B DSH hospitals report to the Health Resources and Services Administration a LIUR for outpatient services based on Medicaid revenues and charity care provided by 340B DSH hospitals and their registered 340B outpatient sites that is not collected by any federal program. HRSA would be required to submit an annual report to Congress regarding the information submitted by the 340B DSH hospitals. Highmark Inc

3 We have concerns the bill would impose new overly burdensome reporting requirements on hospitals requesting data that is not accessible in nature, said the American Hospital Association (AHA). Such reporting requirements would not provide meaningful transparency nor tell the real story of the value of the 340B program. Federal Legislative Efforts to Align Health Care Privacy Provisions The American Hospital Association (AHA) and more than 40 health care organizations last week urged Congress to include legislation that would align 42 CFR Part 2 with the Health Insurance Portability and Accountability Act as part of legislation to address the opioid crisis. The groups sent letters to leaders of the Senate Committee on Health, Education, Labor, and Pensions and the House Committee on Energy & Commerce urging them to include S. 1850/H.R.3545 in their efforts to address the opioid epidemic. To provide the safest and highest quality care, clinicians in hospitals and health systems need access to patients complete medical information, including information about substance use disorders, said AHA Executive Vice President Tom Nickels. The importance of safe care for all patients in treatment for opioid use disorder cannot be overstated and 42 CFR Part 2 is a major barrier to safety for patients in treatment for opioid use disorder. Congress should update this law, which impedes the sharing of critical patient information that is necessary to deliver the most effective and efficient care. The Senate HELP Committee completed markup of its opioid bills last Tuesday, and the Energy and Commerce Committee Health Subcommittee marked up more than 60 bills on Wednesday. Despite the stakeholder letter, activity in Congress on the issue was not positive. The House Energy and Commerce Subcommittee on Health had intended to include H.R among the dozens of bills it advanced in its opioid package, but it was one of a handful of more controversial bills that were pulled at the last minute so as to allow for additional bipartisan discussion. Senators Release Draft PAHPA Reauthorization Bill for Comment Senators Richard Burr (R-NC), Bob Casey (D-PA), Lamar Alexander (R-TN) and Patty Murray (D- WA) last week released for public comment through May 4 draft legislation to reauthorize the Pandemic and All-Hazards Preparedness Act, currently set to expire Sept. 30. Among other provisions, the bill would reauthorize the Hospital Preparedness Program and Public Health Emergency Preparedness Program through It also would require the Department of Health and Human Services to evaluate existing performance measures, benchmarks and standards for the HPP and PHEP programs; develop guidelines for regional systems of hospitals and other facilities of varying capabilities to treat patients and increase surge capacity during public health emergencies; and prioritize HPP grants to entities that enhance coordination among facilities in a regional public health emergency system. In addition, the legislation would encourage HHS to coordinate critical supplies to affected areas and states to allow licensure of medical professionals across state lines during an emergency; and reauthorize the Emergency System for Advanced Registration of Volunteer Health Professionals, Medical Reserve Corps and Strategic National Stockpile. House Hearing Examines Health Care Innovation and Technology The House Ways and Means Health Subcommittee April 26 held a hearing on innovative practices and technology in health care. In a statement submitted to the subcommittee, the American Hospital Association (AHA) highlighted how hospitals and health systems are using technology and new care delivery models to enhance the patient experience and add value. These innovations are allowing hospitals to meet patients needs for greater convenience and online access, AHA said. However, updates are needed to legal and regulatory structures to Highmark Inc

4 continue to enhance the consumer experience, better coordinate care, and allow for greater use of technology. Specifically, AHA urged Congress and the administration to expand access to telehealth, ease participation in new care models, complete the broadband infrastructure, and reduce regulatory burden. Regulatory Issues CMS Issues Proposed Rule to Empower Patients, Remove Hospital Burdens in Annual Medicare IPPS and LTCH Rule The Centers for Medicare & Medicaid Services (CMS) published their proposed Inpatient Prospective Payment System (IPPS) rule designed to empower patients through better access to hospital price information, improve patients access to their electronic health records, and reduce burdens for providers. In an effort to advance the agency s goal to create a patient-centered health care system, the Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would update fiscal year 2019 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The proposed rule seeks to enhance price transparency and interoperability and reduce significant burdens, giving hospitals more flexibility in their operations. In addition to the proposed rule, CMS included a Request for Information to secure feedback from hospitals about ways to enhance interoperability and data sharing among health care providers. By law, CMS is required to update payment rates for IPPS hospitals annually and to account for changes in the prices of goods and services used by these hospitals in treating Medicare patients, as well as for other factors. CMS projects a total increase in IPPS operating payments of 3.4 percent. This reflects: A 1.75 percent increase in payment rates for hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting (IQR) Program and are meaningful electronic health record users Proposed changes in uncompensated care payments, capital payments, and the changes to the low-volume hospitals payments Overall, CMS projects that LTCH PPS payments would decrease by approximately 0.1 percent during fiscal year Although CMS proposes to update the LTCH PPS payment rate by 1.15 percent, the overall projected decrease is due in large part, to the continued phase-in of the dual payment rate system. CMS also proposes to remove the 25 percent threshold in a budget-neutral manner. The proposal includes a -0.9 percent adjustment factor to the LTCH PPS standard federal payment rate. This would maintain aggregate LTCH PPS payments at the estimated levels they would be in absence of this proposed change. With the focus on a patient-centered care health care system, the rule calls for: Overhauling the Medicare and Medicaid Electronic Health Record Incentive Programs to focus on interoperability, improved flexibility, reduced hospital burdens, and the electronic exchange of health information between providers and patients. CMS is re-naming the Meaningful Use program Promoting Interoperability Requiring hospitals to post a list of their standard charges online to increase transparency; and gathering input about barriers preventing providers from informing patients of their out- Highmark Inc

5 of-pocket costs, changes needed to support greater transparency around patient obligations for their out-of-pocket costs, and the role providers should play in this greater transparency Reducing the number of measures acute care hospitals would be required to report across the five quality and value-based purchasing programs with an emphasis on removing duplicative measures, topped out measures (an overwhelming majority of providers are performing highly), or measures that are excessively burdensome to report Implementing additional changes to reduce the number of hours hospitals spend on paperwork by more than two million hours CMS will accept comments about the proposed rule until June 25, Additional information is available in a CMS fact sheet. CMS Releases Proposed Rule for Inpatient Psychiatric Facility PPS for FY 2019 The Centers for Medicare & Medicaid Services last week issued a proposed rule to update the payment rates for inpatient psychiatric facilities for fiscal year CMS proposes a net payment increase of 0.98% or $50 million, compared to FY This includes a 2.8% market-based update, offset by cuts of 0.8% for productivity and a further Affordable Care Act-mandated cut of 0.75%, as well as a decrease of 0.27% due to updating the for high-cost outlier threshold. CMS also proposes to remove eight measures from the IPF Quality Reporting program, which the agency estimates would result in a reduction in costs of $68.1 million. In addition, as with the other fiscal year payment rules released this week, CMS includes a Request for Information to obtain feedback on solutions to achieve better interoperability between providers. CMS Issues IRF, SNF and Hospice Proposed Rules for 2019 The Centers for Medicare & Medicaid Services last week issued proposed rules for inpatient rehabilitation facility, skilled nursing facility and hospice payments for fiscal year For IRFs, net payments would increase by 0.9% ($75 million) relative to FY 2018 payments, including a 2.9% market-basket update, offset by statutorily mandated cuts of 0.8 percentage points for productivity and an additional cut of 0.75%, and a 0.4% decrease in outlier payments. CMS also proposes to remove the FIM instrument and associated function modifiers from the IRF patient assessment instrument. In addition, the agency is soliciting comments on removing the face-to-face requirement for rehabilitation physician visits and other coverage changes. CMS proposes to remove two measures from the IRF Quality Reporting Program. If finalized, IRFs would no longer have to report data for the NHSN MRSA or seasonal flu vaccination measures as of October 1 of this year. SNF payments would increase by 2.4% over FY 2018 levels, as mandated by the Bipartisan Budget Act of 2018, an $850 million increase. No forecast error correction would apply in FY As follow-up to the SNF reform model released by CMS in May 2017, the agency proposes for FY 2019 an overhaul of the SNF payment system that would replace the current unit of payment known as RUGs. CMS states that the proposed new Patient-Driven Payment Model is significantly changed from the version put forward last year. With regard to quality reporting, CMS also proposes to increase the number of years of data used to calculate two measures on Nursing Home Compare from one year to two to improve the validity of the results. The agency offers updates on the SNF Value-based Highmark Inc

6 Purchasing Program, including changes in scoring methodology for low-volume SNFs and an extraordinary circumstances exemption policy. These updates are estimated by the agency to result in a reduction of $211 million in aggregate VBP payments. For FY 2019, it appears aggregate hospice payments and the statutory annual cap would both increase by 1.8% ($340 million) from FY 2018 levels, which is based on a hospital market-basket update of 2.9%, minus the statutorily mandated cuts of 0.8 percentage points for productivity and an additional 0.3 percentage point cut. In addition, the rule implements the BiBA requirement that recognizes physician assistants as attending physicians for hospice beneficiaries. CMS is accepting comments on these proposed rules through June 26. CMS Issues Notice for Payment Adjustment Extensions for Low-Volume and Medicare- Dependent Hospitals The Centers for Medicare & Medicaid Services (CMS) has published a notice of implementation of sections and of the Bipartisan Budget Act of 2018 related to extension of the payment adjustment for low-volume hospitals and the Medicare-Dependent Hospital program. In line with guidance issued during the beginning of March, the notice posted last week requires hospitals to notify their Medicare Administrative Contactor by May 29 that it continues to meet the distance and mileage criteria to remain eligible for the low-volume hospitals adjustment for fiscal year CMS Accepting Applications for Meaningful Use Hardship Exceptions The Centers for Medicare & Medicaid Services (CMS) is accepting applications for eligible hospitals and critical access hospitals to avoid a payment adjustment during fiscal 2019 that can demonstrate meaningful use would result in significant hardship. The deadline for hospitals to apply for the Eligible Hospital Hardship for the 2019 payment adjustment, based on the 2017 reporting period, is July 1, 2018 The deadline for critical access hospitals to apply for the Critical Access Hospital Hardship for the 2017 payment adjustment, based on the 2017 reporting period, is November 30, 2018 CMS Unveils New Strategy to Fuel Data-driven Patient Care, Transparency The Centers for Medicare & Medicaid Services (CMS) announced a new Data Driven Patient Care Strategy as part of the MyHealthEData initiative. The strategy positions CMS to further support industry innovation in unleashing the power of data to inform patients healthcare decisions and transform the healthcare system by enhancing security and privacy, improving quality, increasing efficiency, and reducing costs. In March 2018, the Trump Administration announced MyHealthEData, a government-wide initiative spearheaded by the White House Office of American Innovation, designed to help patients access and share their medical data throughout their healthcare journey while ensuring they are empowered to make decisions about when to share it, keeping their information secure and private. As the latest effort under MyHealthEData, the Data Driven Patient Care Strategy is based on three critical cornerstones: putting patients first, making more data available and taking an application programming interface (API)-approach to exchanging data in a secure and private manner with CMS partners in the spirit of improving healthcare for all beneficiaries. Highmark Inc

7 Additionally, as part of CMS commitment to data-driven innovation, the agency announced that Medicare Advantage encounter data is now available to researchers for the first time, and annual updates are planned. Release of the Medicare Advantage encounter data will provide researchers insight into care delivered under Medicare Advantage and permit research that will improve the Medicare program. CMS is expanding data available to researchers starting with 2015 Medicare Advantage (MA) encounter data, which provides detailed information about services to beneficiaries enrolled in a Medicare Advantage managed care plan in calendar year Researchers already have access to Medicare claims data for the fee-for-service program, and this release of MA data will provide a fuller picture of care provided to Medicare beneficiaries. CMS also plans to release data from Medicaid and the Children s Health Insurance Program (CHIP) next year, realizing such data has the potential to facilitate research that will help drive innovation and competition in the healthcare system and, ultimately, help doctors and patients make the best decisions about care. For more information or to request encounter data, please visit the CMS Research Data Assistance Center website at These CMS data-related announcements follow and build on several ongoing initiatives the Trump Administration launched earlier this year to put patients health information into their own hands and make healthcare data more useful to consumers: Blue Button 2.0: As part of MyHealthEData, CMS in March 2018 launched Blue Button 2.0, which allows Medicare beneficiaries to take charge of their own claims data by providing it to them in a universal, secure digital format. Blue Button 2.0 is a developer-friendly, standards-based API enabling beneficiaries to connect their claims data to the applications, services and research programs they choose. Promoting Interoperability: CMS, in the proposed hospital payment rule issued this week, announced plans to overhaul the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, which are now known as the Promoting Interoperability programs. CMS has proposed to focus the program requirements on EHR interoperability and providing patients with electronic access to their health information, so data follows the patient and consumers can take ownership of and access their records in a useable format. A fact sheet on the CMS Data Driven Patient Care Strategy is available at: State Issues Delaware Legislative Legislation Introduced Mandating Coverage for Treatment of Pediatric Autoimmune Neuropsychiatric Disorders House Bill 386 was introduced mandating coverage for treatment of Pediatric Autoimmune Neuropsychiatric Disorders (PANS) associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. It has been assigned to the House Economic Development/Banking/Insurance/Commerce Committee. Review of this legislation determined that Highmark Inc

8 the majority of treatments are already covered and would therefore have minimal financial impact. To view this legislation go to: Pennsylvania Legislative House Public Hearing Held on Bill Banning Insurance Benefit Changes Mid-Year On Monday, April 30, the House Consumer Affairs Committee convened a public hearing on House Bill 2113, legislation that would prohibit insurers from making changes to health insurance benefits, prescription drug coverage or premiums in the middle of a policy year. The bill, which would not apply to a benefit removed from coverage because it has been deemed unsafe by the Food and Drug Administration (FDA) or when production of a prescription drug has been discontinued, is sponsored by House Republican Caucus Secretary Donna Oberlander (R-Clarion). Highmark Vice President for State Government Affairs, Michael Yantis, presented testimony opposing various provisions in House Bill 2113, including its broad application to health insurance coverage. He participated as a member of the health insurance panel, comprised of representatives from Capital Blue Cross, Independence Blue Cross and the Insurance Federation of Pennsylvania. House Bill 2113 is modeled after principle number 5 of the American Medical Association, Prior Authorization and Utilization Management Reform Principles, which addresses changes made to a medical or drug formulary. Governor Vetoes Workers Compensation Formulary Measure, Creates Alternative Governor Tom Wolf has vetoed Senate Bill 936, legislation that would have amended the Workers Compensation Act to mandate a prescription drug formulary for drugs prescribed for the treatment of work-related injuries. Rather than sign the measure, on April 26 Wolf took executive action to create his own plan to tackle the opioid addiction problem in the Workers Compensation insurance arena. The plan includes the institution of opioid prescribing guidelines, stiffer utilization review procedures, and training of workers compensation judges and providers. Senate Banking and Insurance Committee Chairman Don White (R-Indiana) is the sponsor of Senate Bill 936. Regulatory PID Announces New Autism Benefit Coverage Cap The Pennsylvania Insurance Department has announced the new maximum benefit adjustment for autism spectrum disorders coverage. Section of The Insurance Company Law of 1921 (40 P.S. 764h) requires the Insurance Commissioner to publish on or before April 1 of each calendar year in the Pennsylvania Bulletin an adjustment to the maximum benefit equal to the change in the United States Department of Labor Consumer Price Index for All Urban Consumers (CPI-U) in the preceding year, and the published adjusted maximum benefit is applicable to the following calendar years for health insurance policies issued or renewed in those calendar years. The CPI-U change for the year preceding December 30, 2017 was an increase of 2.1%. Accordingly, the maximum benefit, previously adjusted to $39,668 per year, is adjusted to $40,501 for policies issued or renewed in calendar year Insurance Commissioner Issues Warning About the Proposed Short-Term, Limited-Duration Rule On April 26 th Insurance Commissioner Jessica Altman submitted comments on the federal government s proposed rule on the expansion of short-term, limited-duration health plans, warning that the proposed changes could increase potential for consumer harm and market Highmark Inc

9 destabilization. Consumers will be harmed as they face confusing products and less transparency, and insurers may need to raise rates to continue to offer individual coverage, Altman said. Instead of providing more options at lower cost, this rule would actually increase premiums for consumers who rely on Affordable Care Act coverage to meet their health care needs. Short-term limited-duration insurance offers an alternative to Affordable Care Coverage (ACA) and provides temporary health coverage to individuals who have an unexpected gap in coverage or need health care for a brief period. The plans are initially attractive because they generally have lower premiums but offer nothing close to comprehensive coverage. The Obama Administration, in order to discourage use of short-term plans as an alternative to the comprehensive coverage, had limited the plans to three (3) months and prohibited renewal. The proposed rule, which was issued pursuant to an Executive Order last year and released by the U.S. Departments of Health and Human Services, Labor, and the Treasury on Feb. 20, would allow for short-term plans to be renewable and cover consumers up to 12 months. The rule would not prohibit health insurers from discriminating based on a consumer s medical history and pre-existing conditions because shortterm plans are not subject to ACA consumer protections. Commissioner Altman expressed concern that individuals would unknowingly be left with less than comprehensive care and that the changes under the proposed rule could lure a significant number of healthier individuals away from the ACA market, which would skew the risk in the individual market risk pool and, therefore, destabilize the market. Industry Trends Provider / Delivery System Trends AHA, AARP CEOs Highlight Exorbitantly-priced Drugs in Hill OpEd AHA President and CEO Rick Pollack and AARP CEO Jo Ann Jenkins last week authored an OpEd in The Hill discussing the skyrocketing costs of prescription drugs and what they mean for patients and our health care system. Ultimately, the current system of exorbitantly-priced drugs is unsustainable for everyone patients, employers, insurers, and taxpayer-funded programs like Medicare and Medicaid, they wrote. We stand ready to work together to find commonsense and innovative solutions that will help make drugs affordable for everyone. The OpEd can be found here. ProMedica to Acquire HCR ManorCare ProMedica last week announced it has entered into a joint venture agreement with Welltower Inc. to acquire HCR ManorCare, the nation's second largest provider of post-acute and long-term care services. The Toledo, OH-based not-for-profit health system currently operates in six states. HCR ManorCare, also based in Toledo, operates 450 assisted-living facilities, skilled nursing facilities and rehabilitation centers, memory care communities, outpatient rehabilitation clinics, and hospice and home health agencies operating under the names of Heartland, ManorCare Health Services and Arden Courts. "We want to take down the wall between traditional hospital and post-acute care services in an effort to enhance the health and well-being of our aging population," said Randy Oostra, ProMedica president and CEO. "The lines are blurring between where health care begins and stops. This acquisition provides us the platform to think differently about health and aging." Insurance / Market Trends Humana Launches Hospital Quality Incentive Program Highmark Inc

10 Humana Inc. has launched a national program that will compensate hospitals for improving patient experience, safety and outcomes based on certain quality measures from The Joint Commission s Integrated Care Certification and hospital-based Palliative Care Coordination Certification programs, the insurer announced. The Hospital Incentive Program, which will be open to general acute care hospitals, seeks to better integrate care and reduce duplicative services, hospital readmissions, and complication rates in acute care inpatient admissions, according to the insurer. We re excited to launch our value-based care initiative for hospitals, utilizing several quality standards that include certifications developed by The Joint Commission, said Caraline Coats, vice president of Humana s Provider Development Center of Excellence. This program expands Humana s reach in value-based care as we broaden our efforts to provide a better experience for our members and help them achieve their best health. Humana, Others to Buy Hospice Operator Curo Health for $1.4 Billion Humana and two private equity firms announced a definitive agreement to acquire Curo Health Services, a hospice operator that provides care to patients at 245 locations in 22 states. The group is purchasing Curo for about $1.4 billion, in which Humana will have a 40% interest. The group previously announced a pending transaction to acquire the Kindred at Home Division of Kindred Healthcare, the nation s largest home health provider and second largest hospice operator. Upon the closing of these transactions, the group intends to merge Curo with the hospice business of Kindred at Home to create the country s largest hospice operator, according to the news release. The Wall Street Journal reported last month that Walmart is in preliminary talks to buy Humana. State The Pennsylvania House of Representative is in session the week of April 30. The Delaware General Assembly is in session May 1-3. The West Virginia Legislature has adjourned for the year. Congress The U.S. Congress is in recess the week of April 30. Highmark Inc