National, Federal and State Policy Updates: September 2022
Federal Policy Updates
CMS Releases 2021 MSSP Performance Data
- On August 30, CMS released financial and quality data for the Medicare Shared Savings Program (MSSP) including metrics on accountable care organizations’ (ACOs) expenditures, spending benchmarks, shared savings and losses, and aggregated beneficiary and provider information. Relative to spending targets, the program saved Medicare $1.66 billion in 2021, the 5th year of the program. ACO groups in the MSSP who provide coordinated care and limit unnecessary healthcare utilization comprised 525,000 clinicians serving over 11 million beneficiaries as of January 2022. The most recent data showed that smaller, low revenue ACOs, which are typically physician-led and serve rural areas, generated $237 of savings per beneficiary. CMS proposed to increase advance payments to ACOs in rural and underserved communities in the recent 2023 physician fee schedule which could be used to tackle social determinants of health.
CMS Proposes Medicaid and CHIP Enrollment Rule
- On August 31, CMS released a notice of proposed rulemaking on Medicaid and CHIP enrollment applications and verification processes. The rule would limit renewals to once every 12 months, allow beneficiaries 1 month to respond to requests for eligibility information, and require forms to be prepopulated with beneficiaries’ information. This rule would help standardize Medicaid and CHIP enrollment for those who are low-income, blind, disabled, and 65 or older people and have difficulties enrolling and staying enrolled due to burdensome state verification policies. The rule would also make changes to documentation requirements, streamline income verification processes, and create additional eligibility groups to help prevent churn. This rule is part of a larger effort by the Biden Administration to strengthen Medicaid and access to affordable, high quality health coverage in the ACA market through executive orders and rulemaking.
State Policy Updates
TN Closes Public Commentary on TennCare Waiver
- On August 30, TN submitted a Medicaid 1115 waiver amendment for the implementation of TennCare III including amendments required by CMS related to aggregate cap funding and a closed formulary benefit design. Commenters expressed concern that a capped funding system would lead to reductions in benefits over time opposed to a per-member per-month system but also high drug prices and coverage for those with disabilities. The waiver also proposes additional federal expenditures for designated state programs across mental health, public health, community, and child health services for individuals who churn in and out of Medicaid. The TennCare program also governs statewide managed care delivery, certain employment services, retroactive eligibility, and supplemental payments to safety net providers and hospitals.
SC Department of Corrections to Use Digital SUD Prescription in Treatment
- On September 1, the SC Department of Corrections and Pear Therapeutics, Inc. jointly announced that they would use their digital prescription apps in the treatment of women inmates recovering from opioid and other substance use disorders (SUD). reset and reset-O are prescription digital therapeutics that have been approved by the FDA for treatment of SUD to support rehabilitation and abstinence in out-patient treatment programs in combination with primary care and medication management. This program was supported by a $159,000 grant from SAMHSA, a federal organization that provides grants for substance use and mental health interventions to support a group at much higher risk of relapse and overdose than the general population.
MA Orders Report on Mental Health Legislation
- On September 6, the MA legislature ordered a study on mental health substance use, and recovery to investigate opioid labeling, maternal mental health, intensive stabilization and treatment units, sexual and gender disparities in mental health, and expansion of mental health services in addition to multiple other research requests for information by state lawmakers. The report will be used to inform legislative priorities for the next legislative year and determine the need for legislation to create a certified community behavioral health clinic model and fund related workforce grants.
AMA Releases Report on Opioid Overdoses
- On September 16, the American Medical Association released a report on drug-related overdose deaths, which exceeded 107,000 in 2021. Although the total number of opioid prescriptions has continually decreasing, overdoses have continued to increase. There are still considerable barriers to patients receiving evidence-based mental health treatments and access to harm reduction services including access to naloxone, syringe exchange programs, and fentanyl test strips to decrease overall mortality from opioid use. Over the last 10 years, states have increased the use of prescription drug monitoring programs while doctors have increased prescribing of buprenorphine and naloxone. Enforcement of mental health and substance use disorder treatment parity laws, CDC recommended changes to opioid prescribing limits, and combating stigma for those with pain or addiction, especially within marginalized communities, were highlighted in the report as areas for improvement.
CVS to Acquire Signify Health
- On September 5, CVS announced that it reached an agreement to acquire Signify Health for a total value of $8 billion. Signify provides health risk assessments and value-based care services to a network of more than 10,000 clinicians nationwide. The deal will help Signify’s providers connect with patients, conduct home and virtual visits, and get access to community-based services. Signify focuses on population health by partnering with Accountable Care Organizations (ACOs) to generate savings for Medicare through preventive care and value-based reimbursement. The deal is expected to be completed later this year for $30.50 per share.
FTC Requests Additional Data on Amazon-One Medical Deal
- On September 2, the US Federal Trade Commission asked Amazon to provide more information on its proposed acquisition of One Medical as part of an anti-trust review. Amazon has a limited healthcare presence outside of mail delivery pharmacy services and agreed to shut down its existing virtual primary care service as part of the deal but has faced additional requests for oversight from both Democrat and Republican lawmakers based on anti-trust and data privacy concerns. The request is a normal step in the acquisition process and will take months to complete based on the size and notoriety of the transaction.