Healthcare Policy Update: June 17, 2022
National Policy Update
Spotlight on Maternal Health
- On May 31, the American Hospital Association hosted a dialogue on the use of investment funds to support digital solutions in women and children’s health. Maria Velissaris discussed her efforts in venture capitalism focused on improving health outcomes for minority women through SteelSky Ventures. The women-centered health equity fund has raised about $82 million and prioritizes underrepresented business owners. Next, Lara Khouri gave an overview of the LA Children’s Hospital’s KidsX Accelerator which supports innovation in digital therapeutics addressing issues including postpartum depression, autism, childhood development, and remote patient monitoring.
- On May 6, CMS approved 3 states’ requests to extend Medicaid postpartum coverage to 12 months, bringing the total to 11 (CA, FL, IL, KY, LA, MI, NJ, OR, TN, SC, VA). This option was codified as a state plan amendment option through the American Rescue Plan Act, as current policy only requires Medicaid coverage of new mothers for 60 days after birth. CMS estimates that as many as 720,000 pregnant and postpartum women across all states will be affected. In emphasizing the importance of this policy option to combat maternal health inequities, help treat chronic conditions, and allow new mothers to access mental health treatment, officials cited the statistic that Medicaid covers 42% of all births in the US.
Federal Policy Updates
CMS Releases Behavioral Health Strategy Outline
- On May 31, CMS outlined their goals and recent activities to address substance use disorders (SUD) through mental health services, crisis intervention, and coordinated care. CMS has taken steps to strengthen equity and quality in behavioral health through the use of quality measures in acute and chronic pain management, depression, suicide risk, and alcohol use, and released reports on access to medication for opioid use disorder among Medicare FFS beneficiaries and through telehealth. CMS has improved access to SUD prevention and treatment services through a CMS Action Plan, Medicaid 1115 waivers that allow states to test new approaches to care management, bundled payments for opioid use disorder in Part B, and innovation models such as the Value in Treatment Model. Activities to improve access to mental health services have included mobile-community-based crisis intervention services in Medicaid, integration of behavioral health into certified community health clinics, and coverage of services such as depression and alcohol screenings in Medicare. CMS will continue to evaluate data to support evidence generation and identify disparities between beneficiaries.
HHS to Adjust Medicare Part B Premium in 2023
- On May 27, HHS Secretary Xavier Becerra announced that CMS will adjust next year’s Medicare premiums to reflect the new cost of the new Alzheimer’s drug Aduhelm. Its high initial list price led to a significant 14.5% increase in the 2022 rate announcement ($170 per month). After the drug’s manufacturer Biogen cut the price of the drug in half to roughly $27,000 for a yearly treatment regimen and a national coverage determination limited use of the drug to clinical trials, HHS asked CMS to conduct both an actuarial and operational analysis on the effect of a premium redetermination. After showing that a mid-year premium change would be complex and risky, CMS recommended that the savings from 2022 be incorporated into next year’s rates. Next year’s premium will be announced in November.
Senators Releases PBM Transparency Draft Bill
- On May 25, Senators Maria Cantwell (D-WA) and Chuck Grassley (R-IA) introduced a bill that would regulate pharmacy benefit managers’ (PBM) business practices, increase transparency, and grant the Federal Trade Commission (FTC) additional oversight. Specifically, the legislation would prohibit PBMs from charging a payer more for a prescription drug than they reimburse a pharmacy (known as spread pricing) and ban clawback payments from pharmacies. The bill would also require PBMs to provide full disclosure of their costs, reimbursements, and fees to both plans and pharmacies, and an annual report to the FTC on certain business metrics. The bill would also authorize the FTC to levy civil penalties from PBMs for noncompliance and protect whistleblowers.
State Policy Updates
NH House Passes Drug Affordability Review Board Bill
- On June 6, the NH House passed a bill further clarifying the membership and funding of the state’s prescription drug affordability review board. The bill would establish a fund for administrative costs and codify enforcement of the board’s fees on payers, manufacturers, and wholesale drug distributors. The bill has already passed the Senate must now be reconciled with the House version before being sent to the governor. The board was established in 2020 to collect data on drug cost and utilization from public payers, and manufacturer drug price increases, and is funded through assessment fees. Eight states, CO, ME, MA, NH, NY, OH, and OR, have established affordability review boards or utilization review boards to date.
GA Passes Behavioral Health Analyst Licensing Bill
- On May 2, GA enacted a bill to regulate the licensing of applied behavioral analysts and behavioral technicians and create a board that manages the administration and enforcement of the law. Behavioral analysis is a relatively new profession wherein practitioners design and implement interventions to produce improvements in a person’s behavior. They can help treat mental health disorders, such as autism, developmental disabilities, and substance use disorders and may be reimbursed by public and private payers depending on state regulations. The bill will become effective on July 1.
Value-Based Care Updates
- On May 27, AlayaCare and Home Health Care News published a survey of home health providers’ views on value-based contracting. They found that out of 224 home care professionals, 42% expected value-based contracting to account for more than half of revenue in the near future and be likely to have a large impact on clinical and financial outcomes including patient satisfaction and increased revenue. Respondents noted the importance of value-based care in sharing documents between different sites of care, tracking readmission rates, and measuring client satisfaction. A majority of home health providers also predicted that mergers and acquisitions would increase due to the effects of value-based care and cited key challenges of data integrity and education of clinical staff on best practices.