House Passes Stop Gap; On To Senate To Avoid Shutdown
The House passed a continuing resolution (CR) to fund the government late Friday. This should avert a midnight shutdown. The CR funded government through March 14, 2025. Far-reaching healthcare provisions once going to pass as part of a free-standing bill or within the CR became a closely tailored list of must-haves for healthcare.
The funding bill extends Medicare telehealth flexibilities and CMS’ acute hospital at home program for 90 days, through March 31, 2025. The CR postpones scheduled cuts to Medicaid disproportionate share payments for safety-net hospitals and extends special Medicare reimbursements for low-volume hospitals and Medicare-dependent hospitals until April 1. It sustains funding for community health centers and pandemic preparedness programs until March 31. No relief for Medicare physicians, who now will see a 2.8% rate reduction as of January 1. ACOs did not see an extension of critical funding. Pharmacy benefit manager (PBM) reforms and steps toward site-neutral payments were axed.
Democrats reversed course and supported the bill after refusing to support a similar bill yesterday. One big change: no debt ceiling extension, which Democrats opposed as they wanted a GOP Congress to own the issue in 2025. Hardline Republicans came around too as they did not want the debt ceiling extension in the bill either, which they believe would erode their leverage to obtain spending guts in the future. Instead, Republicans entered into a gentlemen’s agreement with leadership where the borrowing limit will be increased by $1.5 trillion in exchange for $2.5 trillion in net cuts to spending. This will be done through a reconciliation package in the next Congress.
The Senate will undoubtedly adopt the bill later tonight or tomorrow.
12/21 Update: The Senate passed the bill early Saturday morning.
Additional articles: https://www.modernhealthcare.com/politics-policy/spending-bill-house-healthcare-package and https://insidehealthpolicy.com/inside-drug-pricing-daily-news/house-passes-cr-without-key-health-care-reforms-setting-stage-march and https://thehill.com/homenews/house/5051634-government-funding-shutdown-house-bill/
(Some articles may require a subscription.)
#crs #governmentshutdown #congress #healthcare
Biden Announces Rebate Savings From Drug Inflation Caps
The Centers for Medicare and Medicaid Services (CMS) announced that 64 Part B drugs will have a reduced price for Medicare patients at the pharmacy counter in the first quarter of 2025. CMS said patients may save between $1 and $10,818 per day on co-insurance costs for the Part B drugs included on the list.
As part of the IRA, brand drug makers must give rebates to the federal government for single source drugs and biological products, including certain biosimilar biological products, whose price increased more than the rate of inflation. The list of discounted drugs changes each quarter. It also reduces consumer cost-sharing.
CMS press release: https://www.cms.gov/newsroom/press-releases/hhs-announces-cost-savings-64-prescription-drugs-thanks-medicare-prescription-drug-inflation-rebate
#drugpricing #ira #branddrugmakers
New York MA Plan Settles Whistleblower Suit On Risk Adjustment Scores
A western New York health insurer and its vendor agreed to pay a total of up to $100 million in false claims settlements to settle Justice Department allegations of fraudulent risk adjustment scores for health conditions related to rate setting. Independent Health Association of Buffalo, which operates two Medicare Advantage (MA) plans, will pay up to $98 million. Betsy Gaffney, CEO of medical records review company DxID, will pay $2 million. Neither admitted wrongdoing.
Additional article: https://www.beckerspayer.com/payer/medicare-advantage-insurer-to-pay-up-to-98m-to-settle-false-claims-allegations.html
#fwa #riskadjustment #medicareadvantage #overpayments
https://kffhealthnews.org/news/article/medicare-advantage-fraud-lawsuit-settlement-new-york/
Biden Administration Says Exchange Enrollment Will Reach Highest Ever
The Biden administration reported today that a record 16.6 million consumers signed up for plan year 2025 and will receive up to a full year of coverage beginning January 1. About 2 million are new to the Exchanges. This represents selections in the 31 states that use the federal HealthCare.gov website. Plan selection continues in most State-based Marketplaces. The administration believes the program is on track for a record turnout. We shall see as signups recently lagged 2024.
#aca #exchanges #enrollment #coverage
Peterson-KFF Health System Tracker Releases National Health Spending Explorer
The Peterson-KFF Health System Tracker released a National Health Spending Explorer, which tracks national healthcare expenditures since 1960. It is based on the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary annual National Healthcare Expenditure Data releases.
I will write a blog soon on the recent announcement of 2023 expenditures.
Additional article: https://www.healthsystemtracker.org/health-spending-explorer/
#nhed #cms #healthcare
https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/
Peterson-KFF Health System Tracker Releases Drug Price Comparison
Peterson-KFF Health System Tracker has released a comparison of drug prices in America vs. other developed countries.
In 2021, Medicare spent $121 billion on retail drugs. This is about 32% of the US’s total spending. The first ten drugs subject to negotiation now have prices that are about 22% lower than existing net prices on average.
The reality, though, is that prices will remain far above other nations. While negotiated prices in Medicare are below what other government agencies pay, these prices remain well above other developed country averages. The analysis discusses the possible reasons for continued high prices in America.
I plan a blog on this in the near future.
#drugpricing #ira #branddrugmakers
— Marc S. Ryan
