July 30, 2024

Biden Administration Will Accelerate 2026 MA and Part D Rule Before Leaving Office

Interesting article in Modern Healthcare on plans of the Biden administration to accelerate the Medicare Advantage (MA) and Part D rule for 2026. The draft will be published in September, with the final rule sometime before President Biden leaves office. This could mean huge new policy changes for MA and Part D. Trump did something similar.

On one hand, Biden may want to leave office proposing some major reforms. On the other hand, the striking of the Chevron deference precedent could complicate enacting major changes.

The possible list of changes I see — they can’t do all of them, could they?:

  • MA rate savings
  • Further risk adjustment reform
  • Overpayment reform
  • Changes on drug pricing
  • More prior authorization changes
  • Fixing the federal court stay of agent-broker compensation
  • More changes on supplemental benefits
  • More health equity reforms
  • More Special Needs Plan (SNP) changes and Medicare-Medicaid integration
  • Star changes, including guardrail reforms, quality improvement hold harmless changes, and fixing TukeyGate

Separately, will he do more on antitrust and horizontal and vertical integration?

(Article may require a subscription.)

#election2024 #biden #healthcare #regulations #medicareadvantage #partd

https://www.modernhealthcare.com/policy/health-rules-2024-medicare-pay-prior-authorization

Bipartisan Momentum For Site-Neutral Policies

The Health and Human Services secretaries of both the Obama and Trump administrations urged passage of Medicare site-neutral payment reforms and said the savings could pay for other healthcare priorities. As you know, I am a huge fan of this reform and it is part of my healthcare reform proposal and one of its main tenets, price reform. It would also extend Medicare’s life. Hospitals appear to be the only major opposition group.

My blog on the topic here: https://www.healthcarelabyrinth.com/it-is-time-for-site-neutral-payments-in-our-healthcare-system/ .  My podcast on the topic here: https://www.healthcarelabyrinth.com/33-the-need-for-comprehensive-site-neutral-payment-policies/ .

(Article may require a subscription.)

#siteneutral #medicare #hospitals #providers

https://insidehealthpolicy.com/daily-news/obama-trump-hhs-chiefs-parties-can-tap-site-neutral-reform-pay-big-policy-priorities

Survey Shows Healthcare System Complex And Leaves Seniors Uninformed

A new survey of seniors shows they have a hard time understanding the complex healthcare system and feel confused and uninformed. About 49% did not know the difference between Medicare and Medicare Advantage. About 63% said they are overwhelmed making health decisions and 47% said they do not know Medicare Advantage’s supplemental benefits.

Some solutions include health care equity and diverse training and education. The good news: 75% of adults aged older than 65 are on the internet and 61% own smartphones.

In related news, just 55% of U.S. adults were readily able to afford and access healthcare in late 2023, according to a survey by Gallup and healthcare policy organization West Health. This is the lowest since the tracking started in 2021.

Additional article: https://www.healthcaredive.com/news/fewer-than-half-adults-under-50-readily-afford-healthcare/722738/

#medicare #medicareadvantage #aging #healthcare

https://www.fiercehealthcare.com/payers/nearly-half-beneficiaries-dont-know-difference-between-medicare-and-medicare-advantage

Employees Sue Wells Fargo For Abandoning Fiduciary Responsibility Under ERISA

This is at least the second lawsuit I am aware of where employees are suing their employer for abandoning fiduciary responsibility under the self-insured health plan (ERISA) law. Wells Fargo employees argue its employer had inadequate oversight of its self-insured plan, causing workers to pay far more for medications than they would have if they had paid cash. Employer groups generally hand over the keys to the kingdom to health plans and pharmacy benefits managers and know little about real costs to them and their employees. 

(Article may require a subscription.)

#erisa #employercoverage #healthcare #healthplans #pbms

https://www.modernhealthcare.com/legal/wells-fargo-employee-health-plan-drug-costs-lawsuit-cigna-express-scripts

NC To Receive Medicaid Funding To Eliminate Medical Debt

North Carolina has gained approval for a novel Medicaid plan to receive higher federal reimbursement to help cancel medical debt for the state’s population. Hospitals will receive higher rates in Medicaid if they extinguish patients’ medical debt going back to early 2014 for current Medicaid enrollees and on non-enrollees below certain incomes or whose debt exceeds 5% of their annual income. Hospitals also would have to help low- and middle-income patients by providing deep discounts on medical bills. It will help two million low- and middle-income people and get rid of $4 billion in debt.

#medicaldebt #medicaid #healthcare

https://www.medpagetoday.com/publichealthpolicy/medicaid/111296

Drug Prices To Increase Almost 4% Next Year

Vizient, a group purchasing organization, says drug prices are expected to increase 3.81% next year, pushed higher in great measure by cell and gene therapies and weight-loss drugs GLP-1s.

(Article may require a subscription.)

#drugpricing #healthcare #weightlossdrugs

https://www.modernhealthcare.com/supply-chain/drug-costs-2025-vizient

MultiPlan Lobbies Congress On The Positives Of Its Firm

MultiPlan CEO Travis Dalton met with Senate staff over the past weeks. MultiPlan says that it educated Senate staff on the positive contributions it makes when it partners with health plans on out-of-network payments. The New York Times alleges it pays providers little and works with health plans to gain huge fees from employers.

#healthplans #multiplan #providers

https://www.beckershospitalreview.com/finance/multiplan-pushes-back-on-insurer-collusion-allegations.html

KFF Analyzes How Dual Eligibles Receive Their Medicare and Medicaid Benefits

The Kaiser Family Foundation (KFF) analyzes how dual eligibles receive their healthcare from the Medicare and Medicaid programs in a new briefer/analysis. The majority is less integrated than not. Check out my blogs on dual eligibles (covering this KFF briefer) on Wednesday and Special Needs Plans (on Thursday) at the Blog tab.

#kff #dualeligibles #specialneedsplans #snps #medicare #medicaid

https://www.kff.org/medicare/issue-brief/the-landscape-of-medicare-and-medicaid-coverage-arrangements-for-dual-eligible-individuals-across-states/

— Marc S. Ryan

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