March 4, 2024

FFY 2024 Spending Package Agreed To By Key Lawmakers

A bipartisan spending bill has been agreed to by key lawmakers and will need to be voted on in each House.  The package basically cuts in half the Medicare doc fix cut of 3.4%, pushes back scheduled disproportionate share hospital (DSH) payment cuts, and increases annual funding for community health centers. Accountable Care Organizations’ (ACOs) bonus program was also protected. Absent from the bill are major healthcare reforms. Docs are not very happy with the partial fix and no total overhaul of their rates.

Additional articles here: https://www.fiercehealthcare.com/providers/congress-reaches-spending-deal-doc-pay-bump-delayed-dsh-cuts-and-more and https://insidehealthpolicy.com/health-insider/lame-duck-battle-looms-health-wins-skinny-bill-expiring-december and https://insidehealthpolicy.com/daily-news/skinny-health-package-scales-back-doc-fix-adds-chc-funding and https://www.medpagetoday.com/practicemanagement/reimbursement/109008 and https://thehill.com/policy/healthcare/4507164-government-funding-bills-leave-out-phamacy-benefit-manager-industry-changes-as-white-house-mulls-reforms/

(Some articles may require a subscription.)

#governmentshutdown #healthcare

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All Drug Makers Submit Counter Offers In Medicare Drug Price Negotiations

The White House announced that all ten companies involved in the initial Medicare drug price negotiations have sent in counter proposals to what the Centers for Medicare and Medicaid Services (CMS) offered.  This means all companies will continue to negotiate with CMS through August 1.  Final prices are due from CMS on September 1.

Brand drug makers are facing an uphill battle in court as many lawsuits challenging the law have either been thrown out or stays have been denied.

Department of Health and Human Services press release here: https://www.hhs.gov/about/news/2024/03/04/biden-harris-administration-receives-counteroffers-from-drug-companies.html

#branddrugmakers #ira #drugpricing

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UnitedHealth Group’s Assistance Program In Wake Of Cyber Attack Called Stingy

Provider groups are calling the assistance program set up by UnitedHealth Group, Optum, and Change Healthcare stingy and one-sided.  In letters, provider groups have called for government intervention and for approval of funding advancements in Medicare.

Additional articles here: https://www.modernhealthcare.com/cybersecurity/change-healthcare-outage-update-aha-unitedhealth and https://insidehealthpolicy.com/daily-news/aha-congress-hhs-unitedhealth-not-snuff-cyberattack-fix

(Some articles may require a subscription.)

#changehealthcare #cyberattacks

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Elevance Health Challenge Wins Challenge And Scores Boosted

Although details are not known, Elevance Health got the Centers for Medicare and Medicaid Services (CMS) to relook at and boost the plan’s Star scores for 2024.  Elevance had filed a lawsuit against CMS after its scores were announced in October. Elevance will see a boost of $190 million.  Four of its contract scores were revised. Elevance says 49% of its Medicare Advantage (MA) members now will be enrolled in plans rated 4 Star or greater, up from 34%.

(Article may require a subscription.)

#elevancehealth #stars

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Kaiser Tracking Poll Shows Importance Of Healthcare Issues

A new Kaiset Family Foundation (KFF) tracking poll shows the importance of healthcare issues.  Almost 75 percent — majorities of both parties — say they are concerned about unexpected medical bills and other health costs. About 80% say they think it’s very important to hear presidential candidates address what they would do to rein in health care costs. About 55% say they are very worried about prescription drug affordability.

I have argued my Republican Party has a compassion gap when it comes to healthcare. The poll proves it.

#kff #healthcare #healthcarereform

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New Study Says Medicare Advantage Enrollees Get Less Home Care

A new study says that Medicare Advantage (MA) enrollees get less home care than those in the traditional fee-for-service (FFS) program. MA members got fewer home health visits from nurses, therapists and other classes of providers and nearly two fewer days of service between admission and discharge.  The study period was from 2019 and 2022. About 285,000 patients were looked at between the programs.

A new prior authorization rule likely addresses some of these concerns (not that I think the rule is fair or justified.)

#medicareadvantage #medicare

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Federal Appeals Panel Could Pull Preventive Benefits From ACA

As I suspected, the federal appeals panel hearing whether preventive services meet legal scrutiny seem to be leaning toward striking down the benefits.  If they do, they would agree with a lower court that struck the Affordable Care Act (ACA) mandate. While plaintiffs are challenging the benefits on religious grounds, the case turns on regulatory oversight and authority.

#aca #obamacare #prevention #preventivebenefits

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— Marc S. Ryan

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