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HRAs Expanded

Employer HRAs (Health Reimbursement Accounts) have been expanded for more uses.
According to the HHS, press release, “starting in January 2020, employers will be able to use what are referred to as individual coverage HRAs to provide their workers with tax-preferred funds to pay for the cost of health insurance coverage that workers purchase in the individual market, subject to certain conditions. These conditions strike the right balance between employer flexibility and guardrails meant to protect the individual market against adverse selection, and include a notice requirement to ensure employees understand the benefit. Individual coverage HRAs are designed to give working Americans and their families greater control over their healthcare by providing an additional way for employers to finance health insurance.
“Many businesses have struggled with the high costs and complex bureaucracy of providing health insurance coverage, leading to less coverage for workers. Over the last decade, a significant number of small businesses have stopped offering any health insurance to their employees. As a result, a smaller percentage of Americans working in small businesses are being covered by employer health benefits, and many are left uninsured. Moreover, 80 percent of employers that provide coverage only offer one type of health plan to their employees, leaving workers and their families with no choices and plans that may not meet their needs.
“The HRA rule makes it easier for small businesses to compete with larger businesses by creating another option for financing worker health insurance coverage…
“The HRA rule also increases workers’ choice of coverage, increases the portability of coverage, and will generally improve worker economic well-being. This rule will also allow workers to shop for plans in the individual market and select coverage that best meets their needs. Because HRAs are tax-preferred, workers who buy an individual market plan with an HRA receive the same tax advantages as workers with traditional employer-sponsored coverage…
“In addition to allowing individual coverage HRAs,… the rule permits employers that offer traditional group health plans to provide an excepted benefit HRA of up to $1,800 per year (indexed to inflation after 2020), even if the employee doesn’t enroll in the traditional group health plan, and to reimburse an employee for certain qualified medical expenses, including premiums for vision, dental, and short-term, limited-duration insurance. This provision will also benefit employees who have been opting out of their employer’s traditional group health plan because the employee share of premiums is too expensive.”

Kentucky’s Idea Leads

“A proposed regulatory change in Kentucky would allow schools to access Medicaid funding, better equipping them to deliver school-based care to students.

“The state governor announced this week that the Cabinet for Health and Family Services (CHFS) and the Kentucky Department of Education (KDE) submitted the amendment to CMS in late April, seeking to expand patient access to care services within their schools.

“’The importance of school-based health services is proven, and I am grateful that our state agencies are partnering to implement this amendment, which will benefit thousands of students across Kentucky,’ said Governor Matt Bevin. ‘This is an example of state government working across cabinets to find solutions to address the growing need for increased access to mental health services, preventive care, and other health services in our schools.’

“Specifically, the amendment would allow schools to access some Medicaid funds. That increased funding would allow the schools to offer certain treatments to students who are already enrolled in Medicaid.

Covered services would include mental health services, health screenings, diabetes care, and asthma management, the state governor’s office said.

“These proposed amendments come as a part of Kentucky’s efforts to address physical, mental, or behavioral health issues with children before issues grow too serious and potentially too costly.

“‘Given Medicaid’s historic role in supporting children’s health and educational outcomes, ensuring that all eligible students are enrolled in Medicaid and have access to the school-based health services they need are key strategies to supporting a healthy learning environment and academic success,’ said Commissioner Wayne Lewis, KDE commissioner.”

-“HealthPayer Intelligence”


Supreme Court Rules

The Supreme Court ruled today that an Obamacare rule change of Medicare reimbursements to hospitals should be removed, because officials did not follow the proper notice and comment regulations in implementing the new formula.
This ruling involves billions of dollars in Medicare payments to Disproportionate Share Hospitals.
The court ruled in favor of the Disproportionate Share Hospitals, that had sued over the enactment of the 2014 Obamacare policy, which reduced their payments, from CMS, for serving low-income and uninsured patients.
This payment reduction to these hospitals was enforced retroactively to October 1, 2013.
“In 2014, the government revealed a new policy on its website that dramatically—and retroactively—reduced payments to hospitals serving low-income patients,” Justice Gorsuch wrote in the Court’s majority opinion.
“Because affected members of the public received no advance warning and no chance to comment first, and because the government has not identified a lawful excuse for neglecting its statutory notice-and-comment obligations, we agree with the court of appeals that the new policy cannot stand.”
Sources: The Hill, Modern Healthcare, CMS MLN Fact Sheet.

CMS Final Cost Rule

The Centers for Medicare and Medicaid (CMS) has issued a final rule on drug price transparency.  It requires all Medicare Advantage and Part D plans to offer a drug price transparency tool that can be integrated into physician Electronic Health Records (EHRs). This rule will come into effect after a time period that allows EHR developers and healthcare providers to obtain the technology.

“For those who are Medicare-eligible  with drug coverage through a stand-alone Part D drug plan or a Medicare Advantage Prescription Drug plan, the rule requires these plans to include price transparency and low-cost drug alternative lists in their monthly explanation of benefits (EOB) letters to beneficiaries that they already receive…

“Today’s rule requires Part D plans to adopt tools that provide clinicians with information that they can discuss with patients on out-of-pocket costs for prescription drugs at the time a prescription is written,” CMS Director, Seema Verma, said. “By empowering patients with information on the cost of their prescription drugs, today’s rule will ensure that pharmaceutical companies have to compete on the basis of price. This effort builds on new requirements for hospitals to disclose chargemaster prices and other agency initiatives to promote price transparency.”

There is also a mandate included in the provisions to empower clinicians by letting them negotiate prices for physician-administered medications, thereby lowering the cost to patients. Most of these medications are biologics, which CMS acknowledged are exceptionally expensive.

As more biosimilars come to market for these drugs, physicians must be empowered to negotiate lower-cost options on behalf of their patients, CMS suggested.

“Additionally, the final rule outlaws pharmacy “gag clauses,” which are payer-imposed rules that prohibit pharmacists from informing patients about lower-cost medication options.

Reference: Sara Heath, “PatientEngagementHIT”


Tennessee Goes First

Tennessee is the first state in the nation to ask the government for a Block Grant  of Medicaid funding, where the fed will give a set dollar amount of to the state for Medicaid programs, including TennCare.  TennCare is Tennessee’s Medicaid health insurance program that is jointly funded by federal and state tax dollars.

In exchange for a set dollar amount of federal funding, Tennessee will gain more flexibility and management authority to better customize this health insurance program, to fit Tennessee residents, and potentially increase the program’s efficiency.

As Tennessee’s economy continues to improve, the federal share of funding is reduced and this will leave a $41 Million “hole” in the TennCare budget for fiscal year 2020.

Nationwide, the cost of Medicaid increased 4.9% in the last fiscal year.  While Tennessee’s Medicaid costs have increased less than the national average-  the state’s TennCare cost is still projected to increase 2.1%.  This will cause the people of Tennessee to need to find an additional $66 Million in their budget to shore up the loss of federal funds, increased healthcare costs, and increased enrollments. 

The current TennCare budget is $12 Billion dollars.  And, like many states, it is the state’s most expensive state agency.  Federal funds account for 65 cents of every TennCare dollar spent, and that amount is based on the average household income throughout the state.

“This legislation does not seek to reduce funding or limit current eligibility services to anyone,” said state senator Paul Bailey who co-sponsored the bill.

“We need the flexibility to determine what is best for our citizens instead of continuing down the path of a one-size-fits-all program from Washington DC.”

Source: Brett Kelman, The Tennessean; Rachana Pradhan, Politico.


AHA: Stop Centene WellCare

“The American Hospital Association urged the Trump administration on Wednesday to halt Centene’s $17.3 billion acquisition of WellCare Health Plans, claiming it will reduce competition in Medicaid managed-care and Medicare Advantage services.

“Centene and WellCare are both major players in government-sponsored health plans, with both having a presence in Medicaid and on the Affordable Care Act’s exchanges. All told the two insurers would cover nearly 22 million people in Medicare, Medicaid and the exchanges.

“The insurers’ markets overlap in several states, the AHA said in its letter, and they control over half of the Medicaid market in Florida, Georgia and Illinois.”
Source: Modern Healthcare.

Workplace Injuries Cost

“Workplace injuries cost US companies more than $1 billion per week, according to new data from Liberty Mutual.

“According to Liberty Mutual, the 10 costliest causes of workplace injury and illness are:

  1. Overexertion involving outside sources ($13.11 billion)
  2. Falls on same level ($10.38 billion)
  3. Struck by object or equipment ($5.22 billion)
  4. Falls to lower level ($98 billion)
  5. Other exertions or bodily reactions ($3.69 billion)
  6. Roadway incidents involving a motorized vehicle ($2.7 billion)
  7. Slip or trip without falling ($2.18 billion)
  8. Caught in or compressed by equipment or objects ($1.93 billion)
  9. Repetitive motions involving microtasks ($1.59 billion)
  10. Struck against object or equipment ($1.15 billion)

Source: Ryan Smith, “Insurance Business America”

Centene Buying WellCare

“Centene Corp. has said it will buy fellow Medicaid insurer WellCare Health Plans in an estimated $17.3 billion deal.

“All in all, the two insurers would cover nearly 22 million people in Medicare, Medicaid and the ACA exchanges. Centene CEO Michael Neidorff will serve as chairman and CEO of the merged company.

“‘With the addition of WellCare, we expect to bolster and diversify our product offerings, increase our scale and have access to new markets, which will in turn, enable us to continue investing in technology and better serve members with innovative programs designed to meet their needs,’ Neidorff said in a statement.

“…It would include more than 12 million Medicaid beneficiaries and almost 1 million Medicare members, along with a Medicare prescription drug plan WellCare is acquiring from Aetna…

“Centene saw its ACA exchange membership swell to almost 2 million during the latest open enrollment, giving it about a 20% market share across the country. WellCare’s recent growth focused on Medicaid, where it has million members, thanks in large part to its $2.5 billion acquisition of Meridian Health Plan that closed in September.”
Source: ModernHealthcare.

Acting FDA Commissioner

It has been announced that Ned Sharpless, the director of the National Cancer Institute, will be named the acting commissioner of the Food and Drug Administration next month.

“Health secretary Alex Azar confirmed the announcement at a hearing before the House Energy and Commerce health subcommittee.

“Sharpless, a physician-scientist, ran the Lineberger Comprehensive Cancer Center at the University of North Carolina before taking over the NCI in October 2017.

“’Dr. Sharpless’ deep scientific background and expertise will make him a strong leader for FDA,’ Azar said in a statement. ‘There will be no let-up in the agency’s focus, from ongoing efforts on drug approvals and combating the opioid crisis to modernizing food safety and addressing the rapid rise in youth use of e-cigarettes.’”

“Sharpless was an enthusiastic supporter of Gottlieb’s aggressive push to increase tobacco and e-cigarette regulations.

It is uncertain “if Sharpless will lead the FDA in a long-term capacity, he was seen as a likely pick to replace Gottlieb. Sharpless is already well acquainted with the agency, Gottlieb said in a staff memo the FDA provided to STAT.

“One of the things that made me appealing to the White House was that in addition to working in research and as a cancer center director, I’d had some work in the commercialization of ideas, from a basic science lab into a Phase 2 trial asset,” Sharpless told STAT in a 2018 interview, shortly after taking over NCI.”

Source: Sharon Begley, “STAT”




FDA’s Gottleib Resigns

“Scott Gottlieb, MD, announced his resignation as chief of the FDA on March 5. He plans to leave his post sometime next month.

“Dr. Gottlieb has served in his post since May 2017, and has been a staunch advocate for developing new drugs and regulation. His resignation may especially affect biotech and pharmaceutical companies, as well as tech companies looking to move into the healthcare space.

“Before appointing Dr. Gottlieb, President Donald Trump considered a variety of candidates for the position, including individuals who sought to dismantle FDA drug oversight and review process — a move that worried many pharma executives and health sector investors, STAT News reports.

“‘I think Scott was pretty much a best-case scenario for the sector that one could see under a Trump administration, so any replacement is probably going to be worse. Hopefully not much, much worse,’ a Baird biotech analyst told STAT.

“During his time at the FDA, the physician and former venture capitalist also gained a reputation as a supporter of healthcare innovation, establishing programs like Pre-Cert, software that allowed tech giants like Apple to get approval for low-risk health products faster, CNBC reports.

“‘Scott did a lot culturally to make the agency easier to work with,’ Bob Kocher, a partner at venture capital firm Venrock, told CNBC. ‘I think he’ll be missed by many in the tech industry, including the startups.'”  Source: “Becker’s Hospital Review”