AHA Wants Congress To Pressure CMS To Reverse Updates For Inpatient Payment Rule

CMS issues first price transparency fines to 2 Georgia hospitalsSource: Fierce Healthcare, by Robert King

The American Hospital Association (AHA) is turning to lawmakers to pressure the Biden administration to change “woefully inadequate” payment rates proposed for next year.

 

The AHA sent a letter Friday to congressional leaders surrounding the proposed Inpatient Prospective Payment Systems (IPPS) rule, which sets inpatient rates for next year. The hospital lobbying group charged that facilities are facing major challenges not just from the pandemic.

“Historic inflation has extended and heightened the already severe economic instability brought on by the pandemic resulting in razor-thin operating margins from massive surges in input costs, including a struggling workforce, drug costs, supplies and equipment,” the letter said.

 
 

The Centers for Medicare & Medicaid Services (CMS) had proposed a market basket update of 3.2% to Medicare payments for the 2023 federal fiscal year that begins this fall. This was on top of a 2.7% payment update for 2022. The proposed rule released in April calls for a proposed 0.4 percentage point productivity adjustment.

AHA contends that the market basket and productivity update don’t reflect the major inflation jump and growth in expenses.

“More recent data shows the market basket for [fiscal year] 2022 is trending toward 4%, well above the 2.7% CMS actually implemented last year,” the group wrote. “Additionally, the latest data also indicate decreases in productivity, not gains.”

For ACA Enrollees, How Much Premiums Rise Next Year is Mostly up to Congress

For ACA Enrollees, How Much Premiums Rise Next Year is Mostly up to Congress  | KFF

Source: Kaiser Family Foundation, by Cynthia Cox and Krutika Amin

Health insurers are now submitting to state regulators proposed 2023 premiums for plans offered on the Affordable Care Act (ACA) Marketplaces. Changes in these unsubsidized premiums attract a lot of attention, but what really matters most to the people buying coverage is how much they pay out of their own pockets. And the amount ACA Marketplace enrollees pay is largely determined by the size of their premium tax credit. Generally speaking, when unsubsidized premiums rise, so do the premium tax credits, meaning out-of-pocket premium payments hold mostly steady for people getting financial assistance.

For just over a year, ACA Marketplace enrollees have benefited from enhanced tax credits under the American Rescue Plan Act (ARPA), which Congress passed as temporary pandemic relief. The enhanced assistance lowers out-of-pocket premiums substantially, and millions of enrollees saw their premium payments cut in half by these extra subsidies. ACA Marketplace signups reached a record high of 14.5 million people in 2022, including nearly 13 million people who received tax credits to lower their premiums.

Soon, the vast majority of these nearly 13 million people will see their premium payments rise if the ARPA subsidies expire, as they are set to at the end of this year.

The ARPA subsidies were enacted temporarily for 2021 and 2022 as pandemic relief, but congressional Democrats are considering extending or making the expanded subsidies permanent as a way of building on the ACA, as President Biden had proposed during his 2020 campaign. If Congress does not extend the subsidies, out-of-pocket premium payments will return to their pre-ARPA levels, which would be seen as a significant premium increase to millions of subsidized enrollees. In the 33 states using HealthCare.gov, premium payments in 2022 would have been 53% higher on average if not for the ARPA extra subsidies. The same is true in the states operating their own exchanges. In New York, for example, premiums for tax credit-eligible consumers would be 58% higher if not for the ARPA. Such an increase in out-of-pocket premium payments would be the largest ever seen by the millions receiving a subsidy. Exactly how much of a premium increase enrollees would see depends on their income, age, the premiums where they live, and how the premiums charged by insurers change for next year.

For states, the timing of Congressional action on ARPA subsidies matters both for rate review and state enrollment systems. State-based exchanges – as well as the federal government, which operates HealthCare.gov – will need to reprogram their enrollment websites and train consumer support staff on policy changes ahead of open enrollment in November. States will start making these changes as soon as this month. Additionally, as insurers submit premiums for review, state insurance commissioners and other regulators must assess the reasonableness of 2023 rates, and some of that determination will depend on the future of ARPA subsidies. The non-partisan National Association of Insurance Commissioners (NAIC) wrote to Congress asking for clarity on the future of ARPA subsidies by July.

For insurers, the timing matters because 2023 premiums get locked in later this summer. Last summer, when insurers were setting their 2022 premiums, some said the ARPA had a slight downward effect on their premiums, based on the risk profile of enrollees. Insurers are now in the process of setting 2023 premiums and some might factor in an upward effect on premiums if they expect ARPA subsidies to expire. Premiums for 2023 are locked in by this August, so if Congress does not act before its August recess, whatever assumptions insurers make about the future of ARPA subsidies will be locked in to their 2023 premiums. Additionally, although this is not necessarily at the same scale of the uncertainty seen in 2017 surrounding the ACA repeal and replace debates (when many insurers explicitly said that uncertainty was driving their premiums up), it is possible that some insurers will price 2023 plans a bit higher than they otherwise would, simply because of uncertainty around the future of the ARPA’s enhanced subsidies. The NAIC letter to Congress warned that “uncertainty may lead to higher than necessary premiums.”

For enrollees, the timing matters both for knowing how much they will pay and for maintaining continuous coverageNearly all of the 13 million subsidized enrollees will see their out-of-pocket premium payments rise if the ARPA subsidies expire. But if the subsidies are renewed by Congress, but not until the end of the year right before subsidies are set to expire, there could still be a disruption if states and the federal government do not have enough lead time to update their enrollment websites to reflect the enhanced subsidies. In this scenario, the millions of enrollees who currently have access to $0 premium Marketplace plans might have to pay a premium in January – putting them at risk of losing coverage due to non-payment. Similarly, middle-income enrollees might temporarily lose access to advanced payments of the tax credit in the month of January, making it unaffordable for them to maintain coverage.

Congress’s action or inaction on ARPA subsidies will have a much greater influence over how much subsidized ACA Marketplace enrollees pay for their premiums than will market-driven factors that affect the unsubsidized premium. Even if unsubsidized premiums hold steady going into 2023, the expiration of ARPA subsidies would result in the steepest increase in out-of-pocket premium payments that most enrollees in this market have seen. This would essentially be a return to pre-pandemic normal, but the millions of new enrollees and others who have received temporary premium relief may not see it that way.

AHIP Presses Congress, White House To Ramp Up Scrutiny Of Private Equity Provider Deals

AHIP presses Congress, White House to ramp up scrutiny of private equity  provider deals | Fierce Healthcare

Source: Fierce Healthcare, by Robert King

Health insurance trade group AHIP is calling for the White House and Congress to increase scrutiny of private equity control of providers, which the group worries could impact quality and costs.

 

The group earlier this week released letters sent to the White House and congressional leaders outlining parts of a new policy road map and priorities (PDF). Chief among them was more transparency surrounding private equity deals, which has grown in popularity across certain parts of the provider industry.

“While improving transparency of health care prices at the federal level has been a major focus, only the recent executive order related to nursing home care has applied to the activities of private equity entities of the health care marketplace, which have vastly different business models than other health care organizations,” the letter to President Joe Biden said.

AHIP wrote that there needs to be more transparency on private equity control of physician specialty groups and how the deals can impact quality and costs for patients.

The group noted in a white paper that back in 2018 private equity made up 45% of all health mergers and acquisitions. While initial deals applied to certain specialties like orthopedics and urology, AHIP said targets have expanded.

AHIP wants Congress to pass legislation that requires the public reporting of all private equity and hedge fund purchases of specialty groups and other providers such as emergency room physicians or ambulance providers. They also want the federal government to study any anticompetitive impact on the acquisition of providers by private equity firms.

 

Other key priorities in AHIP’s road map include:

  • * Advance use of site-neutral payments to ensure payments are the same no matter the site of care. The Centers for Medicare & Medicaid Services has cut Medicare payments in recent years to off-campus hospital clinics to bring the payments in line with those paid to physician clinics. But the effort led to a legal fight with the hospital industry.
  • * Support the expansion of home-based advance care via “value-based care and payment models,” the road map said.
  • * Remove barriers to telehealth access, which exploded in use since the onset of the pandemic; but, now, regulators are figuring out what to make permanent. AHIP wants the federal government to have network adequacy regulations to account for the availability of telehealth and to ban billing of “distant site facility fees for telehealth services.”

AHIP’s push to scrutinize private equity deals comes as the federal government has delivered more scrutiny of hospital merger deals. The Federal Trade Commission also launched a probe into physician practice acquisitions back in January 2021 to examine their impact on market competition.

NAHU CEO: ‘Medicare For All’ Moves From Congress To The States

NAHU CEO: 'Medicare For All' Moves From Congress To The States –  InsuranceNewsNet

Source: InsuranceNewsNet

Congress has backed off “Medicare for All” for the time being. But legislators in several states are now taking up the charge.

In California, Democrats call for “a universal, single-payer health care system” as part of their party platform. A bid to install such a system failed in the California Assembly at the end of January, but the Golden State’s leaders have promised to make another run at it.

At least a dozen other states are considering bills that would ban private health insurance and establish single-payer health care. That’s bad news for ordinary Americans. It makes little sense to force nine in 10 Americans off their current health plans as part of a drive to bring about universal coverage.

About two-thirds of insured Americans currently depend on private health insurance plans. About 177 million people receive coverage through an employer, and about 34 million people purchase private coverage directly.

A single-payer system could do away with all those plans.

Moreover, Americans like their private plans. In a recent study of people with employer-sponsored coverage, more than two-thirds said they were satisfied with their insurance. More than three-quarters felt confident it would protect them during a medical emergency.

Research by the Kaiser Family Foundation found that what support there is for single-payer declines when people consider its attendant consequences like higher taxes and treatment delays.

Analyses of specific state single-payer plans suggest the downsides would be severe.

The New York Health Act, for instance, would reduce employment in the Empire State by 315,000, according to research published last year by the Foundation for Research on Equal Opportunity. Another report found that if the bill became law, New York residents would have to pay some $250 billion in new taxes.

 

Further, single-payer will lead to lower-quality care. That’s because government payers rely on lower payments to hospitals and doctors to keep costs in check. Look no further than Medicare. The American Hospital Association says hospitals receive just 87 cents for every dollar they spend treating Medicare beneficiaries.

That’s obviously not sustainable. If a single-payer system — and its low payment rates — were adopted widely, doctors and hospitals would respond by reducing the supply of care they’re willing to provide.

That diminution of supply, combined with unlimited demand stoked by making health care free at the point of service, could lead to long waits.

Just ask the Congressional Budget Office. According to a recent CBO analysis, a single-payer system would result in more “unmet demand” for health care services, “greater congestion in the health care system” and “lower payment rates.”

Lawmakers in several states have responded to concerns like these by championing a supposedly more moderate public option — a government-run insurance plan that would supposedly compete against private options.

But any public option would also reimburse providers at lower rates than private plans do. The public plan would use that pricing power to set premiums and deductibles below those of private insurers. As people gravitated toward the cheaper public option, private insurers would gradually leave the market, until only the public plan remained.

A public option is just a slower way of introducing single-payer. And single-payer health care is a cure worse than the disease.

Janet Trautwein is CEO of the National Association of Health Underwriters. This piece originally ran in the Boston Herald.

State-Based ACA Exchanges Make Backup Plans In Case Congress Fails To Act On Enhanced ACA Subsidies

Urban Institute study finds 3M close lose coverage if boosted ACA subsidies  expire

Source: Fierce Healthcare, by Robert King

The Biden administration and states across the country celebrated record-breaking enrollment gains for the Affordable Care Act (ACA) this year.

 

But state-run exchanges are eyeing backup plans for outreach and marketing in case Congress doesn’t extend beyond this year a major driver for those enrollment gains: enhanced income-based subsidies. Some officials have warned that people could drop off coverage—and consumers may shift to less-generous plans—if Congress doesn’t act in time.

“If we are still in this stage of uncertainty, we will have to anticipate either outcome and ramp up planning efforts … with both scenarios in mind,” said Zachary Sherman, executive director of the exchange called Pennie, in an interview with Fierce Healthcare.

 
 

Sherman said Pennsylvania’s exchange signed up more than 110,000 new customers compared to the last open enrollment, and 35,000 of those customers are getting subsidies that they typically would not be eligible for.

The American Rescue Plan’s (ARP’s) enhanced subsidies ensured that anyone making more than 400% above the federal poverty level wouldn’t pay more than 8.5% of their income on healthcare. Previously, that was the cutoff for eligibility for income-based subsidies. The enhancements also ensured that some consumers qualified for zero premiums or $10 a month premiums.

According to a recent Assistant Secretary for Planning and Evaluation report, an estimated 3.4 million Americans currently insured in the individual market would lose coverage and become uninsured if the ARP’s premium tax credit provisions are not extended beyond 2022. Kaiser Family Foundation determined premiums would more than double for many.

 

Pennie isn’t the only exchange that saw massive gains thanks to the subsidies.

Washington’s exchange saw nearly 60,000 residents sign up for coverage for 2022, and 73% of all customers were eligible for subsidies, up from 61% in 2021, the exchange told Fierce Healthcare.

It added that over 100,000 of the exchange customers (42% of total enrollment) pay $100 or less a month, compared to 29% before the ARP was signed into law.

Customers signing up on state-run exchanges saw average premium savings of 7% to 47% for 2022, according to a report from the National Association for State Health Policy. The report added that at least eight exchanges had 20% or more of their customers paying less than $25 a month for coverage.

 

Overall, there were 14.5 million people who signed up for coverage for 2022 when considering both the state-run exchanges and the federally run HealthCare.gov, a record number.

Now, though, states are grappling with how many people could lose coverage if the extra subsidies go away.

Plans likely will start finalizing rates this summer and open enrollment will start in the fall, creating even greater pressure on Congress to act.

Minnesota’s exchange, MNSure, told Fierce Healthcare it expects 70,000 enrollees will lose some benefits and 10,000 would lose all of it.

“Most of them will still get some subsidy. All of them will see a reduced subsidy,” said Libby Caulum, senior director of public affairs for MNSure.

Sherman said 90% of customers get financial assistance and will also see some adjustment, requiring key outreach if the subsidies don’t get extended.

“We will have to do a considerable amount of planning and communication to those populations to help them understand what that means,” he said.

This includes helping consumers understand the automatic renewal process and how to make plan adjustments.

Sherman said that customers took the opportunity to buy more expensive plans than they otherwise would. A consumer that normally would buy a bronze or silver tier plan would instead buy a gold plan.

“If the subsidies go away and the purchasing power of the subsidies is less going into 2023, we will want to make sure people understand that,” he said.

Some of the people who were earning too much to qualify for subsidies before could drop out.

“We will do a lot of education around the value and importance of staying covered about the options available to consumers,” Sherman said. “Maybe you are not in a gold plan but there are other options for you and the implications of buying a less expensive plan.”

Caulum added that predicting consumer behavior could be tricky, and it is difficult to pin down how many enrollees could drop off.

“Once people get coverage it could be sticky for them. They realize the benefit and they don’t want to drop It,” she said.

It isn’t just consumers, however, that could be forced to rethink their available benefits.

Massachusetts Health Connector Authority, for example, applied state funds otherwise allocated for premium assistance to help “reduce cost-sharing for critical services including primary care, mental health visits and prescription drugs,” said Executive Director Louis Gutierrez in a release from the National Association for State Health Policy.

Calling on Congress

The Biden administration, meanwhile, has been relatively mum on its plans on what happens if the enhanced subsidies aren’t extended.

Administration officials said they believe Congress will extend the subsidies. However, Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure recently told reporters the agency can move quickly to implement rules and change outreach efforts in case Congress doesn’t act.

It remains unclear whether lawmakers will extend the subsidies. The $1.75 trillion Build Back Better Act, which extended the subsidies through 2025, was nixed in the Senate after objections from Sen. Joe Manchin, D-West Virginia. But Biden had said late last year the goal is to pass the social spending package in chunks.

However, so far none of those chunks have made significant progress through Congress, despite widespread support from Democrats.

H.R.5659 Would Open Medicare Advantage to End-Stage Renal Patients

Dialysis Patient Citizens (DPC) hailed the introduction of H.R. 5659 as the latest milestone toward opening Medicare Advantage enrollment to end-stage renal disease (ESRD) patients. Stephen Anderson, a patient advocate from Indianapolis said, “As a dialysis patient of five years, I am fortunate to have secondary insurance to cover what Medicare does not. However, I know many patients in my facility don’t have that luxury. Providing dialysis patients access to Medicare Advantage will greatly help to reduce our out-of-pocket costs while improving our health with care coordination measures,” said. A study comparing outcomes of dialysis patients grandfathered into Medicare Advantage plans found that they have lower mortality rates than id their peers in fee-for-service plans. For more information, visit dialysispatients.org.

Groups Call on Congress to Pass Medicare Virtual Colonoscopy Coverage

innovation

The National Medical Association and the American College of Radiology are calling on Congress to pass the CT Colonography Screening for Colorectal Cancer Act (H.R. 4632), which was. Introduced in the House by Reps. Brad Wenstrup (R-OH) and Danny Davis (D-IL), H.R. 4632. It would provide Medicare coverage for seniors who choose to be screened with a virtual colonoscopy (CT colonography). This would remove a financial barrier to care widely covered by private insurance. The American Cancer Society recommends Virtual colonoscopy as a screening exam because it has been shown to increase screening rates. Less invasive than optical colonoscopy, it does not require sedation. After the procedure, patients may return to daily activities.

“Medicare coverage of virtual colonoscopy would increase African-American and other minority access to this test that can overcome many cultural stigmas and attract more people to be screened. This would prevent many cancers, find more cancers before they progress and save thousands of people who might otherwise die from a disease that is often preventable,” said Edith Peterson Mitchell, MD, President of the National Medical Association.

CIGNA, UnitedHealthcare, Anthem Blue Cross, Blue Shield, and other major insurers cover screening virtual colonoscopy. More than 20 states require insurers to cover these exams. Yet, Medicare does not cover beneficiaries for CT colonography. Virtual colonoscopy has been proven comparably accurate to colonoscopy in most people of screening — including those ages 65 and older. President Obama chose a virtual colonoscopy in his first checkup as Commander-in-Chief.

The Cadillac Tax Gets Delayed Until 2018

Congress passed a $1.5 trillion omnibus spending bill and $680 billion tax-extenders package, which funds the government through September 2016. President Obama signed the legislation on Friday. Included in the bill is a provision that will delay the Cadillac tax. The Affordable Care Act (ACA) imposes a 40% non-deductible excise tax on health plans with values exceeding $10,200 in coverage for singles and $27,500 for families beginning in 2018. The provision is indexed to inflation and will rise automatically over time, potentially affecting all employer-sponsored plans. If the tax goes into effect, employers could shift the cost of the tax to employees by raising deductibles and increasing other out-of-pocket costs. The omnibus bill delays the tax for two years, until 2020.

Sen. Sherrod Brown (D-OH) said, “A delay of the Cadillac tax is welcome relief for middle-class workers who shouldn’t be stuck with higher out-of-pocket costs or lower quality health care. Brown sponsored the American Worker Health Care Tax Relief Act of 2015, which would repeal the tax. The bill demands that repeal is accompanied by a proposal to offset lost tax revenue to prevent an increase in the federal deficit and protect the integrity of the health law. He added, “While I plan to continue working with my colleagues toward a full repeal of this tax, a two-year delay of the implementation date of this harmful tax will temporarily ensure that the cost of care isn’t shifted to workers in the short term.”

Terry O’Sullivan, general president of the Laborers’ International Union of North America (LIUNA) said, “LIUNA is just one of many labor, employer, health policy, and other groups opposed to this indefensible, misguided, and regressive 40% middle-class excise tax. Congressional action, while not the hoped-for outright repeal, is a big step in the right direction, and signals a recognition that the tax is deeply flawed. We hope that in the additional two years provided by this delay, Congress and the next President will, once and for all, repeal the deceptively named ‘Cadillac Tax.’”

Judge Says that the House GOP Can Sue the President

The Los Angeles Times reports that House Republicans won the opening round in a lawsuit against President Obama over their claim that his administration spent money for health insurers under the Affordable Care Act without receiving needed approval by Congress. U.S. District Judge Rosemary Collyer ruled Wednesday that the lawmakers have the legal standing to sue. The Constitution “could not be more clear: ‘No Money shall be drawn from the Treasury but in consequence of Appropriations made by Law’,” she said, quoting a key provision. “Neither the president nor his officers can authorize appropriations; the assent of the House of Representatives is required before any public monies are spent.”

The judge rejected pleas by Obama’s lawyers to dismiss the House lawsuit on the grounds it involved a political dispute, not a legal one. Collyer said that the House claimed it would suffer an “institutional injury” if the president and his aides could spend money on their own authority. Her ruling is only the first step, however. She told lawyers she would hear arguments in the fall on whether the administration’s action violated the Constitution. If Collyer, a judicial appointee of President George W. Bush, were to decide in favor of the House on the merits, Obama’s lawyers would appeal to the U.S. Court of Appeals for the District of Columbia Circuit, where Democratic appointees are in the majority. From there, the case could move to the Supreme Court. Unless the dispute moves with unusual speed, a final decision might not come until after Obama has left office. Nonetheless, Collyer’s initial ruling is a victory for House Speaker John A. Boehner, and it is likely to be seen as endorsing the GOP’s view that Obama overstepped his authority. In a statement, Boehner said he was “grateful to the court for ruling that this historic overreach can be challenged by the coequal branch of government with the sole power to create or change the law. The president’s unilateral change to Obamacare was unprecedented and outside the powers granted to his office under our Constitution.”

The White House said it would seek an immediate appeal. “The law is clear that Congress cannot try to settle garden variety disputes with the executive branch in court,” said Deputy Press Secretary Jen Friedman. “This case is just another partisan attack — this one, paid for by the taxpayers — and we believe the courts will ultimately dismiss it.” Many lawyers saw the House suit as unprecedented. In the past, courts have regularly said lawmakers do not have standing to turn their political fights into legal battles. Last summer, when the House voted to sue Obama, many legal experts predicted the suit would be tossed at the first stage. Boehner had first alleged that Obama’s aides had violated the law when they waived several deadlines under the Affordable Care Act.

But more recently, the lawyers for the House focused on a little-known dispute over how to reimburse health insurers who take on more low-income policyholders. The Affordable Care Act said these insurers would be reimbursed for waiving copayments and other costs for these new policyholders, but it did not make clear whether this money would be provided automatically or instead would require an annual appropriation from Congress. So far, the administration has spent $4 billion, and the total spending is expected to reach $175 billion over a decade. After the Republican-led House refused to appropriate money, Health and Human Services Secretary Sylvia Mathews Burwell decided the reimbursements were mandatory under the law and could be provided despite the lack of an appropriation.

Law professor Jonathan Turley, the lead counsel for the House, said the judge’s ruling means the court will decide “an issue that drives to the very heart of our constitutional system: the control of the legislative branch over the power of the purse.” Despite the setback, health law experts do not see this case as posing a major challenge to the future of Obama’s healthcare law. If spending for the reimbursements were cut off, insurers might have to raise premiums somewhat. Other experts say the insurance companies could turn to a federal claims court to seek reimbursements. For the full article, visit latimes.com.

Bill Would Expand Access to Home Healthcare Services

The Partnership for Quality Home Healthcare is urging Congress to advance the Home Health Care Planning Improvement Act (S.578). Under the bill, nurse practitioners could certify home health services for Medicare beneficiaries without getting physician approval. Nurse practitioners are already certified to perform such evaluations for hospice services. Eric Berger, CEO of the Partnership said, “Allowing nurse practitioners to certify patients for Medicare’s home health services would remove barriers to care that restrict access to patient-preferred healthcare for homebound beneficiaries. The Partnership commends Senator Susan Collins and her colleagues in the U.S. Senate for sponsoring this legislation, which would improve access to skilled home healthcare for Medicare’s most vulnerable patient population, particularly those patients living in underserved and rural parts of the country.

Last Updated 06/29/2022

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