This Week: Opioid legislation moves; Shutdown averted for now; CMS Encourages State Work Requirements in Medicaid

Congress

House

Senate

Administration

Courts

Reports

Other

Congress

House

House Passes $854B Spending Bill to Avert Shutdown

On Sept. 26, the House passed an $854 billion spending bill to avert an October shutdown, funding the Department of Health and Human Services (HHS) for fiscal year 2019 and allocating money for the National Institutes of Health (NIH), Pell Grants and programs combating the opioid crisis. The House voted 361-61 to approve the bill, a week after the Senate passed an identical measure by a vote of 93-7.

The package included two appropriations bills, which fully fund the Department of Defense, and the Department of Labor, and Department of Health and Human Services (HHS) as well as Department of Education for fiscal 2019, and make up about two-thirds of the annual appropriations for the year. President Trump announced that he would sign the bill and avoid the possible shutdown. In addition, those federal agencies who had not yet been funded through appropriations will have funding through December 7.

Senate

Final Opioid Bill Partially Repeals IMD Exclusion, Omits Controversial House-backed Privacy Measure

The final opioid legislation unveiled by House and Senate negotiators on Sept. 25 includes two controversial provisions: one expanding Medicaid payments for opioid-abuse treatment in large inpatient facilities and another allowing non-physician providers to prescribe a drug used to treat opioid addiction. The third controversial measure, backed by the House, loosened privacy restrictions on medical records containing information about substance abuse; this measure was dropped from the final version of the bill.

On Sept. 28, the House will take up the bipartisan, bicameral opioid response bill, H.R. 6 (115), under suspension of the rules.

Expanded Sunshine Provision Included in Final Opioid Bill

On Sept. 25, when the House and Senate negotiators revealed the opioid legislation, they included a provision expanding the sunshine law, requiring drug and medical device-makers to publicly disclose payments made to health care providers beyond doctors.

The sunshine provision, which originally appeared in the Senate version of the bill, requires that drug and medical device-makers publicly disclose payments made to nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, physician assistants and certified midwives—not just doctors and teaching hospitals—for promotional talks, consulting and other interactions.

Administration

Trump Administration Pushes for More State Medicaid Work Requirements

On Sept. 27, the Centers for Medicare and Medicaid Services (CMS) administrator, Seema Verma, announced the Trump administration’s intent to approve more state requirements in waivers. These conditions would require Medicaid beneficiaries to work or train for work in order to stay enrolled in the program. A related provision was knocked down by a lawsuit in Kentucky. Another suit is pending in Arkansas. Verma remarked that CMS is “committed to this issue” and “moving closer to approving even more state waivers.” At least eight other states—Arizona, Kansas, Maine, Mississippi, North Carolina, Ohio, Utah and Wisconsin—have pending requests for similar work requirements.

Courts

SCOTUS to Decide on HHS Procedure in Medicare Hospital Payments

On Sept. 27, the U.S. Supreme Court announced it would decide on whether the Department of Health and Human Services (HHS) properly proceeded in changing the calculation for Medicare disproportionate-share hospital (DSH) payments in 2014. The court accepted a petition filed in May 2018 by HHS after a federal appellate court sided with the provider plaintiffs led by Minneapolis-based Allina Health Services in July of this year. HHS estimated that if the department were to lose the case, it would be responsible for $3 billion to $4 billion in DSH payments from 2005 to 2013.

The case pertains to the calculation, the “Medicare fraction,” changes made on DSH payments, without the notice-and-comment rulemaking. This comment period normally allows hospitals to weigh in on changes; third-party contractors, known as MACs, depend on the calculations made by CMS to determine what Medicare owes each hospital, each year. The U.S. Court of Appeals for the District of Columbia Circuit, in a decision written by Judge Brett Kavanaugh, overturned an earlier decision that sided with HHS on the matter.

The U.S. Supreme Court starts its new term Oct. 1.

Reports

GAO Report: Pharmacy Inventory Management Could Benefit from Systemwide Oversight

On Sept. 27, the U.S. Government Accountability Office (GAO) released a report on the Veterans Affairs (VA) office, citing challenges faced when providing health care for 9 million veterans and in managing inventory at VA pharmacies. VA medical centers have struggled to accurately account for and update information on medications in stock. In the report, the GAO found that the VA cannot fully oversee management of pharmacy inventories systemwide because the VA lacks a comprehensive system to manage pharmacy inventory—a new system will not be implemented for up to10 years—and lacks a focal point for systemwide oversight.

The GAO recommends that the VA designate a focal point to oversee systemwide pharmacy inventory management.

Read the report.

CMS: Medicare Advantage Premiums Continue to Decline While Plan Choices and Benefits Increase in 2019

On Sept. 28, the Centers for Medicare & Medicaid Services (CMS) announced that, on average, Medicare Advantage premiums will decline while plan choices and new benefits increase. Medicare Advantage enrollment is projected to reach a new all-time high with more than 36 percent of Medicare beneficiaries projected to be enrolled in Medicare Advantage in 2019. These numbers were reported along with the release of benefit and premium information for Medicare health and drug plans of the 2019 calendar year.

The Medicare Advantage average monthly premium continues to decline, and will be the lowest in the last three years. On average, Medicare Advantage premiums in 2019 are estimated to decrease by 6 percent to $28.00, from an average of $29.81 in 2018. Nearly 83 percent of Medicare Advantage enrollees remaining in their current plan will have the same or lower premium in 2019. Approximately 46 percent of enrollees in their current plan will have a zero premium.

Read the CMS fact sheet.

Other

CMS: Medicare Advantage Premiums Continue to Decline While Plan Choices and Benefits Increase in 2019

On Sept. 27, Aetna Inc. agreed to sell its Medicare Part D prescription business to a WellCare Health Plans Inc. subsidiary, as the company waits for its merger with CVS Health Corp. to be approved by federal and state officials. This transaction could pave the way for CVS Health to complete its $69 billion takeover of the insurer. CVS announced plans to buy Aetna late last year; the deal would increase the drugstore chain’s role in health care, with the companies combining to manage care through CVS stores, clinics and prescription drugs.

Industry experts say regulators are concerned of possible Medicare business overlap between the companies. Aetna is not disclosing terms of its deal with insurer WellCare. Aetna Inc. and CVS Health Corp. are expected to close the deal before the end of this year.