1. Congress

House

House Energy and Commerce Subcommittee Advances FDA User Fee Bill

On May 18, the House Energy and Commerce Health Subcommittee moved forward, on a voice vote, a bill reauthorizing FDA user fee programs for drugs and medical devices.

The subcommittee approved four bipartisan amendments, including one designed to increase generic drug competition to address price hikes of older drugs like Mylan’s EpiPen. Among other things, the amendment would reward new generic competitors with 180 days of marketing exclusivity.

The panel also approved an amendment that would increase penalties for selling or distributing counterfeit drugs and an amendment that would update FDA’s medical device inspection process to a risk-based program.

Finally, lawmakers approved an amendment that would establish a category of FDA-approved over-the-counter hearing aids. The idea is to increase access to and affordability of hearing aids for those with mild to moderate hearing loss.

Days before the House marked up the FDA user fee reauthorization bill, HHS Secretary Tom Price was pushing lawmakers to increase the fees paid by industry to cover 100 percent of medical product reviews, as proposed in President Donald Trump’s skinny budget. In the Senate, where the committee has already moved on legislation, the reaction was that the proposal was too late. The Senate HELP Committee marked up its version of the user fee package to the Senate floor, 21-2, on May 11. Riders attached to the Senate version of the bill address drug importation and counterfeiting, over-the-counter hearing aids, risk-based device inspections, real-world evidence and pediatric drug development, among other things. User fees account for about half of the FDA’s annual budget.

The subcommittee also advanced on a voice vote H.R. 1222, a bill that would enhance research and surveillance at CDC for congenital heart disease and award grants for further study on the condition. And it advanced H.R. 2410, which would increase research, surveillance and prevention for sickle cell disease.

Director Collins Urges Congress to Continue Stable Funding for NIH

In testimony before the House Appropriations Subcommittee on Health on May 17, NIH Director Francis Collins said that stable funding for his agency is essential to continue vital research, hinting that looming cuts in the Trump administration’s budget could create a roller coaster effect. Collins’ remarks came a month after President Donald Trump proposed slashing spending on the agency by $5.8 billion.

Rep. Tom Cole, chairman of the House appropriations subcommittee that oversees the NIH budget, reiterated his opposition to the proposed cuts—calling them “penny wise and pound foolish.” Cole said they would stall progress on recent investments and could potentially discourage promising scientists from entering or remaining in biomedical research.

Senate

Senate Finance Committee Approves the CHRONIC Care Act

On May 18, the Senate Finance Committee unanimously approved a bipartisan bill that would alter the way Medicare treats chronic illnesses.

The CHRONIC Care Act (S. 870) provides more home care options by extending Medicare’s Independence at Home program, enhances team-based care by making changes to accountable care organizations and allows greater flexibility for Medicare and Medicare Advantage plans to pay for telemedicine services, including stroke care.

The legislation, more than two years in the making, allows Medicare to pay for remote stroke diagnosis and treatment, accountable care organizations to provide telemedicine and Medicare Advantage plans to offer telemedicine as a supplemental benefit, as well as pays for dialysis treatment at home through telemedicine.

The measure would allow patients to be assigned to ACOs at the beginning of a year and let providers pay patients $20 to receive certain primary care services with them.

The four telemedicine-related sections of the bill would increase Medicare spending by $150 million over a decade, according to a preliminary CBO estimate. In the past, high CBO scores prevented similar efforts from advancing.

It is unclear when the bill will be considered on the Senate floor or how the House will address the matter.

Sens. Isakson, Casey Propose Sweeping Changes to OTC Drug Regulation

Sens. Johnny Isakson (R-GA) and Bob Casey (D-PA) are circulating a draft bipartisan plan that proposes the most sweeping changes in more than four decades to the FDA’s process for regulating over-the-counter drugs.

FDA, industry groups and health experts say the current regulatory regime is out of date. Under the new proposal, product approvals would be streamlined so FDA would no longer be required to do rulemaking for each therapeutic class. Instead, the HHS secretary could administratively establish standards for each OTC drug type.

The change is expected to not only speed up the process for creating OTC drug standards but could improve the safety of products already being marketed. Under the current rulemaking approach, it may take FDA several years to update standards or labeling of an OTC drug even if the agency identifies a safety or efficacy problem or pulls medicines off the market.

The bill would also create a new user fee program for OTC drugs, which would be analogous to the fees used to help fund prescription drug approvals. The new fees would help FDA cut down on a backlog of reviews it has to perform on ingredients in products that have been on the market for decades.

House Energy and Commerce Committee members have also been working on similar legislation.

Senators Propose Expansion of Substance Abuse Care

On May 17, senators unveiled bipartisan legislation that would ease longstanding federal restrictions on Medicaid reimbursement for substance abuse treatment centers in an effort to expand access to care amid a nationwide opioid epidemic. The bill, the Medicaid Coverage for Addiction Recovery Expansion (CARE) Act, was introduced by Sens. Rob Portman (R-OH), Shelley Moore Capito (R-WV) and Dick Durbin (D-IL), among others.

The proposal would allow substance abuse treatment centers with up to 40 beds to be reimbursed by Medicaid for up to 60 consecutive days. The proposal would roll back a law prohibiting Medicaid from paying for patient care at facilities with more than 16 beds. That law, known as the Institutes for Mental Diseases exclusion, was originally meant to discourage institutionalization, but health experts say it has created a major barrier to care and a severe nationwide shortage of psychiatric beds. Under the bill, Medicaid would reimburse these facilities only for patients being treated specifically for substance abuse at credentialed residential addiction treatment facilities.

Lawmakers Reintroduce the Fair Drug Pricing Act

Sen. Tammy Baldwin (D-WI), Sen. John McCain (R-AZ) and Rep. Jan Schakowsky (D-IL) are resurrecting the Fair Drug Pricing Act, which would require drug makers to submit a report 30 days before they raise the prices, by more than 10 percent in one year or 25 percent in three years, of certain drugs that cost at least $100; and to disclose manufacturing, R&D and marketing costs, as well as net profits associated with the drugs.

The legislation includes new requirements to target loopholes. For instance, some drug makers have openly discussed plans to keep price hikes just below 10 percent to avoid triggering similar thresholds—hence the three-year window.

U.S. prescription drug spending reached a record high of $425 billion in 2015, accounting for almost 16.7 percent of all U.S. health care spending, with expectations that spending will surpass $600 billion by 2020.

For more information, click here.

Senate Health Care Working Group Focusing on Ways to Stabilize Individual Marketplace

On May 16, Sen. Ron Johnson (R-WI) said that the Senate’s health care working group is focusing on ways to immediately stabilize the individual marketplace, such as continuing the ACA’s cost-sharing reduction (CSR) payments, in advance of a long-term solution to replace the Affordable Care Act.

The Trump administration has not committed to making the CSR payments beyond this month, and many insurers have threatened to exit the exchanges in 2018 if the CSRs are not guaranteed.

Johnson said the working group is zoning in on a short-term solution because insurers need to file rates soon for 2018.

In addition to demanding continued funding of the CSRs, health plans have also called for an extension of the ACA’s reinsurance program, which ended in 2016; payment by the federal government of the risk corridor money owed to insurers; and changes to the risk adjustment program, including allowing states to calculate payments by region rather than statewide. Insurers have also lobbied Congress to permanently repeal the health insurance tax, and to revise or repeal the so-called Cadillac tax on high-cost plans.

Sen. John Thune (R-SD) said a health bill will not pass the Senate unless the tax credits in the House version are redesigned to help lower-income and older individuals. Thune said senators have discussed designing tax credits that are geographically adjusted in addition to being age and income adjusted, a policy called for by various stakeholders, including AARP, multiple insurance plan lobbies and the American Medical Association.

Thune said Republicans are waiting on an updated Congressional Budget Office score of the House-passed American Health Care Act to drive their changes to the tax credits. He said individuals need more choices for using their tax credit than what the ACA subsidy allows and tying the credits to age or income is a better way to design them.

Senators Urge OMB to Take Action on Drug Importation

In a May 15 letter to OMB Director Mick Mulvaney, a bipartisan group of senators encouraged executive or administrative action to reduce the financial burden of prescription drugs.

Sens. Chuck Grassley, Amy Klobuchar and John McCain said the administration can make use of a 2003 law that allows the FDA to green light importation of less costly medications from Canada if the HHS secretary certifies the practice would not pose added public health risks while resulting in a significant reduction in costs.

The lawmakers said Mulvaney should work with HHS Secretary Tom Price to immediately begin allowing importation of prescription drugs from Canada in instances in which a drug is off patent or no longer marketed in the United States by the innovator company, has undergone a significant and unexplained price increase, has no direct competitor on the market and is produced abroad by a brand-name company that developed the drug or by a well-known generic company that commonly sells pharmaceuticals in the United States.

The lawmakers said the policy could be limited so it does not hurt companies that developed the new medications. They also urged Mulvaney to explore other options for executive actions on drug pricing.

The letter came after the OMB director suggested that the government should look at increasing the levels of discounts drug companies provide to patients in Medicare Part D to make those rebates more on par with those provided to Medicaid.

2. Administration

HHS Further Delays Medicare Bundled Payments, 340B Drug Program Changes

HHS is postponing a pair of Medicare bundled payment programs for the second time, according to a final rule posted May 18.

The notice delays the start of payment models for knee and hip replacements and cardiac care until Jan. 1, and hints at the possibility of making more policy changes to the efforts.

HHS initially delayed the bundled payments in March, citing the Trump administration’s freeze on pending Obama-era rules and regulations. This additional delay gives providers more time to prepare and allows the agency to consider any final tweaks. HHS Secretary Tom Price has in the past criticized mandatory demonstration projects like bundled payments for hip and knee replacements.

In a separate final rule, HHS also postponed changes to the 340B Drug Program. The new parameters—which were tentatively scheduled to take effect on May 22—set a ceiling price for participating drug companies and clarified how civil monetary penalties would be imposed. Those policies will now start on Oct. 1.

CMS Releases Federal Funding Methodology for Basic Health Program

On May 17, CMS released an informational bulletin to states providing more information specifying the final values for the factors needed to calculate the federal BHP payment rates for 2018 that were not included in the 2017 and 2018 BHP Payment Notice. It does not alter the payment methodology or definitions of any of the factors. In addition, the bulletin reminds states operating a BHP for 2018 of the need to make two decisions: (1) whether to develop a retrospective population health factor (PHF) adjustment methodology; and (2) whether to use the 2017 or 2018 qualified health plan (QHP) premiums as the basis for calculating the 2018 BHP federal payments.

The informational bulletin can be accessed on Medicaid.gov.

For more information on BHP, click here.

CMS Announces Regions for CPC+ Round 2

Strengthening primary care is critical to promoting high-quality, patient-centered care and reducing overall health care costs in the U.S. The Comprehensive Primary Care Plus (CPC+) model is an advanced primary care medical home model that rewards value and quality by offering an innovative payment structure to support primary care practices to improve quality, access and efficiency. The model offers two tracks with different care delivery requirements and payment methodologies to meet the diverse needs of primary care practices.

On May 17, CMS announced the four regions it has selected for the Comprehensive Primary Care Plus (CPC+) Round 2 and the health insurance companies that will participate. They join the 54 payers in 14 regions that were selected for Round 1 last year. The goal with the payment design model is to improve health outcomes while lowering costs.

Following payer applications and selections, the following four regions were selected for CPC+ Round 2:

  1. Louisiana: Statewide
  2. Nebraska: Statewide
  3. North Dakota: Statewide
  4. New York: Greater Buffalo Region (Erie and Niagara Counties)

Eligible practices located in these regions may apply from May 18, 2017, to July 13, 2017, to participate in CPC+ Round 2.

For more information, click here.

CMS Announces Streamlined Direct Enrollment Process for Consumers Seeking Exchange Coverage

On May 17, CMS announced a new streamlined and simplified direct enrollment process for consumers signing up for individual market coverage through exchanges that use HealthCare.gov. Consumers applying for individual market coverage during the upcoming open enrollment period through direct enrollment partners will now be able to complete their application using one website. This reduces needless regulatory burden for businesses that provide direct enrollment services and offers consumers easier access to health care comparisons and shopping experiences for coverage offered through HealthCare.gov.

In prior years, consumers who signed up for health coverage using a third-party website were redirected to HealthCare.gov to complete their application. Consumer feedback showed that the process was confusing and made it harder to finish the application. The new process allows consumers to start and finish their application through the third-party website of direct enrollment partners approved to use the proxy direct enrollment pathway.

For more information, click here.

CMS Offering New Health Coverage Enrollment Option for Small Businesses

On May 15, CMS announced a plan to change the way that small businesses enroll in insurance coverage through the federal exchanges, offering employers the help they need to find affordable insurance for their employees.

The Federally-Facilitated Small Business Health Options Program (FF-SHOP) was mandated under the ACA but failed to sign up significant numbers of small employers. Out of the nearly 30 million small businesses in the country, less than 8,000, just 0.1 percent, of small businesses currently participate in the FF-SHOPs in 33 states, which cover less than 40,000 individuals nationwide. SHOP programs are now defunct and do not provide needed insurance coverage for small businesses.

As part of the changes CMS intends to propose, employers would still obtain a determination of SHOP eligibility through HealthCare.gov. The move would reduce the federal government’s role in health care coverage decisions and make it easier for issuers to use their own enrollment systems for SHOP plans. Online enrollment would be removed from HealthCare.gov and small employers would access coverage through an agent or broker, or an issuer of their choice, for plan years beginning on or after Jan. 1, 2018.

The FF-SHOPs exist in states where the SHOP program is operated by the federal government. Small businesses with SHOP coverage that took effect in 2017 would be able to continue using HealthCare.gov for enrollment and premium payment until their current plan year ends. Some employers that purchase SHOP coverage are also able to access the Small Business Health Care Tax Credit. This option will still be available to small employers who purchase coverage under the new enrollment approach.

Under the intended approach, state-based SHOPs not using HealthCare.gov could continue to operate as they have previously.

For more information, click here.

3. Other

States File a Motion to Intervene in Obamacare Subsidy Lawsuit

More than a dozen states are trying to intervene in a lawsuit to save a key piece of Obamacare—cost-sharing subsidies that insurers receive to reduce costs for their customers. The states argue that the Trump administration is no longer representing their interests in the case, because the president has repeatedly threatened to kill the subsidies.

“Immediate loss of CSR funding, with any future funding subject to the myriad uncertainties of the appropriations process, would harm millions of state residents and the States themselves,” the states’ motion contends.

The effort is led by New York Attorney General Eric Schneiderman and California Attorney General Xavier Becerra. All of the states seeking to intervene are led by Democratic attorneys general.

House Republicans sued last year to block funding for the subsidies, arguing that it amounted to an illegal appropriation. They prevailed at the lower court level, but the Obama administration appealed that decision.

The Trump administration has given mixed signals about how it intends to proceed. The White House faces a May 22 deadline to tell the court if the administration will press forward with the appeal.

If the appeal is dropped, it’s anticipated that the subsidies would go away immediately. That could cause insurers to drop out of the Obamacare exchange markets, wreaking havoc for individuals who get coverage through the marketplaces.

To read the motion to intervene, click here.

Insurance Commissioners Urge Funding for Obamacare Subsidies

State insurance commissioners are urging the White House and Congress to fund Obamacare’s cost-sharing subsidies ahead of a May 22 legal deadline for how to proceed on the issue.

The National Association of Insurance Commissioners sent letters to OMB Director Mick Mulvaney and Senate leaders warning that the Obamacare markets could collapse if the government doesn’t keep making the payments and provide stable funding to help cover the health law’s low-income customers.

“Your immediate action is critical to the viability of the individual health insurance markets in a significant number of states across the country,” reads the letter to Senate leaders.

Last year, House Republicans successfully challenged the legality of funding. The lower-court decision was appealed by the Obama administration. A judge has set a deadline of May 22 for the parties to decide how to proceed in the House lawsuit. If the Trump administration decides to drop the appeal, it’s expected that the payments to insurers would cease immediately.

Insurance commissioners are also calling on the Senate to provide funding to help stabilize the individual market. They’re seeking funds that states can use to create either reinsurance programs or high-risk pools to protect insurers from the costs of particularly expensive customers.

Earlier this month, the House passed the American Health Care Act, which includes $138 billion over a decade in part to help states take care of residents with chronic, costly medical needs. The Senate is in the process of drafting its own bill.

Coalition Unveils Package of Proposals to Lower Drug Prices

On May 16, a coalition of insurers, drug makers and pharmacy benefit managers unveiled a package of proposals that they say will lower drug prices. Some of the proposals include: pushing FDA to issue guidelines on preapproval communication between industry and payers; creating a priority review voucher for certain generics coupled with expedited FDA review of these drugs; exempting value-based arrangements from price reporting requirements; shielding value-based arrangements from anti-kickback and Stark laws; and encouraging data sharing.

The reforms would save taxpayers between $2.6 and $5.6 billion over 10 years, while reducing national health expenditures by as much as $36-71 billion by 2026, according to the Council for Affordable Health Coverage.

Among those in the coalition are the Biotechnology Innovation Organization, Sanofi and GlaxoSmithKline; PBM interests including the Pharmaceutical Care Management Association, Express Scripts and CVS Health; insurers Aetna and Cigna; and business groups including the U.S. Chamber of Commerce.

The group’s white paper “Prescriptions for Competition, Value, and Innovation: Positive Reforms to Increase Access and Affordability for Prescription Drugs” describes their recommendations.

4. State Activities

California: Covered California to Hold Three-Month Open Enrollment Period

Covered California is preparing for a three-month open enrollment period this fall. The open enrollment period for 2018 coverage will run from Nov. 15, 2017, to Jan. 31, 2018—the same as last year—despite the federal government’s plans to shorten HealthCare.gov’s enrollment period to six weeks, Peter Lee, the exchange’s executive director, said at a recent board meeting.

“The stabilization rules very clearly provide that the state-based marketplaces will be given discretion to do what’s right in their states,” Lee said, adding that his plan to extend California’s enrollment period has received support from CMS officials.

Covered California officials presented the board with a proposed $314 million 2017-18 budget that includes $105 million for marketing and outreach, as well as nearly $86 million to run the exchange’s service center. The plan also provides for an 11-month operating reserve of $289 million, which would allow for some flexibility given the uncertain political climate.

Covered California’s operation is funded primarily by charging health plans a 4 percent assessment on premiums for the 1.4 million people covered in the exchange. The exchange relies on no state or federal money, other than the federal subsidies.

Covered California recently released a paper outlining the key ingredients for its success. A day earlier, the exchange released an analysis of its healthy risk pool mix.

5. Regulations Open for Comment

FDA Considers Establishing New Office of Patient Affairs

The FDA is considering establishing a new Office of Patient Affairs that would centralize its work on patient involvement in the review and approval of drugs and medical devices, according to a March 14 notice in the Federal Register.

Comments on the new office are due by June 12, 2017.

FDA Submits Interim Final Rule on Long-Delayed Menu Labeling Rule

On April 27, FDA submitted an interim final rule to the White House Office of Management and Budget concerning a long-delayed menu labeling rule. By submitting an interim final rule to OMB they are delaying its existing final rule, slated to take effect May 5. The apparent change in course follows a recent petition by the National Association of Convenience Stores and the National Grocers Association asking FDA to push back the final rule’s effective date.

The move to submit the interim final rule follows years of controversy and debate about the menu labeling requirements, which stem from a little-noticed provision in the Affordable Care Act that calls for mandatory calorie disclosure on menus at chains that have 20 or more locations.

The agency’s notice to OMB offers no detail about whether it is seeking other changes to the rule, but says FDA will be taking comments.

CMS Releases Proposed Hospital Pay Rule

In a new proposed 2018 Medicare payment rule, CMS says it will look to cut hospital industry regulations and streamline oversight, and it’s asking hospitals themselves for help. The agency is soliciting ideas for changes to rules and procedures governing acute-care and long-term care hospitals. The initiative aims to “relieve regulatory burdens for providers,” as well as promote flexibility and innovation, CMS said in a statement.

The new proposed rule would suspend for one year a provision penalizing long-term care hospitals that receive more than 25 percent of patients from a single acute-care hospital. It would also reduce certain quality reporting requirements for hospitals that have implemented electronic health records.

CMS projects the rule would increase Medicare spending on inpatient hospital services by $3.1 billion in 2018, with operating payments to hospitals increasing 2.9 percent. Long-term care hospitals’ Medicare payments are projected to decrease by $173 million, or 3.75 percent, over the same period.

Comments on the rule must be submitted no later than 5 p.m. EDT on June 13, 2017.

CMS Proposes 2018 Payment and Policy Updates for Medicare Hospital Admissions

CMS is offering hospitals a 90-day meaningful use reporting period in 2018, according to a proposed payment rule released April 14.

The first major payment regulation released under HHS Secretary Tom Price marks a change from the back-and-forth over electronic health records meaningful use requirements seen under the Obama White House. The previous administration would typically propose a yearlong reporting period, then scale it back at the last minute after intense lobbying pressure. As a Republican congressman from Georgia, Price often pushed the Obama administration hard for 90-day meaningful use reporting periods.

In connection with the 21st Century Cures Act, CMS also is proposing to remove from meaningful use clinicians who see most of their patients at ambulatory surgery centers.

Price and CMS are also changing previously finalized requirements from electronic clinical quality measures. Under the proposed rule, hospitals can select six measures and report on them for the first three quarters of 2018.

For more information, click here.

CMS is Accepting Measure Submissions for the Advancing Care Information Performance Category until June 30

CMS is still accepting measures for the Advancing Care Information performance category of the Merit-based Incentive Payment System (MIPS). The Annual Call for Measures and Activities ends June 30, 2017.

CMS encourages providers to identify and submit measures for the MIPS Advancing Care Information performance category. To be considered, proposals must include specific criteria including, but not limited to, measure description, measure type and numerator and denominator descriptions.

CMS requests that stakeholders consider outcome-based measures, patient safety measures and cross-cutting measures that use certified EHR technology to support the improvement activities and quality performance categories of MIPS.

Use the Advancing Care Information Submission Form to propose measures for inclusion, and send the form to CMSCallforMeasuresACI@ketchum.com.

To learn more about the process for submitting measures, please visit the Call for Measures webpage, and review the Call for Measures and Activities fact sheet.

CMS Looks to Boost Medicare Payments to Rehab Hospitals, Nursing Facilities and Hospices

CMS could boost Medicare payments to a swath of rehabilitation hospitals, nursing facilities and hospices under a trio of new proposed rules.

On April 27, the agency floated a $390 million bump in federal payments to skilled nursing facilities in 2018—or roughly 1 percent higher than this year. Hospices, meanwhile, would receive a 1 percent increase worth $180 million.

CMS is planning to increase reimbursement to rehab hospitals by $80 million for 2018, in addition to eliminating a penalty on facilities that don’t submit certain data to the federal government on time.

Similar to proposed payment rules for other providers, CMS is asking the industries for input on regulations it should overhaul or eliminate. CMS Administrator Seema Verma and HHS Secretary Tom Price have pledged to review all of the agency’s rules in a bid to cut unnecessary or burdensome regulations.

Comments on the trio of rules must be received no later than 5 p.m. on June 26, 2017.

CMS Seeking Comments on Data Elements in IMPACT Act

CMS has contracted with the RAND Corporation to develop standardized patient/resident assessment data elements in alignment with the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act).

CMS seeks comments from stakeholders on data elements that meet the IMPACT Act domains of cognitive function and mental status; medical conditions and co-morbidities; impairments; medication reconciliation; and care preferences. The public comment period opens on April 26, 2017, and closes on June 26, 2017.

For more information, view the public comment webpage.

CMS Issues 2018 IPPS Proposed Rule

CMS issued the FY 2018 Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) rule on April 14, which proposes a number of changes to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs.

The proposals include:

  • For CY 2018, modifying the EHR reporting period from the full calendar year to a minimum of any continuous 90-day period for new and returning participants in the Medicare and Medicaid EHR Incentive programs.
  • Adding a new exception from the Medicare payment adjustments for Eligible Professionals (EPs), Eligible Hospitals and Critical Access Hospitals (CAHs) that demonstrate through an application process that complying with the requirement for being a meaningful EHR user is not possible because their certified EHR technology has been decertified under ONC’s Health IT Certification Program.
  • Implementing a policy in which no payment adjustments will be made for EPs who furnish “substantially all” of their covered professional services in an ambulatory surgical center (ASC); applicable for the 2017 and 2018 Medicare payment adjustments.
  • Using Place of Service (POS) code 24 to identify services furnished in an ASC as well as requesting public comment on whether other POS codes or mechanisms should be used to identify sites of service in addition to or in lieu of POS code 24.

Comments must be submitted by 5 p.m. on June 13, 2017.

To learn more, review the proposed rule or click here.

CMS Publishes Post-Acute Care Proposed Rules

On May 11, CMS published the following proposed rules:

6. Reports

GAO: PTSD, Traumatic Brain Injury Need to be Considered in Misconduct Separations

In a new report, GAO says actions are needed to ensure post-traumatic stress disorder and traumatic brain injury are considered in misconduct separations.

PTSD and traumatic brain injury can affect the behavior of service members in the armed forces and may lead to separations for misconduct. GAO examined misconduct separations and found that service members diagnosed with PTSD, TBI or certain other conditions can receive an “other than honorable” discharge—making them potentially ineligible for VA health benefits.

However, not all of the military services have consistent policies in place to address the impact of these disorders on misconduct separations. GAO recommended that DOD direct the military services to address inconsistencies in their separation policies.

To read the report, click here.