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WEEKLY FEDERAL UPDATE

WEEK OF MONDAY, JULY 9, 2018

Key House Panel Releases Eight Draft Bills To Change 340B

The House Energy and Commerce Health Subcommittee will hold the long awaited 340B legislative hearing on Wednesday. 15 bills, including eight drafts, will be discussed reviewed. While witnesses have not been announced, it is expected the list will consist of Representatives with 340B legislation pending before the Subcommittee and the Administration. Among other changes, the legislation would stop the CMS regulation that cut payments for 340B drugs, create a patient definition, increase DSH percentage requirements to qualify for 340B, create new reporting requirements, impose a user-fee for covered entities, and require certain hospitals to pass along their savings to patients. Click here for the hearing notice and list of bills to be discussed. The day before the hearing, HHS Secretary Alex Azar will address the 340B Health summer conference, click here.

New Home Health Payment System Proposed for 2020; HHAs To Get 2.1 Percent Pay Hike

CMS' proposed rule for the home health prospective payment system was released by CMS last week that includes completely redesigning the home health pay system in 2020. The proposal focuses less on therapy and more on clinical characteristics, combined with changes to the quality reporting program proposed for 2019. CMS states that the redesign on of the payment system would save the government $60 million annually. CMS also released the proposed update for calendar year 2019, projecting that Medicare payments to HHAs would be increased by 2.1 percent, or $400 million. Additionally, the rule proposes to implement a number of provisions included in the Bipartisan Budget Act of 2018, including changes to the home health rural add-on that the agency estimates would lead to a $20 million cut, and home infusion transitional pay for 2019 and 2020 as well as changing the unit of payment under the home health PPS, from 60-day episodes of care to 30-day periods of care. Click here for the CMS fact sheet, and here for the proposed rule.

U.S. Opposes World Health Resolution Encouraging Breast Feeding

A resolution to encourage breast-feeding was expected to be approved quickly and easily by the hundreds of government delegates who gathered this spring in Geneva for the United Nations-affiliated World Health Assembly. The United States delegation, embracing the interests of infant formula manufacturers, upended the deliberations. American officials sought to water down the resolution by removing language that called on governments to 'protect, promote and support breast-feeding' and another passage that called on policymakers to restrict the promotion of food products that many experts say can have deleterious effects on young children. Click here for details.

Nursing Home Staffing Less Than Reported

Most nursing homes had fewer nurses and caretaking staff than they had reported to the government for years, according to new federal data, bolstering the long-held suspicions of many families that staffing levels were often inadequate.

The records for the first time reveal frequent and significant fluctuations in day-to-day staffing, with particularly large shortfalls on weekends. On the worst staffed days at an average facility, the new data show, on-duty personnel cared for nearly twice as many residents as they did when the staffing roster was fullest. Click here for more.

CMS Puts ACA's Risk Adjustment Program on Hold

CMS on Saturday issued a press release confirming that about $10.4 billion in risk adjustment payments for 2017 will not be made until the litigation described in the link is resolved. CMS states that it is seeking a "quick resolution" in the case but is, in the meantime, prohibited from collecting or making payments under the current risk adjustment methodology for 2014 to 2018. Click here for the CMS release.

CMS: ACA Exchange Enrollment Down 9 Percent

CMS has released the nationwide enrollment data of the Affordable Care Act marketplaces that shows sign-ups are down by 9 percent from 11.8 million to 10.6 million in 2018. The report also shows that there has been a slight increase in the percentage of exchange customers who qualified for subsidies, as of February, 87 percent of enrollees qualified for financial assistance, up from 84 percent at the same point in 2017. To read the reports, click here. Even though the percentage of new enrollees is down, another analysis shows the ACA still has a lot of life, click here.

  • While most courts have sided with the ACA during the Trump Administration, a more conservative Supreme Court could result in the ACA being overturned and the approval of other initiatives. Click here for the NY Times report.


CMS Plans Demo To Exempt Doctors In MA APMs From MIPS

Doctors in areas where Medicare Advantage is popular might be able to avoid the Merit-based Incentive Payment System if CMS officials follow through with a demonstration they announced June 29. It seems at least some of those MIPS-exempt doctors could be eligible for a 5 percent bonus reserved for those who participate in alternative pay models. CMS used an information-collection notice to lay out the demonstration. The Trump administration has relied heavily on informal processes, such as requests for information, that do not require the agency to follow through on proposals or release input it receives to the public. Click here for more from CMS.

Drug Prices Still on the Rise

Pharmaceutical manufacturers appear to be rejecting the Trump Administration's call for voluntarily reducing their prices as drug prices surged over the past month, according to new data. Pfizer increased prices on 41 drugs, while Novartis and Bayer both raised the prices on some of their expensive treatments like cancer drugs. A new Wells Fargo report found 104 price increases in June and the first two days of July, with an average jump of 31.5 percent which follows reports of 48 increases in May. These increases are well above the current U.S. inflation rate, which is less than 3 percent. HHS points out that this is the normal time of year when drug manufacturers post price increases. For more details, click here.

  • Kaiser Health News looks at how these hikes are impacting HIV prevention efforts, click here.


Emergency Room Visits Increased Significantly Over Decade

The rate of emergency department visits increased for all age groups between 2006 and 2015, according to a new government report. The highest increase, 20 percent, was among patients between 45 and 64. The AHRQ report showed that the overall rate of ED visits per 100,000 population reached a 10-year high in 2015; however, the proportion of ED visits that resulted in hospital admission decreased for all age groups from 2006 to 2015. To read the full report, click here.

  • ED's are also running out of vital drugs, according to a New York Times investigation, click here.


CMS Releases Final 2016, Preliminary 2018 DSH Allotments

CMS posted the final federal share disproportionate share hospital (DSH) allotments for federal fiscal year 2016 and the preliminary federal share DSH allotments for FY 2018. The agency also announced final FY16 and the preliminary FY 2018 limitations on aggregate DSH payments that states may make to institutions for mental disease and other mental health facilities. As the ACA reductions were postponed until 2020, the notice contains only the state-specific final FY 2016 DSH allotments and preliminary FY 2018 DSH allotments, as calculated under the statute without application of the reductions that would have been imposed under the ACA. State specific allotments begin on page 15 of the document, click here.

Cleveland's Largest Safety Net Hospital Cut Opioid Prescriptions by 60 Percent in 18 Months

Largely accrediting alerts set up in their electronic medical record system, MetroHealth System said it estimates they cut opioid prescriptions by 3 million pills. The alerts flag patients who may be at risk for addiction to guide them toward alternative drugs and lower doses. Additionally, there is an alert to add a prescription for the antidote drug Naloxone when prescribing opioids, leading to a 5,000% increase in Naloxone prescribing in the past three months. They are also working with community leaders and created an Office of Opioid Safety to focus on education, advocacy and treatment. Click here for details.

  • Tennessee-based Comprehensive Pain Specialists is closing all 30 clinics with its CEO being charged with conspiracy to defraud the United States. Click here.


The South Sees Highest Amount of Rural Hospital Closures

According to research from the North Carolina Rural Health Research Program, since January 2010, 85 rural hospitals have closed and 26 states have had at least one closure, most in the southern part of the U.S. The highest number of closures were in Texas with 14 followed by Tennessee which had eight, Georgia with six, and Alabama, Mississippi, and North Carolina each with five closures since 2010. To view the full list of closures by state, click here.

  • A rural hospital in Idaho, Doctors' Hospital, was notified by CMS that it did not treat enough inpatients in the past 12 months to meet CMS’ conditions of participation and lost billing privileges, click here.


11 States Awarded State Innovation Models by CMS

Eleven states were awarded State Innovation Models Initiative Model Test Awards in round two for the program, the CMS Innovation Center announced last week. Model Test Awards provide financial and technical support for states to test and evaluate multi-payer health system transformation models. States must implement a proposal capable of creating statewide health transformation for the majority of care within the state. The initiatives meant to accelerate the development and testing of new payment and service delivery models add up to over $620 million. Click here for details.

25,000 New Workers Added to the Health Care Sector

The Labor Department June Job's Report shows that the health care sector added 25,000 jobs in the month, a 12 percent growth from the previous month. The latest report from the Bureau of Labor Statistics details that hospitals added 11,000 jobs and ambulatory services added 14,000 employees. Overall, this leads to a health care job growth of over 300,000 in the past 12 months. To view the report, click here.

Study: Women, Not Men, Have Higher Risk of Diabetes When Working Long Hours

Canadian researchers found that women who consistently worked 45 hours or more per week had a 63 percent greater risk of diabetes compared with those who worked 35-40 hours per week. The relationship between diabetes risk and long hours for women was slightly attenuated when adjusted for potentially mediating factors such as smoking, leisure time, physical activity, alcohol consumption and BMI. There was no similar correlation found between diabetes development and work time found among men. The study did not evaluate the reason for this gender difference but researchers suggest it could have to do with the stress caused by the larger share of unpaid work women do in off-hours, household chores for example. Women who work longer hours also tend to be in lower-paying jobs than men, another contributor to stress. Click here for the study.

Health Groups File for 2020 California Ballot Initiative to Create Soda Tax

Two of California’s health care provider organizations - the California Medical Association and the California Dental Association - announced they will pursue a statewide soda tax initiative on the 2020 ballot to pay for public health programs. The initiative proposes a 2-cents-per-fluid-ounce tax, or an additional 24 cents tacked onto the cost of a 12-ounce can, an extra $1.34 for a 2-liter bottle sold in the state. This comes after California lawmakers passed a 12-year ban on cities and counties imposing any local soda tax. Click here.
  • In a bid to protect the environment, Hawaii's State Senate is debating a bill to ban major sunscreens, click here.


Drinking Coffee Leads to Longer Life: NIH

A study by NIH researchers shows a link between coffee drinking and living longer. Those that drink around two or three cups of coffee a day have a 12% lower risk of death than those that do not drink coffee. The study, that included half a million people, showed that it did not matter the type of coffee: regular, decaf, or instant. All had around the same benefits. The thinking behind the benefits is not the caffeine but instead all the other nutrients in coffee. The study pointed to improved heart and liver function and a decrease in Type 2 diabetes. Click here for the full study.

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