- No Surprises Act (NSA) and Transparency Rules (TinC)
- DC and Federal Update
- State Activity
- The Industry
HIGHLIGHTS: Congress sends multiple letters to HHS on NSA; Transparency bill addresses ERISA contract issues; Government shutdown imminent… again; Medicare drug price negotiations continuing smoothly; Updates on Change Healthcare cyberattack.
No Surprises Act (NSA) and Transparency Rules (TinC)?
Members of Congress sent a letter to the HHS Secretary requesting proper implementation of the NSA. The letter singles out several proposals the lawmakers want to see finalized, including IDR process improvements, enforcement of plans’ QPAs, network shrinking, compliance, and enforcement of statutorily required payment timelines.
The Senate Health, Education, Labor, and Pensions (HELP) Committee sent a letter to HHS about how the recent Change Healthcare cyberattack impacts the NSA’s IDR process.
- Calling HHS’s response “inadequate,” the committee sent a list of questions for the agency about its role and responsibilities in the face of the attack.
- The committee asked whether there will be an extension of the IDR submission timeline for NSA claims — implying that the committee believes there should be. The letter gives a deadline of April 1 for HHS’s answers, meaning we might have an answer as to whether to expect any changes to the IDR process shortly.
Fortune reports on 75 unions and employers that have endorsed the Senate’s healthcare price transparency bill (S 3548), and why Congress must pass it to make healthcare “more affordable, accessible, and equitable.”
- The bill appears to allow employer groups (ERISA) to access 835s and 837s and other information from any of their contractors, including providers/facilities, network or association of providers, service providers offering access to a network of providers, TPAs, and PBMs.
- The bill also requires plans to make public a MRF “user guide,” and amps up enforcement of transparency regulations.
- The bill, however, is not a part of the current appropriations package, and Congress is unlikely to pass any healthcare bill until after the November election.
DC and Federal Update
Congress is yet again staring down a potential government shutdown and considering a spending package debuted by Congressional leaders one day before the deadline.
- The package, which consists of six bills and comes with a $1.2 trillion price tag, must be approved by midnight Friday (3/22/24) to prevent a partial shutdown.
- While the package includes funding for federally funded health centers and other HHS programs, it does not include provisions affecting commercial healthcare.
Following the Biden administration’s initial offers to drugmakers for Medicare drug price negotiations, pharmaceutical representatives have emerged “surprisingly optimistic.”
- Several leaders from drug companies indicate they are actively engaged in the process and not discouraged by negotiations.? The drugmakers submitted counteroffers earlier this month, and at least one drugmaker indicating that the impact would be “modest.”
- In contrast, drugmaker lawsuits against the gov’t continue, but have thus far not proven successful.
At a recent House Ways and Means Committee hearing, lawmakers and witnesses agreed that they should work to increase the use of telemedicine and remote monitoring, but there was debate on whether some of these services should be paid at lower rates than in-person visits.
- At a separate hearing this week, the HHS Secretary also spoke on the value of telehealth services, noting that continuing certain telehealth flexibilities are vital to improving access to care.
- Telemedicine is on Congress' 2024 "things-to-do" list, before current extensions on telehealth waivers expire at the end of the year. But, again, not much expected to happen in Congress until after the election.?
CMS has issued guidance for Medicare expanding coverage for weight loss drugs like Ozempic and Mounjaro.
- While several Part D plans already cover similar drugs for Type 2 diabetes, the new guidance authorizes coverage for anti-obesity drugs if they are approved for additional health benefits and used for those conditions.
- Recently, the FDA approved Wegovy for reducing the risk of cardiovascular death, heart attack and stroke.
The States
Wonder where your state falls in terms of healthcare expenses?? See Forbes’ listing of “Most Expensive States for Healthcare” here.
- North Carolina earned the top spot for most expensive, and 5 others of the top 10 were in the South: FL, TX, SC, GA, and LA.
- At the other end of the spectrum, the Pacific region and the West overall had the most affordable healthcare.
The Industry
Latest on Change Healthcare cyberattack:
- The WSJ reports on how Availity, a competitor of Change, set up a free claims processing service for providers that were impacted by the attack. Availity estimates that 300K providers have used the service as of last week.
- CMS has released?flexibilities for state Medicaid agencies?to offer financial relief?to providers during the outage at Change Healthcare.
- Last week we reported on lawsuits that have been filed against UHG/Change by patients impacted by the attack. Now, providers have joined in the litigation with class action suits of their own.
- As analyzed in this article, a report from Fitch Ratings indicates that the cyberattack could damage the credit of smaller providers, pharmacies, and other healthcare organizations that rely on Change for financial services.
- UHG has released $2B in advanced payments and begun releasing medical claims preparation software in a move to restore services.
- The breach raises bigger questions about the digital security of the U.S. healthcare system. As such, Politico considers four big questions for the feds following the massive hack.
- MedPage Today considers the types of actions the U.S. can/should take to prevent future data breaches.
This update is solely for informational purposes and should not be relied upon as legal advice.????????
