Category: Uncategorized

MM Curator summary

Despite industry opposition, hospitals will now have to report the prices they accept from insurers as payment.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

The U.S. Court of Appeals for the D.C. Circuit on Tuesday upheld a Trump administration rule that requires hospitals to disclose the prices they negotiate with insurers for a range of health tests and procedures.

The 2-0 decision by the appeals court means that American patients will have access to hospital pricing information starting on Jan. 1, 2021, helping them find the lowest costs and the highest quality of care when deciding on treatment.

“This transformative hospital price transparency rule has been fought at every step by the swamp and defenders of the status quo,” White House Press Secretary Kayleigh McEnany said in a statement.

“Today’s ruling should reassure the American people that President Donald J. Trump refuses to bow to the influence of special interests who would prefer to keep patients in the dark. This initiative is just one in a series of rules that will bring unprecedented price transparency to all elements of healthcare,” she added.

The Centers for Medicare & Medicaid Services (CMS) issued the transparency rules in November 2019, calling on hospitals to make public the often-secret rates that they negotiate with insurance companies for all services, drugs, and supplies. The Department of Health and Human Services (HHS) said in a statement at the time that hospitals must make public all standard hospital charges in a single data file.

The moves came as a result of Trump’s signing of an executive order in June 2019 over price transparency.

Hospitals, insurer organizations, and advocacy groups objected to the rules, and said that the Trump administration did not have authority to require the disclosures, which they held to be trade secrets. The hospitals also disputed that the policy would benefit consumers and lead to lower costs, arguing that compliance would instead be too burdensome and interfere with their care for patients.

The finalization of the rule prompted the American Hospital Association (AHA) to file a legal challenge. They argued that the White House didn’t have the authority to make the rule and in doing so had violated the First Amendment in its creation, and had acted in an “arbitrary and capricious” manner.

A federal judge ruled on June 23 that the Trump administration rules were legal. But the groups appealed on Oct. 15.

In the appeal, the groups said that the price transparency rules would pose a “herculean” and costly task of compiling health care costs, while reducing competition and causing confusion about patients’ out-of-pocket expenses.

Circuit Judge David Tatel, however, said concerns about the burdens “miss the mark,” and pointed to HHS Secretary Alex Azar’s findings that greater disclosures would benefit the “vast majority” of consumers and likely result in lower—not higher—prices.

“The Secretary weighed the rule’s costs and benefits and made a reasonable judgment that the benefits of easing the burden for consumers justified the added burdens imposed on hospitals,” Tatel wrote.

The latest decision upholds the June 23 ruling by U.S. District Judge Carl Nichols.

Melinda Hatton, the AHA’s general counsel, said the group was disappointed and hopes that a potential Biden administration would revise the rule and exercise “enforcement discretion” until the CCP (Chinese Communist Party) virus pandemic runs its course.

On Twitter, Azar praised the decision. “Big win for American patients today. The DC Circuit ruling is another major victory for President Trump’s transformative healthcare agenda. Starting January 1, Americans will have access to the actual prices paid for the most common hospital services,” he wrote.

The U.S. Chamber of Commerce supported the hospital groups, saying the rule could cause hospitals to demand higher prices for their services if they saw other hospitals charging more.

The case is American Hospital Association et al v. Azar, D.C. Circuit Court of Appeals, No. 20-5193.

Janita Kan and Reuters contributed to this report.

Clipped from: https://www.ntd.com/appeals-court-upholds-trump-rule-requiring-hospitals-to-show-prices-upfront_546698.html

 

MM Curator summary

TN received approval for its first-of-its-kind innovation waiver to share savings it creates in its Medicaid program with CMS.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

Seema Verma, chief administrator of the Centers for Medicare & Medicaid Services, says the changes in the way Medicaid is funded and regulated in Tennessee “could be a national model moving forward.”

With less than a dozen days left in power, the Trump administration on Friday approved a radically different Medicaid financing system in Tennessee. With this move, the federal government is for the first time granting a state broader authority in the operation of its health insurance program for the poor without interference from Washington, allowing Tennessee to make decisions on such issues as whether to add new benefits or eligibility categories or spend Medicaid dollars outside of health care, if it thinks that would help enrollees.

Instead of the open-ended federal contribution to the funding of Medicaid in all other states — which increases with higher enrollment and associated health costs — Tennessee will instead get a capped amount of money, via an annual block grant.

The annual funding cap will increase if enrollment grows. What’s different is that, unlike with other states, Medicaid funding to Tennessee won’t automatically keep up with rising expenses.

The approval is a 10-year “experiment,” according to Friday’s announcement by Seema Verma, administrator of the federal Centers for Medicare and Medicaid Services. The approach has been pushed for decades by conservatives who say states too often chafe under strict federal guidelines about enrollment and coverage. They think they can find ways to provide care more efficiently, she says.

But Michele Johnson, executive director of the Tennessee Justice Center sees the move as a step backward for the state’s Medicaid program.

“No other state has sought a block grant, and for good reason,” Johnson says. “It gives state officials a blank check and creates financial incentives to cut health care to vulnerable families.”

Tennessee is one of 12 states that have not approved expanding Medicaid under the Affordable Care Act – a decision that’s left tens of thousands of working adults in Tennessee without health insurance.

Whether this change in the way Tennessee’s Medicaid program is funded will stick is an open question. The incoming Biden administration is likely to oppose the move, but to unravel it, officials would need to set up a review that includes a public hearing.

Implementing such a fundamental change via an executive branch action rather than getting Congress to amend Medicaid law is also likely to be met with court challenges.

In any event, the changes to the state’s program will take months to implement because the shift in policy requires final approval by the legislature, and officials in Tennessee must also negotiate quality of care targets with the administration.

TennCare, the state’s Medicaid program, says the new system would give it unprecedented flexibility to decide who is covered and what services it will pay for.

Under the agreement, TennCare will have a specified annual spending cap, to be based on historical spending, inflation and predicted future enrollment changes. If the state can operate the program at a lower cost than the cap and maintain or improve quality, the state then shares in the savings.

Trump administration officials say the approach adds incentive for the state to save money, unlike the current system, in which increased state spending is matched with more federal dollars. If Medicaid enrollment grows, the state can secure additional federal funding. If enrollment drops, it will get less money.

“This groundbreaking waiver puts guardrails in place to ensure appropriate oversight and protections for beneficiaries, while also creating incentives for states to manage costs — while holding them accountable for improving access, quality and health outcomes,” Verma said. “It’s no exaggeration to say that this carefully crafted demonstration could be a national model moving forward.”

The agreement is somewhat
different from traditional block grants championed by conservatives, the CMS notes, since it allows Tennessee to get more federal funding as enrollment grows. And while the state is given flexibility to increase benefits, it can’t on its own cut benefits.

However, opponents — including most advocates for low-income Americans — say the approach will threaten care for the 1.4 million people in TennCare — a group that includes children, pregnant women and the disabled. Federal funding covers two-thirds of the cost of the program.

Democrats have fought back against block grant Medicaid proposals since the Reagan administration and most recently in 2018 as part of Republicans’ failed effort to repeal and replace major parts of the Affordable Care Act. Even some key Republicans opposed the idea because it would cut billions in funding to states, and that would make it harder to help the poor.

The approval of Tennessee’s request comes as Medicaid enrollment is at its highest-ever level.

More than 76 million Americans are covered by the state-federal health program — a million more than when the Trump administration took charge in 2017. Enrollment has jumped by more than 5 million in the past year as the economy slumped with the pandemic.

Medicaid, part of President Lyndon B. Johnson’s “Great Society” initiative of the 1960s, is an entitlement program in which the government pays each state a certain percentage of the cost of care for anyone eligible for the health coverage. As a result, the more money states spend on Medicaid, the more they get from Washington.

The newly approved demonstration project in Tennessee calls for CMS to work with the state to set spending targets that will increase at a fixed amount each year.

The plan also includes a “safety valve” to increase federal funding in the case of unexpected increases in enrollment.

“The safety valve will maintain Tennessee’s commitment to enroll all eligible Tennesseans with no reduction in today’s benefits for beneficiaries,” according to a CMS written statement.

Tennessee has committed to maintaining coverage for eligible beneficiaries and existing services while staying under the spending targets.

In exchange for taking on this financing approach, the state will receive a range of operating flexibilities from the federal government, as well as up to 55% of the savings generated on an annual basis when spending falls below the aggregate spending cap and the state meets certain quality targets, yet to be determined.

The state can spend that money on various health programs for residents, plus areas that Medicaid funding typically doesn’t cover, such as improving transportation and education and employment for enrollees.

Ten years is an unusually long time for a federally granted waiver of its rules, but the Trump administration has approved other long-term experiments in recent years to give states more flexibility.

“The block grant is just another example of putting politics ahead of health care during this pandemic,” says Johnson of the Tennessee Justice Center. “Now is absolutely not the time to waste our energy and resources limiting who can access health care.”

State officials in Tennessee applauded the approval.

“It’s a legacy accomplishment,” says Gov. Bill Lee, a Republican. “This new flexibility means we can work toward improving maternal health coverage and clearing the waiting list for developmentally disabled.”

“This means we will be able to make additional investments in TennCare without reduction in services and provider cuts.”

Kaiser Health News is a nonprofit, editorially independent program of the Kaiser Family Foundation, and is not affiliated with Kaiser Permanente. KHN chief Washington correspondent Julie Rovner contributed to this report.

Clipped from: https://www.npr.org/sections/health-shots/2021/01/09/954985151/trump-officials-approve-tennessees-controversial-request-to-revamp-medicaid-fund

 

MM Curator summary

CMS officially withdrew the Medicaid Financial Accountability Regulation after a year of intense industry protest on the reg that would have changed multiple financing schemes used to maximize federal funding.

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

The Centers for Medicare & Medicaid Services has officially withdrawn a controversial Medicaid proposal that providers warned could up to $50 billion from the program annually. 

CMS Administrator Seema Verma announced the move to officially rescind the Medicaid Fiscal Accountability Rule (MFAR) from the federal register on Twitter Thursday afternoon.

In late November, some had feared that CMS would walk back on the decision to withdraw after Verma defended the proposal while speaking with the National Medicaid Directors Association.

“While we support its intent, further work is needed to ensure accountability for states while protecting critical safety-net care for vulnerable patients,” Verma wrote. “While the proposed rule will be withdrawn, I thank Congress for recently enacting new payment transparency requirements which help accomplish our goals.” 

The agency in mid-September announced plans to rescind the MFAR proposal. The decision was cheered soundly by long-term care providers who feared the rule would cripple Medicaid financing in states and jeopardize beneficiaries’ access to care.

Clipped from: https://www.mcknights.com/news/cms-officially-withdraws-50b-threat-to-medicaid/