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NOTEWORTHY
2019 HealthCare.gov Enrollment Approaches 2 Million
The Centers for Medicare & Medicaid Services (CMS) reports that more than 1.9 million people selected a 2019 health plan through HealthCare.gov between November 1-17. This includes more than 748,000 who signed up last week - week 3 of sign-ups and the halfway point. More than three-quarters of those selecting plans were renewing coverage and the rest were new consumers. The report shows total plan selections for the period in the 39 states using HealthCare.gov for 2019 open enrollment, which runs through December 15.
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CVS Health and Aetna Close Deal
CVS Health and Aetna closed their $69 billion merger on Wednesday, November 28, bringing together one of the nation's largest pharmacy chains and one of the largest health insurers.
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Pelosi Wins Democratic Caucus Nomination for Speaker
California Rep. Nancy Pelosi, who has served 14 years as House Democratic leader, is on her way to securing another two after winning the Democratic Caucus's nomination for Speaker on November 28.
She will need a majority of the entire House - 218 votes if all members are present and voting - to secure the gavel. The final vote is to be held on January 3.
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FEDERAL
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HCA Testifies Before the HELP Committee
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Jonathan B. Perlin, M.D., Ph.D., M.S.H.A., M.A.C.P., President, Clinical Services and Chief Medical Officer for HCA Healthcare, testified before the Health, Education Labor & Pensions (HELP) Committee on November 28, on Reducing Health Care Costs by improving affordability through innovation. Dr. Perlin testified regarding a number of HCA initiatives that includes a study that defined the now industry-standard 39-week "hard stop," which sanctions obstetricians for elective, pre-39 week delivery that raises the risk of complications for newborns. This practice also saves the Medicaid program an estimated billion dollars annually.
Dr. Perlin also testified about HCA's collaboration with colleagues at AHRQ, CDC, and Harvard following HCA's successful best practices to reduce "methicillin resistant staph aureus," known as MRSA. After 18 months, across 43 HCA hospitals, and 75,000 patients, it was discovered that the practice of an antiseptic sponge bath with antibiotic nose drops reduced potentially fatal MRSA infections by 37 percent and all bloodstream infections by 44 percent.
The third data science Dr. Perlin offered the Committee was the "big data" product of meaningful use. "We now have algorithms that monitor every patient in every hospital that's been part of HCA for more than a year. This system identifies patients with sepsis as accurately as the best clinicians and excludes patients without sepsis twice as accurately. It gives new clinicians a support system that can make them as good as the best clinicians, and it does what no clinician can do; it monitors all the relevant labs and other data 24x7x365."
Other witnesses included:
Lee S. Gross, M.D.
President, Docs 4 Patient Care Foundation and Founder
Epiphany Health Direct Primary Care
North Port, FL
Cheryl DeMars
President and Chief Executive Officer
The Alliance
Madison, WI
Dow Constantine
Executive of King County
Seattle, WA |
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Senate Urged to Vote on Overdose Prevention and Patient Safety Act
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More than 220 organizations, including the American Hospital Association, urged Senate committee leaders to consider the Overdose Prevention and Patient Safety Act (H.R. 6082), and encourage Senate leadership to bring the bill to the floor for a vote during the lame-duck session. The House-passed bill would align federal regulations governing the confidentiality of drug and alcohol treatment and prevention records with the Health Insurance Portability and Accountability Act and strengthen consumer protections. "Modifying Part 2 to ensure that HIPAA-covered entities have access to a patient's medical record will improve patient safety, treatment, and outcomes across the care delivery spectrum, enhancing the entire opioid package passed by the House and Senate," the organizations said in a letter to leaders of the Senate Health, Education, Labor and Pensions Committee. |
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CMS to Update Overall Hospital Star Ratings in February
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The Centers for Medicare & Medicaid Services (CMS) will update its overall hospital quality star ratings on Hospital Compare in February 2019, the agency announced. The January refresh of other data on Hospital Compare will also move to February. Hospitals in the program will be able to preview their overall star ratings and other data updates relevant to them for February at QualityNet in early December 2018. CMS also will host a Nov. 27 webinar on the new QualityNet user interface for these quality reporting programs. In July, CMS delayed updating the overall star ratings to analyze and address stakeholder concerns with the data. |
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Senator Grassley to Move to Finance Committee
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Senator Charles Grassley (R-IA) announced last week that he plans to trade his Senate Judiciary Committee gavel to lead the Finance Committee next year, which leaves Senator Lindsey Graham (R-SC) in line to replace him as Chairman.
Senator Grassley's move to Finance was not a foregone conclusion, because the Judiciary panel has played an outsized role in the successful confirmation of more than 80 of President Donald Trump's nominees to lifetime appointments on the federal bench. That number could include future Supreme Court justices beyond Neil Gorsuch and Brett Kavanaugh in the next Congress, heightening the influence of the Judiciary Chairman.
However, Grassley, a former Finance chairman, opted to return to a committee that also enjoys extensive jurisdiction, including taxes and trade, as well as Medicare and Medicaid. The Iowa Republican is set to replace retiring Senator Orrin Hatch (R-UT) as Finance Chief next year, while also replacing him as Senate pro tempore, a post traditionally given to the longest-serving majority Senator, which is also third in the presidential line of succession.
Grassley's departure paves the way for Graham to take the helm at Judiciary, giving the South Carolina Republican valuable power over Department of Justice confirmations - including the next attorney general. It also gives the next chairman oversight of the DOJ as it supervises Special Counsel Robert Mueller's investigation into Trump. |
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Verma on Work Requirements - CMS Will 'Put Out As Many As We Can'
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In response to patient advocate calls, on November 27, CMS Administrator Seema Verma signaled that the agency intends to proceed full steam ahead in approving Medicaid work requirements, despite growing calls from patient advocates and federal Medicaid advisers for the agency to slow down.
As it pertains to Arkansas, who lost approximately 8,000 beneficiaries since the work requirement was established, Ms. Verma stated that there is not enough evidence to determine why the Medicaid members were disenrolled in the program. She said that some may have found insurance elsewhere, or found jobs, and some may simply have chosen not to participate in the program. The end result is that more data is needed before they can say the work program is not working. |
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Stakeholders Push Congress to Repeal Cadillac in Lame Duck
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Stakeholders are urging Congress to repeal the Affordable Care Act's Cadillac tax during the remaining weeks of the lame-duck session, even though outgoing House Ways & Means Committee Chairman Kevin Brady (R-TX) has signaled that legislation regarding health care taxes is not a top priority for the House GOP during their few remaining days in the majority.
The Save American Workers Act, a $51.6 billion legislative package that passed the Ways & Means Committee earlier this year, includes a one-year delay of the Cadillac tax, and also provides four years of relief from the employer mandate and replaces the mandate's 30-hour threshold classification for full-time employees with a 40-hour threshold. House Republicans and industry stakeholders have unsuccessfully attempted to bring the legislation to the floor for months.
Despite the push for Congress to revisit the legislation, Brady has said that the House GOP may not have time to do so in the lame-duck session due to a laundry list of last-minute, must-pass bills, including meeting the December 7 deadline to fund the government. But Brady also previously told reporters that he hopes to include parts of the legislation in an end-of-year package, if possible.
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STATE
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Kentucky
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CMS Reapproves Medicaid Waiver With Work Requirement
The Centers for Medicare & Medicaid Services (CMS) has reapproved a Section 1115 Medicaid demonstration waiver for Kentucky that requires some adult beneficiaries to work or participate in other "community engagement" activities, such as job training or community service, to remain eligible for coverage. The demonstration program also includes a substance use disorder program for Medicaid beneficiaries, and continues coverage to former foster care youth from another state. Kentucky expects to roll out the program regionally over several months beginning next April.
CMS initially approved the waiver in January, but a federal judge sent it back to the agency for further review, concluding that the Department of Health and Human Services (HHS) failed to adequately consider whether the demonstration would meet the Medicaid program's objective to help provide medical assistance to residents. CMS then opened a new federal public comment period. In reapproving the waiver, the agency said the demonstration "is likely to assist in promoting Medicaid's objectives."
In addition to Kentucky, CMS has approved work and community engagement waivers for Arkansas, Indiana, and Wisconsin, and 10 other states have submitted waiver applications. The Arkansas requirements also are being challenged in court. The Medicaid and CHIP Payment and Access Commission this month urged HHS to pause disenrollments related to the work requirements in Arkansas, and establish mechanisms to effectively evaluate and monitor work requirement demonstrations before allowing states to enforce them.
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Kansas
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New Governor is Pro-Medicaid Expansion
Governor-elect Laura Kelly (D) says she thinks Kansas can expand Medicaid in the coming year, and that a task force will develop her expansion proposal. Kelly knows it is not up to her to pass Medicaid expansion, but up to the Legislature, which she hopes will act on expansion next year. If presented with a bill that does what it needs to do, she said she will sign it. Kelly, a Democratic State Senator who beat Republican Kris Kobach, made Medicaid expansion one of her top priorities on the campaign trail.
For states that expand Medicaid eligibility to people who make up to 138 percent of the federal poverty level, the federal government pays 90 percent of the cost of expansion. For a family of four, 138 percent of the federal poverty level is $34,638 in annual income. |
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Mississippi
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Run-Off Election Results
Mississippi Governor Phil Bryant (R) appointed fellow Republican Cindy Hyde-Smith to the Senate seat vacated by former GOP Senator Thad Cochran (R), who resigned for health reasons earlier this year. Hyde-Smith is now running to fill out the remaining two years of Cochran's term against former Democratic Representative Mike Espy, who also served as Agriculture Secretary in the Clinton administration. At the end of the day, Hyde-Smith received 54 percent of the votes to Espy's 46 percent. This shores up Majority Leader Mitch McConnell's (R-KY) lead in the Senate with 53 Republicans to 47 Democrats. |
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Tennessee
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Lee to Retain Haslam's Commissioners for Human Services, Mental Health
Governor-elect Bill Lee plans to retain two Commissioners from fellow Republican Governor Bill Haslam's administration. They are Danielle Barnes, the Commissioner of the Department of Human Services, and Marie Williams, who heads the Department of Mental Health and Substance Abuse Services. Other current Commissioners are also expected to be held over for the Cabinet of the new Lee administration.
As The Tennessee Journal reported earlier this week, Lee plans to name Stuart McWhorter as Commissioner of the state Department of Finance and Administration. McWhorter was Lee's finance Chairman during the Governor's race and is currently the Chairman of his inauguration planning efforts.
Lee plans to have most of his Cabinet named by the time he is sworn in as Governor on January 19.
For more information, click here.
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Utah
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Love Concedes Election
Republican Representative Mia Love officially conceded to Democrat Ben McAdams on Saturday, acknowledging his victory in their tight race for Utah's 4th Congressional District.
While the vote count favored McAdams on election night, the edge shifted to Love as more ballots were tallied. When county canvasses certified the final outcome on November 27, the Democrat finished with a 694-vote margin of victory, just outside the 0.25 percentage-point window for a recount.
McAdams, the two-term mayor of Salt Lake County, has styled himself as a moderate who wants to work on bipartisan legislation.
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Virginia
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Medicaid Expansion Drawing More Enrollees Than Expected
Just a few weeks after registration opened for its expanded Medicaid program, Virginia officials say they have already drawn thousands more applicants than initially anticipated. The state had expected the new program to enroll 300,000 over the next year and a half, but now expect that number to reach 375,000. The new estimates will not alter the total expansion population, which the state has said will be about 400,000. Officials attributed the increase to automatic enrollment of residents who are already signed up for other social benefit programs like the Supplemental Nutrition Assistance Program, commonly known as food stamps. He said the state now expects that 256,000 people will be enrolled by January 1, 2019 when the coverage goes into effect.
1115 Demonstration Waiver Submitted to CMS
Virginia's 1115 Demonstration Waiver, COMPASS, was submitted to the Centers for Medicare & Medicaid Services (CMS) on November 20th. The waiver includes a work requirement that lawmakers voted to approve as they separately approved the expansion of Medicaid earlier this year. Virginia is already enrolling people into the expanded Medicaid program and their coverage will start on January 1, 2019. If approved by CMS, the work requirement and its copay, healthy behavior, housing, and employment support provisions would apply to certain recipients within the expansion population. Now that the waiver has been submitted, CMS has 15 days to review then a 30 day federal public comment begins. The work requirement and other provisions would not go into effect until after CMS approval, and there is no defined timeline for that decision. |
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INTERNATIONAL
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CHA - UK
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Brexit Deal Agreed, But Unlikely to Pass Parliament
Prime Minister Theresa May met Jean Claude Juncker, President of the European Commission last Wednesday in Brussels to finalise the terms of the Political Declaration on the Future Relationship with the EU. May returned to Brussels on Saturday to finalise it before the special European Council meeting, which signed off on the deal on Sunday. Now the deal needs to be put to the UK parliament. May faces an uphill battle to achieve this. Around 410 Members of Parliament (MPs) have come out against the deal, with only 220 saying they will support it. May needs a further 100 votes to win it. If it fails, the UK enters unprecedented territory, with many scenarios likely to unfold, including a potential vote of no confidence in the Prime Minister, a second general election, a second referendum, or a renegotiation. Meanwhile, Chancellor of the Exchequer, Philip Hammond MP, has stated that the UK will become poorer by leaving the EU. |
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