ACHP Media Monitoring Report – November 15, 2017



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November 15, 2017

Senate tax proposal would repeal individual mandate
The latest version of the Senate tax bill includes a repeal of the ACA’s individual mandate. As of now, the House bill does not include provisions repealing the mandate. Senators are including the repeal in an effort to offset the tax plan’s $1.5 trillion in tax cuts. According to the nonpartisan CBO, repealing the individual mandate is expected to save the government $340 billion over the next 10 years, but also lead to 4 million more uninsured in 2019 and 13 million more uninsured over the next decade. The CBO also notes that, if the Senate bill is passed as written, it could trigger automatic spending cuts, including a funding cut of $25 billion for Medicare.

Risk-corridor payments reach over $12 billion
The latest CMS data show that the federal government now owes health insurers $12 billion in risk-corridor payments. The payments are to cover losses health plans incurred on the insurance exchanges between 2014 and 2016. Data also shows that some of the payments are owed to insurance companies that have already closed, partially due to the lack of risk-corridor payments. Thirty-six lawsuits, including a class-action involving about 150 insurers, have been filed against the U.S. government by health plans seeking to recoup the risk-corridor payments. Two of those three dozen cases will soon be argued before the U.S. Court of Appeals for the Federal Circuit. In February, ACHP filed an amicus brief in one of the pending risk-corridor cases.

Medicare costs rising due to increase in hospital-employed physicians
According to an analysis released by Avalere, hospital acquisition of health care providers is helping drive up costs for Medicare because hospital-employed physicians performed more services in costlier hospital outpatient settings. This has resulted in up to 27 percent higher costs for Medicare and 21 percent for patients. According to the report, a 49 percent increase in hospital-employed physicians between 2012 and 2015 led to cost increases for four specific procedures in cardiology, orthopedics, and gastroentology, resulting in $3 billion increase in Medicare costs. Some payers have been pushing back on hospitals and systems that have profited off reimbursement rules that allow them to charge higher fees for services delivered in hospital off-campus facilities. CMS also recently finalized a proposal to slash what Medicare pays for are obtained at hospital-owned off-campus facilities.

EHR can impact use of social determinants of health
Insurers and providers have increasingly focused on addressing social determinants of health and believe the use of electronic health records (EHR) may help. Updating the EHR to include patient questionnaires on tobacco use, diet, exercise and housing quality can help address barriers to health. Physicians and payers can use this information technology tool to both help individual patients and to guide interventions for broader communities.

Medicaid work requirements
CMS Administrator Seema Verma plans to give states greater latitude in shaping the eligibility requirements and benefits packages offered by state Medicaid programs. CMS has already suggested it will allow states to implement work requirements, and Verma has also suggested she is open to allowing states to charge monthly premiums, perform drug tests, and cap how long people can receive Medicaid benefits. Verma has compared the changes to similar requirements for other federal assistance programs, such as food stamps. However, some are concerned the requirements could force millions of Americans out of the program, jeopardizing their health. Nearly 75 million people are covered by Medicaid, including 16 million added since 31 states and the District of Columbia expanded their programs under the ACA.

CMS reminding providers how to charge dual-eligible patients
CMS has recently become concerned about reports that some dual-eligible recipients of Medicare and Medicaid are being wrongly charged by providers, despite their participation in the Qualified Medicare Beneficiary (QMB) program. The QMB program, which covers more than 7 million people, is set up so that Medicaid pays the premiums of dual-eligible Americans. But some of these people are being billed for medical services and, in some cases, ending up in debt because of charges they never should have been asked to pay. CMS is circulating a notice to providers to make sure they’re aware of the erroneous billing that has been occurring and to teach providers about the CMS tools designed to prevent it.

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