September 11, 2017
Senators come out in support of CHIP reauthorization
Senators on both sides of the aisle have stated support for extending the Children’s Health Insurance Program (CHIP), although last week’s Senate Finance Committee hearing on the reauthorization did not include a discussion regarding details of the program or how long to extend federal funding. If a CHIP reauthorization bill isn’t passed by September 30 either as a standalone bill or bundled with other must-pass reauthorizations, states will be forced to start winding down the program over the next few weeks or months.
Notes from HELP committee hearing with governors
Governors from Colorado, Massachusetts, Montana, Tennessee and Utah testified before the Senate HELP Committee on Thursday on strategies for stabilizing the ACA exchanges. All the governors urged Congress to guarantee CSR subsidies as quickly as possible and many favored simplifying and expediting approval for 1332 waivers that allow states flexibility in their exchange models. The Senate will hold additional hearings this week with key industry stakeholders.
The future of ACA “innovation waivers”
As the Senate HELP Committee resumes hearings on ACA stabilization this week, Chairman Lamar Alexander (R-TN) intends to focus on 1332 waivers, also known as state innovation waivers. States can already seek a waiver from many of the ACA’s mandates, but have to prove that the system won’t reduce coverage, affect patients’ benefits or increase federal spending. Alexander wants to focus on expediting and simplifying the filing process for 1332 waivers.
Senate approves $2 billion increase in NIH funding
A Senate subcommittee approved a $2 billion raise for the NIH for the 2018 fiscal year. The funding increase would bring NIH funding to $36 billion and contradicts a request from the Trump administration to cut the institution’s funding by more than 20 percent. The bill includes $414 million in new spending for Alzheimer’s research, an additional $140 million for the Brain Research through Advancing Innovative Neurotechnologies brain-mapping initiative, and $290 million for the All of Us precision medicine study. The bill will now be sent to the full Senate as part of a larger spending package for approval before being reconciled with the House bill.
CMS’ home payment model worries providers
CMS has proposed a new home payment model to combat concerns that the current reimbursement system discourages providers from serving patients with clinically complex or chronic conditions. Under the proposed home health groupings model, Medicare payment would be based on patients’ characteristics rather than the number of visits for various forms of therapy and would increase payment for skilled-nursing and home health aide visits for medically complex patients. Providers are concerned, given the CMS projections that the new model will result in a home health spending cut of $950 million in 2019 compared with the expected $80 million reduction if the current system is maintained. Experts believe not-for-profit and for-profit groups will adapt to the new system by changing their marketing strategies and rebalancing their patient mix.
Avoidable ER visits less frequent than previously thought
A very small fraction of emergency room visits are avoidable, according to a new study out by the University of California San Francisco. Only three percent of ER visits did not require some type of procedure, test or medication according to Federal ER visit data. In an effort to save money, some states and health insurers charge higher out-of-pocket costs or refuse to pay claims they deem as unnecessary visits in order to encourage people to use lower cost options like urgent care centers. However, this study suggests that most ER visits are valid.
Medicare spending slows
A new CBO report shows that the total spend on Medicare has grown by 3 percent in the first 11 months of the fiscal year. The average annual growth between 2010 and 2016 was over 4 percent and the average growth in the years between 2000 and 2010 was 9 percent. While the slowdown in spending is a good sign for the future of the program and for the federal budget, CBO downplayed the significance of the change, saying that the current growth rate is reflective of typical growth in the number of beneficiaries and the cost of services for those beneficiaries.
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