Weekly Policy Updates
Friday, September 18, 2020
TOP LINKS FOR THE WEEK
FEHB & OPM
Vote on new OPM Director Delayed: The Senate Homeland Security and Government Affairs Committee has delayed a vote, originally scheduled for September 16, on John Gibbs, the Trump Administration’s latest candidate for the OPM Director job. Mr. Gibbs’s controversial remarks in online posts and lack of significant federal human resources experiences drew concerns from federal employee unions and the Senior Executive Association. A new date for a confirmation vote has not been announced.
Democrats to Investigate Trump Appointees Meddling in CDC COVID-19 Reports: The House Democrat coronavirus subcommittee announced Monday that they were launching an investigation into Trump's political appointees’ involvement with Centers for Disease Control and Prevention (CDC) reports on coronavirus data. The announcement follows reports that HHS spokesperson Michael Caputo and his team placed substantial pressure on CDC officials to align their weekly Morbidity and Mortality reports with Trump statements, or halt some of the reports altogether. The House panel is demanding the administration submit all communications by CDC Director Robert Redfield regarding the reports alongside more documents from HHS political appointees.
Trump Signals Willingness for Larger COVID-19 Relief Package, Despite GOP Reservations: One week after Senate Republicans failed to pass a “skinny” COVID-19 relief package, Trump tweeted Wednesday telling Republicans to “go for the much higher numbers… it all comes back to the USA anyways.” Senate Majority Whip John Thune (R-S.D.) responded that a larger price tag on any package would be much more difficult to get Republicans on board, while House Minority Leader Kevin McCarthy (R- C.A.) also appeared skeptical of a potential $1.5 trillion deal. Conversely, Democratic leadership responded positively, urging the administration’s negotiators to “meet us halfway.” Pelosi has faced increasing calls from centrist Democrats to call a vote for new relief legislation in the $2.2 trillion range but she has indicated she has no intention of holding a vote without bipartisan support.
House Democrats Float Funding the Government Through February: House Democrats are discussing an option to fund the government with a stopgap bill into February, according to spokespeople for Democratic leadership. Neither chamber has introduced legislation to fund the government, but lawmakers are expected to use a continuing resolution (CR) to continue funding at 2020 levels past the September 30th deadline. Republicans are backing a bill that would include stopgap funding until mid-December, while Democrats are debating supporting a December bill or pushing for a bill going into early 2021. The longer bill may abate worries of a shutdown during a lame-duck period if Joe Biden is elected president, although a shorter bill could force a larger deal before the end of the year.
Senate Democrats Seek HHS and Department of Education Guidance on Student Mental Health: Senators Elizabeth Warren (D-M.A.) and Bill Cassidy (R-L.A.) issued a bipartisan letter to HHS Secretary Alex Azar and Secretary of Education Betsy Devos asking for their departments to release guidance to schools and universities on how to address the rising mental health needs of students. The letter cites the increased challenges that have been exposed or exacerbated by the COVID-19 pandemic, such as CDC data reporting almost 75 percent of people aged 18-24 had at least one adverse mental health symptom directly and 25 percent of people aged 13-19 reported poorer emotional health. Warren and Cassidy’s request includes issuing guidance on how to provide support, services, and accommodations to students.
Trump Executive Order on Aligning Prescription Prices with Other Countries: President Trump signed an Executive Order that ties payments for prescription drugs from Medicare to the prices offered in other developed countries. The EO means that Medicare would pay the “most favored nations” price from among OECD countries. The scheme would start in a limited way in 2020 with Part B drugs and move to Part D drugs in 2021.
Census Data Show Increase in Uninsured Rate: The Census Bureau is reporting that the number of uninsured grew by approximately 1 million in 2019, resulting in a rate of 9.2 percent uninsured. The rise is attributed in part to a series of actions by the Trump Administration to limit access to ACA Exchange plans and Medicaid, as well as the introduction of association and short-term plans which undermine ACA Exchange plans. The Census survey results, which reflect the pre-Covid environment, show wide variation in uninsured rates by state, ranging from 3 percent in Massachusetts to greater than 18 percent in Texas.
MedPac Weighs Keeping Telehealth Changes Post Covid: The Medicare Payment Advisory Commission (MedPAC) is considering making permanent some policy changes that have been instituted to increase access to telehealth during the pandemic. These changes to Medicare payment policy include allowing reimbursement for telephone visits, aligning reimbursement for video and in-person visits, and relaxing requirements for practitioner licensure in the state of patient residence. Some have expressed concerns about the lack of access to appropriate technology for Medicare beneficiaries, the increased potential for fraud and poor quality care with telehealth, and the threat to privacy from cyber attacks.
Employers Facing Difficulties with 2021 Rates: Credit Suisse reports that only 60 percent of employers surveyed are using actual 2020 experience to project 2021 trend rates. Other are using 2019 data or the first two months of 2020.
Centene and Cigna Plan to Expand ACA Marketplace presence – Centene, which already counts 2.2 million ACA Marketplace enrollees, is expanding to 400 new counties and 13 existing states and two new states (New Mexico and Michigan). Cigna is adding 79 counties to its reach, bringing its plan offerings to a total of 220 counties across 10 states.
Increasing Telehealth in Primary Care: A recently-released survey of primary care providers published in Health Affairs prioritizes policy changes that will result in expanded access to primary care through telehealth. These changes include harmonizing telehealth reimbursement with in-person care, covering care monitoring devices, providing incentives for the development of patient-friendly technology, and updating telehealth malpractice policies.
MIPS Scores for Physicians affiliated with Hospital Systems Higher: A study published in JAMA shows that physicians affiliated with hospital systems score significantly better on quality scores found in the Merit-based Incentive Payment System (MIPS). Conversely, physicians in practices with high concentrations of Medicaid and Dually Eligible members score lower. The MIPS scores are not adjusted by the coverage status of the beneficiary.