• Senators Bernie Sanders and Roger Marshall have worked to create compromise legislation which reauthorizes the Telehealth Technology-Enabled Learning Program, allocating $11 million per year through fiscal year 2026. These efforts are a part of the Bipartisan Primary Care and Health Workforce Act, a bill which aims to support the healthcare workforce and shore up programs that strengthen the network of primary care. PBM reforms, including the Pharmacy Benefit Manager Reform Act and the Modernizing and Ensuring PBM Accountability Act, are potential sources of funding for the new legislation. The Bipartisan Primary Care and Health Workforce Act bill would prohibit hospitals from billing facility fees for telehealth services and for the evaluation and management of healthcare services. However, The Federation of American Hospitals President and CEO, Chip Kahn, expressed concerns that the bill could jeopardize access to telehealth and essential healthcare services, particularly in rural and underserved areas. (Inside Health Policy, September 14, Inside Health Policy, September 15)
• CMS is expected to release information on states’ review of their eligibility processing errors in the automatic Medicaid renewal process. The error, which CMS mandated states review, specifically occurs in a state’s ex parte renewal process where an entire family enrolled in Medicaid is determined ineligible and is disenrolled from the program if the state needs more information from just one of the family members to confirm eligibility. More than a dozen states initially reported this glitch before CMS started asking states to review and analyze the issue. (Inside Health Policy, September 15)
• On September 13, CMS announced manufacturers of thirty-four Medicare Part B drugs will be required to pay inflationary rebates put in place by the Inflation Reduction Act (IRA). CMS predicts that individuals taking these Medicare Part B drugs will save up to $614 per dose in coinsurance rates as a result. The updated coinsurance rates for the listed drugs will be 20% of the inflation-adjusted payment. The lower coinsurance rates will be in effect from October 1, 2023, to December 31, 2023. CMS also stated the Part B drugs affected by the adjustment could be updated quarterly. The information from CMS comes just weeks before drug makers with products selected for Medicare Part D price negotiations have to decide whether to participate in the program. There are currently eight active lawsuits pending against HHS seeking to delay the new price negotiation program. (Inside Health Policy, September 14)
• On September 14, leaders of the House Energy & Commerce and Oversight Committees sent a letter to HHS Secretary Xavier Becerra with threats to subpoena the agency to obtain documents on COVID-19 origins if their prior request for information is not addressed. Information that is being requested includes all communications from the National Institutes of Health (NIH) officials on a grant made to EcoHealth Alliance. The letter requests all materials be provided by October. (Inside Health Policy, September 15)
• With the threat of a government shutdown looming, many health-related programs that are due to sunset at the end of the month without congressional action are in jeopardy. Key health interests not only have billions of dollars potentially on the line but also millions of people that could have services cut. The programs that are in line to be renewed or sunset include the Community Health Center Fund, holding off DSH cuts, the reauthorization of the Pandemic and All Hazards Preparedness Act, the Emergency Plan for AIDS Relief, and a range of programs aimed at fighting the opioid epidemic. (Axios, September 18)
• On Monday, CMS published a final rule to streamline the enrollment and renewal process for Medicare Savings Programs (MSPs). CMS cited reductions in the administrative burden on states and eligible beneficiaries allows for seniors and adults with disabilities to more easily attain MSPs coverage. Under the rule, Medicare beneficiaries who receive Supplemental Security Income (SSI) will automatically be enrolled into the qualified Medicare beneficiary eligibility group. Approximately 10 million low-income individuals are currently enrolled in MSPs, and CMS believes that an additional 860,000 beneficiaries will enroll because of the final regulation. (Modern Healthcare, September 18)

• Home health provider, Help at Home, will be ending all its services in Alabama by the end of September. The provider is expected to lay off nearly 800 employees by November 4. Help at Home claims that the state’s regulatory and reimbursement environment has made it difficult to recruit, hire, and retain workers in Medicaid-funded home care. (Modern Healthcare, September 18)
• The California Legislature passed a pair of bills that will address the state’s homelessness, mental health, and drug crises. The first bill, SB 326, will increase program funding for SUDs to treat the most seriously mentally ill individuals while the second bill, AB 531, authorizes the state to issue $6.4 billion in bonds to build more housing for homeless people as well as treatment beds for those with significant needs. Once Governor Newsome signs the bills, California voters will have the opportunity to approve the bills in a March primary ballot. (KFF Health News, September 15)
• On September 12, the Oregon Health Authority (OHA) voted to seek approval from CMS to establish a Basic Health Program for residents who make too much money to qualify for Medicaid. Currently, only Minnesota and New York have such programs in place, Kentucky intends to roll out a Basic Health Program in November 2023. Oregon’s program would help to stabilize coverage and promote continuity of care for individuals with fluctuating incomes who may currently be switching between Medicaid and private insurance. In April, CMS approved an expansion of Medicaid eligibility in Oregon to 200% FPL while Oregon prepared to implement the program. The Basic Health Program allows states to provide insurance coverage to people with incomes between 133% FPL and 200% FPL. The program also allows the federal government to redirect 95% of what it would have spent to subsidize exchange plans for this population back to the state. Oregon plans to begin enrollment in July 2024 and anticipates more than 100,000 individuals to sign up for the program. (Modern Healthcare, September 15; Health Payer Specialist, September 18)
• With most states beginning to reach the height of their redetermination processes, Idaho is finishing up its process after removing approximately 121,000 ineligible or likely ineligible people from its Medicaid rolls. Idaho expanded Medicaid six months prior to the pandemic and experienced growth of nearly 150,000 during the continuous coverage requirement. Of the 121,000 people who lost coverage, an estimated 42% lost coverage for procedural or paperwork reasons. Idaho also condensed its unwinding process, opting to complete the process in eight months compared to the 12-month period recommended by CMS. (Inside Health Policy, September 13)
• The nursing shortage is prompting more states to pay family members to provide skilled nursing care to medically fragile children at home. Florida and New Jersey are the latest states to pass laws that allow a family member to receive free training as a certified nursing assistant and be paid through the Medicaid program to provide up to 40 hours a week of home-based care to medically fragile children. The children receiving care have significant medical needs and require 24/7 care. Arizona, Colorado, Indiana, Massachusetts, New Hampshire, and Pennsylvania have similar laws in place. (Modern Healthcare, September 19)

News

• UnitedHealth has experienced a second wide-ranging records hack. The breach was discovered on December 29, 2022, and exposed information including names, member IDs, plan types, and county and state of residence but did not involve social security numbers, driver’s licenses, or financial information. No information has been released about why the payer waited nine months to publicize the breach. Members in California, Louisiana, Maryland, North Carolina, and South Carolina have been affected thus far. (Health Payer Specialist, September 6)
• Walmart is exploring the acquisition of ChenMed, a value-based care provider that operates in over 125 medical centers and provides services aimed at seniors in 15 states. ChenMed focuses on affordable care for underserved patients across the country. If successful, this deal would mark the largest foray for Walmart in healthcare. This news comes as other retail giants, such as Walgreens and CVS Health, continue to move into the healthcare industry. (Health Payer Specialist, September 11)

• Have you seen the public comments on CMS’ proposed rulemaking “Medicaid Program; Ensuring Access to Medicaid Services?” In case you didn’t have time, Sellers Dorsey summarized everything you need to know. We covered comments relating to the Medicaid Advisory Committee, HCBS, documentation of access, and more. Click the link here for our exclusive summary.