New 340B Policy

• On October 26, the Health Resources and Services Administration (HRSA) issued a policy that could result in some hospital outpatient clinics losing their 340B drug discount program eligibility. HRSA posted a notice in the Federal Register that requires hospitals participating in the drug pricing program to register offsite clinics with HRSA and list them on Medicare cost reports to qualify for 340B drug discounts. This policy reverses a 2020 policy that aimed to streamline 340B certifications during the pandemic. The 340B program provides discounts on pharmaceuticals for hospitals and other providers that treat low-income and uninsured patients. Under this new policy, hospitals with large outpatient networks stand to pay tens of millions of dollars more on prescription drugs. 340B-eligible hospitals have 90 days to notify HRSA that they have started the process of complying with the new policy (Modern Healthcare, October 26).

• The White House’s new Office of Pandemic Preparedness and Response (OPPR) is calling on providers and community health organizations to help promote widespread vaccination against COVID-19, influenza, and respiratory syncytial virus (RSV). Separately, the CDC has been calling for the rationing of the short supply of the immunization nirsevimb, which has recently been approved to protect babies and some toddlers from severe RSV. Since the public health emergency is over, health agencies have fewer resources to reach out and spread information about the importance of vaccinations.  (Inside Health Policy, October 25).

Federal Regulation

• On October 25, CMS opened healthcare.gov for consumers to review qualified health plans (QHPs) for the upcoming 2024 open enrollment period. CMS Administrator Chiquita Brooks-LaSure emphasized the availability of affordable health care coverage for families and encouraged consumers to preview plans and premiums before open enrollment begins on November 1 and ends on midnight, January 16, 2024 for most states. This year, there are slightly fewer QHPs on the Marketplace than last year at 210. However, 96% of consumers still have a choice of three or more insurers. Pre-tax credit premiums are rising slightly, with benchmark premiums increasing by 4% from Plan Year 2023 to Plan Year 2024 and enhanced subsidies are available to 67% of healthcare.gov consumers. This year CMS is also changing its process for automatic re-enrollment to help consumers take advantage of financial assistance, including cost-sharing reductions. CMS has also finalized a policy that allows door-to-door assistance by navigators, Community Application Counselors (CACs), and others. Previously, these groups were not allowed to go to a consumer’s residence for the initial interaction (Inside Health Policy, October 25).

Federal Litigation

• On October 20, the Supreme Court announced they will hear the Missouri v. Biden case that could prohibit federal health representatives from communicating with social media platforms about whether to remove posts the government identifies as false or misleading, potentially resulting in a comprehensive ruling that would limit coordination between government officials and social media companies on health misinformation. The Supreme Court granted an injunction temporarily staying the Missouri v. Biden Court of Appeals ruling, allowing such communication to continue while the court hears the case. The Supreme Court is expected to rule on the case in 2024 (Inside Health Policy, October 25).

Waivers

• Section 1115
  • Montana
    • On October 20, 2023, the state submitted a request to amend its section 1115(a) demonstration titled “Montana Waiver for Additional Services and Populations (WASP).” Formerly known as “Montana Basic Medicaid for Able Bodied Adults.” This demonstration amendment aims to provide fertility preservation services for Healthy Montana Kids (HMK) eligible individuals between the ages of 12 and 35 with an active diagnosis of cancer where the treatment would put them at risk for infertility. The demonstration would provide authority for the collection of eggs and sperm consistent with established medical practices or professional guidelines published by the American Society of Reproductive Medicine or the American Society of Clinical Oncology. The federal comment period is open from October 26, through November 25, 2023.
  • Massachusetts
    • On October 16, 2023, Massachusetts submitted a request to amend its section 1115(a) demonstration titled “MassHealth Medicaid and Children’s Health Insurance Plan (CHIP) Section 1115 Demonstration.” The demonstration aims to provide pre-release services to individuals in certain public institutions; provide 12 months of continuous eligibility for adults and 24 months of continuous eligibility for members experiencing homelessness who are 65 and older; remove waiver authority of retroactive eligibility; expand Marketplace subsidies; expand health-related social needs (HRSN) services to include short-term post hospitalization housing and temporary housing for pregnant members and families; increase HRSN integration funding; extend Medicare Savings Program to the Commonwealth’s statutory limit; and preserve CommonHealth members’ ability to enroll in One Care Plans. The federal public comment period is open from October 30 through November 29, 2023.

SPAs

• Georgia’s new Medicaid work requirement program, Georgia Pathway to Coverage, has enrolled 1,343 people, a significantly lower figure than the 33,707 individuals who are estimated to be eligible. As of June 2023, there are 2.5 million enrolled in Medicaid in the state. In the ongoing Medicaid redetermination, the state has renewed coverage for 260,000 individuals and disenrolled 342,432 individuals, including children in the state’s CHIP, PeachCare for Kids. Recently, the state Department of Community Health also posted an RFP for its Medicaid program with contracts worth an estimated $6 billion for one year with six annual renewal options. The programs out for bid by the state include Georgia Families, PeachCare for Kids, Planning for Healthy Babies, and Georgia Families 360 (Health Payer Specialist, October 30).
• The South Carolina Department of Health and Human Services (SCDHHS) has announced a new grant program which aims to enhance medical care access in rural and underserved areas. The state expects to distribute at least $15 million in one-time funds for healthcare facility creation or improvement. Recipients of the grant can receive up to $3 million in infrastructure funds. Areas of focus include primary care, maternal and infant care, pediatrics, and behavioral health. Grant-funded facilities are obligated to operate for a minimum of five years. This funding was appropriated by the South Carolina General Assembly. Applications are due by December 4, 2023, and notification of the awards will occur on February 2, 2024. More information is available here (SCDHHS, October 12).
• The delayed Florida bids for the Medicaid contracts were due on October 25. The bids were originally due on August 22, but were pushed back with no comment from the Agency for Health Care Administration, the agency overseeing the process. The Notice of Intent to Award has also been pushed back to February 2024, originally slated for announcement on December 11, 2023. Currently, Aetna, Centene, Molina, UnitedHealth Group, AmeriHealth Caritas, and Humana hold the current Florida Medicaid managed care contracts, which expire in December 2024. Eleven MCOs submitted bids, all but two of which already hold a health care contract in the state. Sentara Care Alliance, formerly Optima Health, and ImagineCare are the two respondents who do not have current contracts in the state. The other bidders are Sunshine Health, Aetna Better Health of Florida, Molina Healthcare of Florida, United Healthcare of Florida, Simply Healthcare Plans, South Florida Community Care Network d/b/a Community Care Plan, Florida Community Care, Humana Medical Plan, and AmeriHealth Caritas of Florida (Health Payer Specialist, October 25; Florida Politics, October 25).

News

• A recent bill signed into law in California will increase the state’s hourly minimum wage for healthcare workers from $15.5 to $25 over the next 10 years. Larger health systems, hospitals, and dialysis clinics have until 2026 to implement the new rate while rural independent hospitals and those with high mix of Medi-Cal and Medicare patients have until 2033. The law will affect wages for roles that support and relate to patient care. However, ancillary healthcare staff like foodservice workers, janitors, medical coding, and billing workers will see the biggest bumps in pay. It’s estimated that 469,000 workers will benefit from the minimum wage law. Workers in home health services and skilled nursing facilities will experience the highest wage increases by approximately 41.1% and 36.7% respectively. Skilled nursing facilities (SNFs) will have a hard time complying with the higher wages if it’s coupled with CMS’s proposed rule for minimum staffing requirements. Trade organizations representing SNFs indicated that higher minimum wage would cause overall pay inflation forcing some facilities to reduce their service or close due to unsustainable labor costs (Modern Healthcare, October 26).
• UnitedHealthcare Group has completed its acquisition of the health technology firm EMIS Group. The deal is valued at $1.5 billion. EMIS offers multiple IT platforms to the UK’s National Health Service, the country’s public healthcare system (Health Payer Specialist, October 30).
• A recent blood test created by Quest Diagnostics which allows patients to test for Alzheimer’s disease and receive results in the privacy of their own homes has sparked concerns among researchers and clinicians. Quest’s blood test measures elevated levels of amyloid-beta proteins, a signature characteristic for Alzheimer’s disease, and is only targeted primarily for people ages 50 and older. Researchers and clinicians are concerned that the Quest blood test isn’t backed by significant scientific research, making it highly likely to get false-positive results. Quest highly emphasizes that the test is not meant to diagnose Alzheimer’s but instead is meant to help assess the individual’s risk of developing the condition (KFF Health News, October 26).
• Healthcare systems are increasing efforts to erase medical debt and relieve patients from billions of dollars in bills. Medical debt is defined as “any money owed for healthcare services, including surgeries, clinic visits, dental procedures, and prescriptions.” Medical debt disproportionately affects low-income and/or uninsured patients. Local governments across the country are partnering with providers and others to establish debt relief plans, with some municipalities taking advantage of one-time federal assistance from the $1.9 trillion American Rescue Plan Act of 2021. Along with short-term solutions, healthcare systems are also looking for ways to prevent future debt (Modern Healthcare, October 26).
• The company GNC is expanding into the healthcare sector as GNC Health. GNC Health plans to offer telehealth and prescription services through a subscription model with three tiers. The first tier starts at $34.99 per year and offers “free” virtual urgent care and other lifestyle care. The second, or Plus, tier includes primary care, 400 prescription medications at no cost, and can be used by up to six members of the same household for $9.99 per month for individuals or $29.99 per month for families. Finally, the third or Premier tier includes mental health and physical therapy services at $39.99 per month for individuals or $59.99 per month for families (Health Payer Specialist, October 25).
• UPMC is closer to finalizing its acquisition of Washington Health System (WHS), another western Pennsylvania healthcare provider. According to an integration and affiliation agreement filed by the two organizations on October 18, WHS will merge into its affiliate The Washington Hospital (TWH) and UPMC will become the sole corporate member of TWH. WHS will also be rebranded as UPMC Washington. The financial terms of the deal have not yet been disclosed and the merger still needs to be approved by Pennsylvania regulators (Health Payer Specialist, October 25).

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