Federal & State Updates


FEDERAL UPDATES

Congressional Activity

 

Chairmen Hatch and Walden Express Concern, Call for Robust Regulatory Impact Analysis of HHS Proposed Rule on Pharmaceutical Rebates.  This week, Senate Finance Committee Chairman Orrin Hatch (R-UT) and House Energy and Commerce Committee Chairman Greg Walden (R-OR) addressed a letter to Mick Mulvaney, director of the White House Office of Management and Budget (OMB), urging him to include a robust regulatory impact analysis of a forthcoming regulation on pharmaceutical rebates that currently is moving through the OMB review process.

 

Federal Regulatory Activity

 

General

CMS Issues Guidance on Non-Mirrored Off-Exchange Plans Without CSR Loading.  On August 3, CMS issued guidance on “Offering of plans that are not QHPs without CSR ‘loading.’”

 

CMS Publishes Proposed Rule on Risk Adjustment for 2018 Benefit Year.  This week, CMS posted a prepublication version of a proposed rule on risk adjustment for the 2018 benefit year.  In the July 30 edition of the Federal Register, CMS published a final rule on risk adjustment for the 2017 benefit year to enable 2017 risk adjustment transfers to proceed.  For benefit year 2019 and beyond, these issues were addressed in the final 2019 Notice of Benefit and Payment Parameters.  Comments are due to CMS by 5:00 pm on September 7, 2018.

FDA Issues Draft Guidance to Encourage New Drugs for Treating Opioid Use Disorder.  This week, the FDA announced the release of draft guidance outlining nonbinding recommendations to support drug developers in demonstrating the effectiveness and benefits of new or existing MAT drugs for the treatment of OUD.

Medicare

Administration Announces New Policy on Step Therapy for Medicare Part B Drugs.  This week, CMS announced that it is giving Medicare Advantage plans the option to apply step therapy for physician-administered and other Part B drugs beginning in January 2019 as part of a patient-centered care coordination program. The following are links to a CMS press release, fact sheet, and a memo sent to Medicare Advantage (MA) organizations.

 

CMS Proposes Changes to Medicare Shared Savings Program.  This week, CMS released a proposed rule making several changes to the Medicare Shared Savings Program (MSSP) requirements.   CMS proposes to establish “pathways to success” through redesigning the participation options available under the program to encourage Accountable Care Organizations (ACOs) to transition to two-sided models.

A fact sheet on the proposed rule can be found on the CMS website here.

Medicaid

CBO Examines Growth of Medicaid Managed Care.  A new report from the Congressional Budget Office (CBO) provides an analysis of data on enrollment and spending in Medicaid managed care programs.

 

CMS Rebate Guidance.  The CMS guidance released to states and manufacturers through State Release #186 and Manufacturer Release #109 provides information pertaining to the line extension unit rebate amount calculation that was revised by the Bipartisan Budget Act (BBA) of 2018 (Pub. L. 115-123) that becomes effective on October 1, 2018.  These releases are available at: https://www.medicaid.gov/medicaid/prescription-drugs/program-releases/index.html.

Waivers

1115 Waiver Demonstration – New Hampshire Health Protection Program Premium Assistance.  New Hampshire has submitted an application to extend its section 1115 demonstration titled, “New Hampshire Health Protection Program (NHHPP) Premium Assistance” demonstration for the next five years, which the state requests to rename “Granite Advantage Health Care Program.” The application seeks to make several changes to the demonstration effective January 1, 2019, in accordance with the provisions adopted by the New Hampshire State Legislature in Senate Bill 313 and now enacted in law.

Pending Application

View/Submit Public Comments

 

STATE UPDATES

Health Policy Institute (HPIO):

HPIO/Policy Focus Focuses on Approaches to Balance the Healthcare Spending Side of the Health Value Equation.    HPIO will be hosting a forum on August 23 at Nationwide & Ohio Farm Bureau 4-H Center, 2201 Fred Taylor Dr., Ohio State University.  This forum will explore factors that drive high healthcare spending in the U.S. and discuss policy approaches that can impact healthcare spending, with a focus on payment reform, drug prices and investing early in children and prevention.

Health Policy Institute of Ohio.  The Health Policy Institute of Ohio has released an addendum to its Private Health Insurance Basics series titled “2017 Update: Current policy issues impacting the individual health insurance market in Ohio.”  HPIO released its latest edition of Private Health Insurance Basics as a series of six fact sheets in October 2016.  The new fact sheet serves as an update to the original series, giving policymakers and stakeholders the latest information on the most relevant policy issues related to the individual private health insurance market.  The fact sheet includes information on:

Current and expected trends in premium price increases

ACA marketplace enrollment

Federal state innovation waivers

 

Health Policy Institute of Ohio.  HPIO’s newly updated healthcare cost and quality data transparency resource page includes federal, state and local-level healthcare cost and quality datasets, tools and reporting, as well as information on organizations setting healthcare quality standards. In 2012, HPIO released its first Health Data Transparency Basics publication which provides an overview of the availability of transparent, accessible health data and discusses how access to information on price and quality impacts consumer choice, quality of care, healthcare spending and health outcomes.  Due to growing interest in the topic, HPIO released a second iteration of the publication in 2016, Healthcare Data Transparency Basics, which explores the rationale for healthcare price transparency, the challenges it presents and potential policy approaches at the state level to increase transparency.

Heath Policy Institute of Ohio – Education, Poverty and Health Presentation to House Task Force.

In a presentation before the House Speaker’s Task Force on Education & Poverty, Health Policy Institute of Ohio staff detailed the correlations between health, income and education, recommending that lawmakers and community stakeholders always view the factors as linked.  Along with the Department of Health and the Governor’s Office of Workforce Transformation, HPIO has made a handful of health-related recommendations that could improve student outcomes.  Among the suggestions are those to incentivize school-based health centers and modify Medicaid rates.

– Gongwer story on the Task Force meeting

– HPIO policy briefs on education

 

Health Policy Institute of Ohio – Medicaid Basics.

The Health Policy Institute of Ohio has released Ohio Medicaid Basics 2017.  A two-page executive summary is also available.

Guide to Evidence-Based Prevention.  HPIO has added a new fact sheet to its recently updated Guide to Evidence-Based Prevention. The new evidence summary fact sheet highlights evidence-based prevention strategies to increase food security and access to healthy food in Ohio.

The Guide includes a policy brief, Navigating Sources of Evidence, that defines “evidence-based prevention” and provides guidance on how to find credible sources of evidence for what works to prevent Ohio’s greatest health challenges.

 

Office of Health Transformation:

OHT/Working Together to Fix Healthcare.  Governor John Kasich was a guest on NBC’s Meet the Press where he was talking about the need for both parties in Congress to work together to fix Obamacare.  Watch it here

Office of Health Transformation.  Governor Kasich penned a piece in the New York Times  titled: End the Partisan Warfare on Health Care.  The piece is available at: https://mobile.nytimes.com/2017/03/10/opinion/john-kasich-end-the-partisan-warfare-on-health-care.html

Ohio’s expansion fate in the news. The Columbus Dispatch reported on what may lay ahead for Ohio’s Medicaid expansion. In the story, OHT Director Greg Moody reaffirmed the administration’s intent to preserve Medicaid expansion in the upcoming budget proposal. Read more here.

OHT/Physicians Boost Use of Ohio’s Rx Reporting System.  Governor John R. Kasich has made use of the Ohio Automated Rx Reporting System (OARRS) by prescribers of controlled substances a priority in the fight to reduce abuse of prescription pain medication. The OARRS website used by Ohio doctors, nurses, dentists and pharmacists allows prescribers to track a patient’s opioid prescription history with the goal of stopping drug abuse before it starts. A recent audit conducted by the Ohio Board of Pharmacy found more than 12,000 physicians to be non-compliant with laws enacted in 2015 requiring the use of OARRS. By partnering with the Ohio Medical Board, all 12,000 physicians were urged to make the necessary corrections immediately. As a result, more than 1,800 new accounts have been created in OARRS and daily use of the system has increased from 83,544 requests to over 96,300 per weekday.

 

Common Sense Initiative:

Common Sense Initiative/Annual Report.  CSI released the 2016 Annual Report of the Common Sense Initiative.

CSI/Business Survey. The Lt. Governor Mary Taylor distributed the following message, which solicits comments and feedback on Ohio’s business and regulatory environment. If interested, I would encourage you to participate in providing feedback. The link and information is below.

Since 2011, Lieutenant Governor Mary Taylor has led Ohio’s Common Sense Initiative (CSI) Office which is intended to promote innovation and common sense regulation of Ohio’s businesses. The Executive Order creating CSI explicitly recognized that Ohio’s business community is a partner in the state’s success, so while regulations play an important role in promoting fair competition and protecting the public, they should do so in a way that also facilitates economic growth and opportunity.

The CSI Office functions as a partnership between the Administration, state agencies, the business community, and the public to develop a regulatory framework that balances the important need for regulation with the equally important need to promote economic opportunity and job creation. It has created a more jobs-friendly regulatory climate in Ohio by independently evaluating the economic impact of state agency regulations on Ohio businesses.

Continued reform and updating of Ohio’s regulations helps Ohio’s economy and job creation by fostering a more business-friendly environment, but we need your help. Below is a link to this year’s CSI business survey. Please take a few minutes to give us your feedback by completing this survey. It should take about 5-7 minutes to complete. Your feedback is important to the success of the CSI Office and will help us identify specific areas where government hinders Ohio’s business community’s ability to create jobs. All responses are anonymous unless you choose to provide your contact information at the end of the survey.

Click the link to start the 2016 CSI Annual Business Survey.

 

Ohio Department of Medicaid:

Ohio Department of Medicaid and Ohio Department of Mental Health and Addiction Services – Behavioral Health Redesign.  The state Behavioral Health Redesign Benefit and Service Development Work Group met to continue to discuss the implementation of the new billing codes, redesign timeline, and trainings. You can find the information discussed during the meeting at: http://bh.medicaid.ohio.gov/Portals/0/Users/008/08/8/20161130-BSD-Workgroup-Meeting-FINAL.pdf?ver=2016-11-30-115047-323

 

ODM Medical Care Advisory Committee. The ODM Medical Care Advisory Committee received an update from the Department on the new shared living services that will be made available to individuals receiving services on the PASSPORT and MyCare waivers.  The Shared Living service will provide a live-in caregiver for PASSPORT recipients who need assistance with self-management and the presence of another person (occasional or continuous) in order to assure their health and safety. The Shared Living service includes personal care, chore, individual living assistance and homemaker tasks appropriate to an individual’s needs. The shared living service also assists individuals with managing the household, handling personal affairs, and self-administration of medications.

Dr. Mary Applegate provided the committee with a presentation on ODM’s Managed Care Quality Strategy as well as a briefing on the managed care plan quality improvement projects. Dr. Applegate informed the committee of the new “Transformational Quality Strategy” that shifts the focus to population health. She also provided an update on a number of the quality improvement project success through the Minds Matter project, the OPQC Progesterone Project, and MOMS project (focused on neonatal abstinence).

Dr. Applegate then went on to discuss ODM’s Medicaid managed care plan quality oversight as well as the quality oversight for the MyCare Ohio demonstration. Also discussed was the transformation of the managed care plans care management system, value-based purchasing efforts, and special needs populations.

 

Ohio Department of Insurance:

Ohio Department of Insurance – Checklist for College Bound kids.

The Ohio Department of Insurance (ODI) created an insurance checklist to help college students and their parents ensure appropriate financial protections are in place for the upcoming school year.

Taylor Steps Down as ODI Director, Froment Takes Over.  Governor Kasich announced that Lieutenant Governor Mary Taylor will step down from her duties as Director of the Ohio Department of Insurance.  Replacing Taylor is Jillian Froment who has served as the agency’s deputy director since 2011.  Taylor remains Lieutenant Governor for the State of Ohio.

 

ODI/Form, Rate and Binder Filings Training Webinar.  The Ohio Department of Insurance hosted a 2018 Plan Year Major Medical Form, Rate and Binder industry training on March 7, 2017.  The power point presentation used in the training is available at:

http://insurance.ohio.gov/Company/Documents/ACA%20Filing%20Resources/ODI_Training_2018PY_20170307.pdf

 

Joint Medicaid Oversight Committee:

Joint Medicaid Oversight Committee – Behavioral Health Redesign Update.  JMOC received an update on the State’s Behavioral Health Redesign project from ODM Director Barbara Sears and OMHAS Director Tracy Plouck.  The Directors provided an update on the work to date and highlighted recent policy updates.  Those updates include:

Modifications to allow Qualified Mental Health Specialists with a minimum of 3 years of experience in a relevant field to render MH day treatment;

Updates to the RN/LPN scopes of practice;

Reimbursement updates TBS/PSR;

Training and testing updates.

You can find the presentation at: http://www.jmoc.state.oh.us/meetings.

 

Joint Medicaid Oversight Committee/2016 Progress Report.  The Joint Medicaid Oversight Committee release its 2016 progress report titled, Slowing Ohio’s Medicaid Per Capita Spending.  The report states that since the creation of JMOC that year over year per capita Medicaid spending has slowed as well as the per member per member spending has been lower than estimated.  Per the report the changes that have been made to the program have saved $1.6 billion across all funds in fiscal years 2015 and 2016 compared to the Executive Budget PMPM estimates.

The report states that a key factor in the savings is the expanded use of managed care as well as increased use of home and community based alternatives.  The report:

acknowledges policies that have increased spending such as provider rate increases, new services and program inflexibility.

– discusses opportunities to lower spending such as behavioral health integration, improved maternal and infant health, and increasing value in health care.

 concludes with a discussion on improving quality through managed care.

calls for JMOC to increase its attention to managed care quality by increasing its review of current initiatives, progress made, and barriers that impeding better results.

 

You can find the report at: http://www.jmoc.state.oh.us/reports.  JMOC Chairman Burke also issued the following release regarding the report: http://ohiosenate.gov/burke/press/burke-highlights-report-showing-16-billion-in-ohio-medicaid-savings.

Joint Medicaid Oversight Committee. TheJMOC committee reviewed the State Fiscal Years 2018-2019 Biennium Growth Rate Projections report from the committee’s actuary Optumas.  Following the presentation, the committee voted to set the FY2013-2019 growth rate at 3.3%.  This rate is the midpoint between Optumas’s lower and upper bound rates of growth. You can find the presentation and the Optumas report at: http://www.jmoc.state.oh.us/meetings.