IHA Daily Briefing: July 12

Thursday, July 12, 2018

House Subcommittee Holds 340B Drug Program Hearing
CMS Revises DMEPOS and ESRD Programs
Survey Analyzes Medicaid Telehealth Policies
Register Now: Utilization Review Boot Camp

House Subcommittee Holds 340B Drug Program Hearing
A hearing yesterday on “Opportunities to Improve the 340B Drug Pricing Program” by the U.S. House Committee on Energy and Commerce Subcommittee on Health, discussed numerous legislative proposals to revise the program. Several witnesses provided testimony related to a variety of issues with the program, established in 1992, designed to give healthcare providers access to discounted drugs. In addition, AHA submitted a statement for the hearing strongly supporting the 340B program and commenting on the proposed bills and legislative drafts released last week related to the program.

AHA supports numerous proposals including:

  • Eliminating a Centers for Medicare & Medicaid Services’ final rule that reduces Medicare reimbursement to certain public and non-profit hospitals for outpatient drugs purchased under the 340B program by nearly 30 percent, or $1.6 billion, (H.R. 4392 and H.R. 6071);
  • Increasing parity in transparency requirements between 340B covered entities and drug manufacturers (H.R. 6071); and
  • Permitting 340B-eligible hospitals that are subject to the orphan drug exclusion to purchase orphan drugs through the 340B program when the drugs are used to treat an illness other than the rare conditions for which the orphan drug designation was given.

In addition, AHA expressed opposition to and concerns about a number of bills and discussion drafts under consideration by the committee.

"We continue to oppose efforts to decrease the size and scope of the program or that add overly burdensome and unworkable reporting requirements on covered entities that do not improve access to care for vulnerable communities," AHA said.


CMS Revises DMEPOS and ESRD Programs
CMS issued a proposed rule yesterday revising payment rules for Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) and the End-Stage Renal Disease (ESRD) program. According to CMS, durable medical equipment proposals in the proposed rule are designed to increase access to items for patients and simplify Medicare’s DMEPOS Competitive Bidding Program (CBP). The rule also includes ESRD proposals that address new renal dialysis drug and biological costs, foster treatment innovations by incentivizing new therapies for patients on dialysis, and reduce facility-related documentation burden.

Also in the rule, CMS proposes market-oriented reforms to the DMEPOS CBP. The process for competing contracts with suppliers currently in effect under the DMEPOS CBP has not yet been initiated. As a result, current contracts for the DMEPOS CBP will expire on Dec. 31.  Beginning Jan. 1, 2019, and until new contracts are awarded under the DMEPOS CBP, beneficiaries may receive DMEPOS items from any Medicare enrolled DMEPOS supplier.

See a CMS press release and fact sheet for more details.


Survey Analyzes Medicaid Telehealth Policies
According to a survey by Manatt Health, Illinois’ Medicaid telemedicine policies were classified overall as “moderate.” The survey analyzed each of the 50 states’ Medicaid program policies and laws related to telemedicine in the following key areas:

  • Practice standards and licensure;
  • Coverage and reimbursement;
  • Eligible patient settings;
  • Eligible provider types;
  • Eligible technologies; and
  • Service limitations.

Illinois’ classification for each of the categories listed was restrictive, progressive, moderate, restrictive, progressive, and progressive, respectively.

Manatt Health said that the survey is intended to “inform health systems and providers, state policy makers, and technology companies, regarding state-specific policies for providing healthcare services via telemedicine generally, and for Medicaid beneficiaries specifically.”


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