DC Weekly Update – June 22 (TEST)

CONGRESS: Continued focus on opioids; hearing on quality and innovation in Medicare Advantage.

The House Energy and Commerce Committee held the first of two mark-ups on opioid-related legislation. 25 opioid bills were considered and passed by voice vote. The bills include policies related to research, workforce development and support, e-prescribing, physician access to patient SUD history, provider and patient education, comprehensive treatment, prior authorization, improved disposal and packaging, and telemedicine, among others. Chairman Walden remained optimistic about bringing an opioid legislative package to the House floor for a vote before the Memorial Day recess. While both the House and Senate have shown a commitment to addressing the opioid crisis, substantial work remains to bring legislation over the finish line.

Medicare Advantage:
The House Ways and Means Health Subcommittee held a hearing on quality and innovation in the Medicare Advantage program. At the hearing, witnesses from academia and health plans spoke about opportunities to strengthen the MA program, including evolving the Stars Rating program, improving the Plan Finder tool beneficiaries use to compare and select health plans, and increasing enrollment in MA plans. Lawmakers from both sides of the aisle voiced support for the MA program and expressed interest in policies that could further strengthen and grow MA. Watch the hearing here.

ADMINISTRATION: Cross talk from HHS on Medicare Risk Contracting; limits on Medicaid waivers.

Risk Contracting in Medicare:
Speaking at the American Hospital Association conference this week, CMS Administrator Seema Verma expressed concerns that accountable care organizations (ACOs) that have not taken downside risk are increasing Medicare spending, encouraging consolidation in the marketplace, and reducing competition and choice for beneficiaries. Verma also said that ACOs that have taken downside risk have shown significant savings to Medicare and improved quality. However, speaking at the Medical Device Manufacturers Association, newly confirmed director for the CMS Innovation Center, Adam Boehler, said that “value-based care…does not need risk.” He added that there are many ways to define value and to improve quality and lower cost, without risk.

While the future direction of the Innovation Center and its models may not be completely clear, stakeholders received some insight into next steps when CMMI released a request for information (RFI) on direct provider contracting. More on the RFI in our +Insight.

Medicaid Waivers:
This week, New Hampshire became the fourth state to receive CMS approval for an 1115 Medicaid waiver with work requirements. However, the agency is not necessarily rubberstamping all of the elements of state waiver applications. Separately this week, CMS denied a request from Kansas to place a three-year lifetime cap on some adult Medicaid enrollees. We expect to continue to see CMS move through state Medicaid waiver applications at a steady pace.

Next Week’s Dose: The President’s long-anticipated drug pricing speech.

The President is scheduled to give his widely anticipated drug pricing speech on Friday, May 11. While details have not been released, news reports have focused on the policies included in the administration’s budget proposal earlier this year.

For more information, please contact Mara McDermott or Rachel Stauffer.