Groups Raise Concerns Regarding CMS Part B Demonstration

One hundred groups have written to the Centers for Medicaid and Medicare Services (CMS) expressing concerns with the agency’s notice on the Medicare Part B Drug Payment Model released accidentally last month. While the details of the proposed pilot have yet to be unveiled, the notice to Medicare contractors was enough to raise concerns that the proposal could hurt the care of Medicare beneficiaries with complex conditions. In an attempt to decrease Part B drug costs, one potential demo would revise the six percent add-on to the average sales price (ASP) that providers are paid to administer drugs. The patients that rely on these drugs to treat diseases and conditions like cancer, rheumatoid arthritis, and primary immunodeficiency diseases often have to try multiple treatments before finding the right one, and might be harmed by an initiative that may cause an abrupt halt in their treatment or force them to switch from the most appropriate medication. The signatories ask that the agency not proceed with the Medicare Part B payment initiative. The letter was signed by 100 patient groups, health plans, members of the pharmaceutical industry, and provider organizations. Policy changes to Medicare Part B were also discussed during the meeting of the Medicare Payment Advisory Commission (MedPAC) this month. Commissioners explored policies such as reducing the drug payment from ASP plus 6 percent to ASP plus 3.5 percent and a flat fee, or setting an ASP inflation cap, but there was no consensus around any of the policy proposals.

Lawmakers Investigate Special Enrollment Periods

Senate Finance Committee Chairman Orrin Hatch (R-Utah) and Sen. John Barrasso (R-Wyo.) have written to Centers for Medicare and Medicaid Services (CMS) Acting Administrator Andy Slavitt requesting information about the administration of the Federally Facilitated Marketplace’s (FFM) Special Enrollment Periods (SEP). These enrollment periods allow patients who have experienced significant life events to enroll in a health insurance plan outside of the regular enrollment period. CMS has allowed 34 SEPs, which the lawmakers argue has caused complications for state markets and has allowed individuals to “game the Affordable Care Act” by waiting to enroll in a plan until they need medical services. Sen. Hatch and Sen. Barrasso pose a number of questions for Mr. Slavitt. They ask for further details on CMS’ processes for establishing SEPs, plans to eliminate unnecessary SEPs, and the verification of qualifications of individuals enrolling during an SEP.

Upcoming Congressional Meetings and Hearings

POSTPONED: Senate Finance Committee markup to vote on the nomination of Mary Katherine Wakefield to be deputy HHS secretary; time and place TBD

Senate Homeland Security and Government Affairs hearing titled: “The Homeland Security Department’s Budget Submission for Fiscal Year 2017;” 10:00 a.m., 342 Dirksen Bldg.; March 8

Senate Health, Education, Labor and Pensions Committee executive session on the innovation agenda; 10:00 a.m., 106 Dirksen Bldg.; March 9

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