POLICY BRIEFINGS


Open Enrollment from Nov. 1 through Dec. 15


This year’s HealthCare.gov open enrollment began on Sunday. While millions of people have been left uninsured as a result of the economic impact of the current public health crisis, outreach efforts to promote enrollment have not been a focus of the current administration, which previously cut funding for Affordable Care Act (ACA) marketplace advertising and navigator efforts. Nevertheless, experts are predicting that enrollment will hold steady with previous years, which has hovered around 11 million people since 2015. Open enrollment for HealthCare.gov ends December 15, though some states will keep their enrollment open for a longer period. Average premiums for the most popular coverage option have decreased two percent, and only four percent of counties will only have one insurer.


HHS Issues Series of Key Rules


On October 29, the U.S. Department of Health and Human Services (HHS) released a series of regulations pertaining to health coverage transparency, compliance with information blocking requirements, the home health prospective payment system (HH PPS), implementation of the SUPPORT Act, and coverage of COVID-19 vaccines and therapeutics.

The Centers for Medicare and Medicaid Services’ (CMS) Transparency in Coverage Final Rule would require insurers in the group and individual markets to disclose price and cost-sharing information. Most health plans, including employer-based group plans and insurance issuers offering group and individual coverage, will be subject to the reporting requirements. Plans must make publicly available standardized and regularly updated cost data files starting on January 1, 2022. Beginning January 1, 2023, health plans will be required to offer an online shopping tool that allows consumers to see the negotiated rate between their provider and their plan, as well as a personalized estimate of their out-of-pocket cost, for 500 of the most shoppable items and services. These tools will be required to show the costs for any remaining procedures, drugs, durable medical equipment, and other items or services available for plan or policy years beginning on or after January 1, 2024.

The Office of the National Coordinator for Health Information Technology (ONC) extended the compliance deadline for its information blocking regulation until April 5, 2021. This means that health care providers, IT developers, and health information exchanges will have an additional six months to comply with the data sharing deadline due to the impact of the coronavirus pandemic. The original deadline was set for today. Stakeholder organizations had expressed concerns that compliance with the technical requirements would divert resources away from patient care during the current public health emergency, or make it more difficult for patients to access their own data during this time. ONC also extended the deadlines for meeting health IT certification standards and for adopting standards to allow patient data to flow into apps until December 31, 2022.

The 2021 Home Health PPS Final Rule updates HH PPS payment rates and wage index for calendar year (CY) 2021. The final rule implements changes to the home health regulations regarding the use of telecommunications technology in providing services under the Medicare home health benefit, and also implements the permanent home infusion therapy services benefit and supplier enrollment requirements for CY 2021.

The Drug Enforcement Administration’s (DEA) Implementation of the SUPPORT Act: Dispensing and Administering Controlled Substances for Medication-Assisted Treatment amends certain regulations to make them consistent with the SUPPORT Act. The law expanded the conditions a practitioner must meet to provide medication-assisted treatment as well as the options available for a physician to be considered a qualifying physician. The SUPPORT Act also allows a pharmacy to deliver prescribed controlled substances to a practitioner’s registered location for the purpose of maintenance or detoxification treatment to be administered under certain conditions by a practitioner.

CMS also released its fourth COVID-19 Interim Final Rule with Comment Period (IFC), which largely focuses on coverage of vaccines and therapeutics across Medicare, Medicaid, and group and individual plans. The rule aims to ensure that patients, including Medicare, Medicaid, CHIP, and most privately insured individuals, pay no out of pocket costs for a COVID vaccine, even if it is under an emergency use authorization (EUA).


OWS Purchases Lilly COVID Antibody Drug


The White House’s Operation Warp Speed (OWS) announced that it has agreed to purchase 300,000 doses of bamlanivimab, Eli Lilly’s antibody drug for the treatment of COVID-19, for $375 million, with the option to purchase more doses through next year. An emergency use authorization (EUA) for the treatment, which has been shown to reduce symptoms, virus levels, and risk of hospitalization for those with mild to moderate COVID-19, is expected to be granted soon. Eli Lilly recently halted a clinical trial for bamlanivimab for hospitalized COVID-19 patients because it was not effective. The company will manufacturer one million doses of the product before the end of the year. The U.S. Department of Health and Human Services (HHS) has stated that the treatment will be provided to Americans at no cost.


Fed Eases Terms of Main Street Lending Program


The Federal Reserve has lowered the minimum loan amount under the Main Street Lending Program from $250,000 to $100,000, making the emergency loans available for more small businesses and nonprofits. While as much as $75 billion in relief funding has been set aside by the Treasury Department to cover potential losses from the Main Street loans, only approximately $4 billion in loans have been made under the program since its inception this summer. Many banks have been reluctant to participate because of the necessary underwriting and the risk of loan defaults. Under the Main Street Lending Program, the Federal Reserve purchases 95 percent of a bank loan to a company with fewer than 15,000 employees or less than $5 billion in annual revenue. As a part of the changes announced last week, companies will be allowed to exclude Paycheck Protection Program (PPP) loans of up to $2 million when calculating how much debt they hold while also increasing the maximum amount others can borrow.


PhRMA Launches Award for Health Disparities Research


The PhRMA Foundation has announced a new Challenge Award program that is soliciting research proposals to evaluate how the value assessment field can better serve diverse populations and address the causes of health disparities. A total of $85,000 will be awarded to selected researchers who propose solutions to the question “How can value assessment methods and processes better account for populations that are typically underrepresented in research and drivers of health disparities?” Letters of intent should be submitted no later than December 1, 2020. More information about the application process is available on the PhRMA Foundation’s website here.


Physicians See Slight Decline in Average Income


Anew survey reveals that physician pay remained flat this year amidst the coronavirus pandemic. The average pay for physicians increased by 1.5 percent according to a Doximity survey of more than 40,000 of the nation’s doctors. Because of the 2.3 percent inflation rate in 2019, this represents a slight decline in average physician income. The cancellation of appointments and elective procedures resulting from the current public health crisis is likely to blame. Certain specialties have appeared to fare better than others, however, including vascular surgery, geriatrics, and emergency medicine, which saw pay increases of nearly five percent. Doximity also reported on the observed wage gap between male and female doctors, which increased to 28 percent from 25.2 percent last year.


Hart Health Strategies COVID-19 Resources


Hart Health Strategies Inc. continues to update the following resources related to the coronavirus pandemic. Please remember to clear your cache to ensure you download the most recent documents.



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