Today, the White House released its FY 2019 budget proposal, outlining its policy priorities for the fiscal year. In health care, the President’s budget focuses on prescription drug pricing and opioid funding. It included a number of legislation proposals relating to Medicare Part D, as well as the creation of a Medicaid demonstration allowing states to test new financing structures to cover prescription drugs. The proposal also discusses the future of the Affordable Care Act, including the Medicaid expansion, as well as appropriating cost-sharing reduction payments for FY 2018 through the end of calendar year 2019. Proposals in the budget that are regulatory in nature are certainly items worth monitoring since its likely they would be approved and implemented under this Administration.

We cover this and more in the budget analysis, which can be found here.

 

 

Based on the most up-to-date information on the budget deal, we have developed a new timeline for the major health care extenders. This new timeline is important because these provisions were once all tied together and now, they are not.

Click here for the health care extender timeline.

*Note this post assumes the budget deal will pass tonight and is based on information as of 4:00pm on February 8, 2018.

**Emma Zimmerman of ML Strategies contributed to this post.

Late Monday night (February 5, 2018), the House of Representatives released a continuing resolution to keep the government funded and running until March 23, 2018. This CR includes many health care related provisions, specifically many of the health care “minibus” riders. In the chart below we summarize major health care provisions in this CR specific to the health care minibus. Note, the entire CHRONIC Care Act is included in this CR. Additionally, two key health care provisions are not included in this CR – the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) and the Money Follows the Person (MFP) program. Please click here to see our chart summarizing key health care provisions of the February 5 CR.

 

This week, President Trump will deliver his first State of the Union address to a joint session of Congress. Following his speech, both parties will leave town for party retreats where they will discuss priorities for the year ahead. The immediate concern is the government funding deadline of February 8th, which will need to be addressed to avoid a government shutdown. Meanwhile, we are beginning to see responses to proposed Medicaid work requirements in states, which will have implications for state and federal policy making in the months ahead. We cover this and more in our preview, which can be found here.

On January 11, 2018, CMS released a Letter to Medicaid Directors outlining guidance that work requirements can be used as a basis for eligibility for certain adult Medicaid beneficiaries through 1115 waivers. Medicaid beneficiaries that can be subject to work requirements include non-elderly, non-pregnant adult Medicaid beneficiaries who are eligible for Medicaid on a basis other than disability. The guidance also outlines that exemptions/protections from work requirements must be made for individuals who are medically frail or have substance use disorders. It also details that states should outline how they would support beneficiaries with limited employment opportunities (economically depressed area, rural area, transportation limitations, etc.). The guidance suggests state could use good cause exemptions similar to those used in SNAP and TANF. Continue Reading CMS Guidance on Work Requirements for Medicaid Eligibility

Congress has its work cut out for itself between now and the end of the year. Between addressing the programs that constitute the Health Care Minibus, funding the government, and tax reform, there are also questions related to a market stabilization package (Alexander-Murray), the 340B program, the opioid epidemic, and another hurricane relief package. For the complete December preview, please click here.

The release of the House and Senate GOP tax plan this month has left Washington on edge as it comes to grips with the realities of tax reform. However, the elimination of the medical expense tax deduction in the House Republicans’ tax reform package stands out above the rest as misguided. This elimination would not only affect filers using the deduction, but it also stands to have broader implications for our health care system.

ML Strategies has published a new blog post in Health Affairs on the consequences of the deduction’s removal to the Medicaid program. It can be found here.

In this post, I will be focusing on the intersection of off-label communications with government enforcement of health care fraud through the False Claims Act. Over the past eight years, the U.S. Department of Justice (“DOJ”) has been particularly aggressive in using the False Claims Act to pursue recoveries from individuals, health care providers, and drug manufacturers that participate in federal health benefit programs. In fact, from 2009 to 2016, DOJ collected $19.3 billion from health care False Claims Act settlements and judgments, with $2.5 billion recovered in fiscal year 2016, alone. (More DOJ false claims statistics can be found here.) DOJ’s enforcement efforts are not solely targeted against garden variety billing fraud, but also involve claims arising from alleged violations of health care regulatory requirements. Among other things, the DOJ has been targeting claims for reimbursement for off-label uses of regulated products. DOJ’s aggressive policy of holding manufacturers accountable for off-label claims under the False Claims Act is entirely consistent with FDA’s stance on off-label communications as described in the January memo. However, recent court interpretations of off-label communications as protected First Amendment speech, as well as interpretations of the causality component of False Claims Act claims, have apparently caused DOJ to reconsider its strategy with respect to such cases. Continue Reading The Past, Present, and Future of Government Regulation of Off-Label Communications – Part 5

As a part of our ongoing blog series we have provided details on the structure, funding, and outlook of several expiring health care provisions, that we’ve referred to as the health care minibus. The minibus includes all of the health care extenders left behind from the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Health care extenders refer to a number of temporary policies that need reauthorization or annual appropriations, including but not limited to, the Children’s Health Insurance Program (CHIP), the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, community health center funding, therapy caps, special needs plans (SNPs), and Medicaid disproportionate share hospital (DSH) payment reductions.

In this post we will discuss Medicaid DSH funding cuts and recent activity to address such cuts. Continue Reading Disproportionate Share Hospital Payments: A Minibus Rider

Our colleagues on the Employment Matters blog have been following Massachusetts’ efforts to make up a funding shortfall in the Commonwealth’s Medicaid program and its Children’s Health Insurance Program (CHIP). Back in May, they blogged on the two options introduced by the Senate to offset these rising costs: (1) a “play-or-pay” option that would impose a per employee assessment on companies that do not offer their workers’ health plans, or (2) an across the board increase in the Employer Medical Assistance Contribution (or “EMAC”).

Last week, they provided an update on the Commonwealth’s effort. On August 1, Massachusetts Governor Charlie Baker signed into law H. 3822, “An Act Further Regulating Employer Contributions to Health Care” (the “Act”). This Act (i) increases the Employer Medical Assistance Contribution (“EMAC”) from an annual maximum fee of $51 per employee to $77 per employee; and (ii) imposes a penalty on employers of up to $750 for each non-disabled worker who receives health insurance coverage through MassHealth or the Massachusetts Health Connector (i.e., the Commonwealth’s Affordable Care Act marketplace).

Read their full update here.