Healthcare Policy News
Antitrust Exemption Repeal Legislation Passes House
The House of Representatives recently passed the Competitive Health Insurance Reform Act of 2019. The legislation, led by Reps. Peter DeFazio (D-OR), and Paul Gosar, (R-AZ), would repeal the McCarran-Ferguson antitrust exemption for health insurance companies and is a high priority of the AAOS. If signed into law, the government will be empowered to enforce the full range of federal antitrust laws against health insurance companies engaged in anticompetitive conduct. Current law unfairly gives health insurance companies the distinct advantage of collaboration on pricing, which can allow for patient pricing to go up while decreasing coverage. Fair antitrust laws more broadly remain a Tier 1 issue on the AAOS Unified Advocacy Agenda and ongoing advocacy efforts.
Congress Reaches Agreement on Funding, Changes to Medicare Loans
On September 22, the House of Representatives voted overwhelmingly to continue funding the government until after the November election. The temporary funding measure lasts until December 11 and will avert a September 30 government shutdown if quickly passed by the Senate as expected. The legislation contains AAOS-requested changes to the Medicare Accelerated and Advance Payment Program including the extension of the recoupment period from 120 days to one year after the loan was issued. The recoupment rate is also being lowered from 100% to 25% for the first 11 months and 50% for the following six months, while the interest rate is being reduced from the current 9.6% to 4%. Medicare and Medicaid provisions set to expire will also be extended, such as quality measurement activities and the prevention of an increase for Medicare Part B premiums in 2021, along with Food and Drug Administration user fee collection and National Institutes of Health research grants.
Supreme Court Battle to Divide Congress and Delay Legislative Activity
With Supreme Court Justice Ruth Bader Ginsburg’s death on September 18, who was a champion of many civil and social right issues, President Trump now has an opportunity to appoint another justice to the high court. That candidate will need to be approved by the Republican-held Senate, and Majority Leader Mitch McConnell (R-KY) has already stated that he plans to hold a vote in advance of the November presidential election. His announcement, however, has drawn partisan ire from Democrats given his refusal to conduct a vote on then President Barack Obama’s nomination of Merrick Garland in 2016. President Trump’s new Supreme Court nominee will likely move the court further to the right, creating new tensions in an already highly partisan environment. This battle over control of the highest court is sure to divide the Senate even further making passage of bipartisan legislation even more challenging.
New Payment Models to Improve Care for Cancer, Renal Patients
On September 18, the Centers for Medicare & Medicaid Services (CMS) announced two new models aimed at improving the quality of care for Medicare beneficiaries which will begin on January 1, 2021. The Radiation Oncology Model aims to incentivize cost-effective, clinically meaningful treatments for patients receiving radiotherapy. This mandatory bundled payment model will apply to radiotherapy providers and suppliers in randomly selected geographic areas, with a scope projected to cover roughly 30 percent of eligible Medicare fee-for-service radiotherapy episodes. The End-Stage Renal Disease Treatment Choices Model aims to incentivize home dialysis and kidney transplantation to improve outcomes for patients. Also mandatory, this model is expected to cover approximately 30 percent of kidney care providers. AAOS continues to track new value-based care model developments in the Centers for Medicare and Medicaid Innovation (CMMI) and share those updates with the musculoskeletal community.
CMS Issues Part I of 2022 Medicare Advantage and Part D Advance Notice
The Centers for Medicare & Medicaid Services (CMS) released Part I of the Contract Year (CY) 2022 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part C and Part D Payment Policies. The news comes about three months earlier than usual to give more time to Medicare Advantage and Part D plans to estimate plan costs for 2022. Per CMS’ proposal, the CMS-Hierarchical Condition Categories model will be fully phased in CY 2022. Also beginning in 2022, the Part C risk score used for payment will be calculated based completely on encounter data.