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Healthcare Policy News
MedPAC Makes Recommendations on Value-based Care in June 2022 Report to Congress
In the June 2022 report, the Medicare Payment Advisory Commission (MedPAC) recommends implementing “a national episode-based payment model for certain types of proven clinical episodes (e.g., hip and knee replacements) that will enhance savings and/or improve outcomes” including requiring certain providers to participate in these models. Additionally, the Commission proposes implementing a foundational population-based payment approach that reduces the number of accountable care organization (ACO) model tracks, moving away from rebasing ACOs’ spending benchmarks based on actual ACO spending to an administrative update that is unrelated to ACOs’ actual spending performance and is known to ACOs in advance. To align payments across outpatient settings, such as hospital outpatient departments, ambulatory surgery centers and physician offices, the Commission made specific recommendations on ambulatory payment classifications sets including a suggestion to policymakers to consider an alternative to the budget neutrality requirement for hospitals that serve higher proportions of low-income patients. Read the full report here…
Energy & Commerce Subcommittee Looking into Medicare Advantage Plans, Prior Authorization Denials
On June 28, the Energy & Commerce Oversight Subcommittee will hold a hearing on private sector Medicare Advantage Plans. This hearing comes on the heels of the Office of Inspector General for the U.S. Department of Health and Human Services releasing a report that found Medicare Advantage Organizations (MAOs) improperly denied up to 85,000 prior authorization requests in 2019 alone. The report found that MAOs often used additional internal criteria that weren’t included in Medicare coverage rules or had additional documentation requirements that allowed them to deny prior authorization requests. The report included dozens of individual examples of improper denials for orthopaedic patients, including wrongful denials of MRIs, shoulder and knee x-rays, inpatient admission, rehab admission, durable medical equipment, follow-up visits, and joint injections. The AAOS-endorsed Improving Seniors’ Timely Access to Care Act aims to reform the prior authorization process within Medicare Advantage plans, and AAOS Office of Government Relations representatives are told that the legislation will be voted on in the Ways & Means Committee next month. Read more about the hearing here…
Senate HELP Committee Sends User Fee Reauthorization Bill to Floor Vote
Earlier this week, the U.S. Senate Health, Energy, Labor and Pensions (HELP) Committee passed legislation to reauthorize the Food and Drug Administration’s (FDA) product user fees. The bill is intended to reauthorize the Prescription Drug User Fee Act, Generic Drug User Fee Act, Biosimilar User Fee Act, and Medical Device User Fee Act, which are all set to expire on September 30. The bill differs significantly from the legislation passed by the U.S. House of Representatives, meaning the two bills must go through a reconciliation process to sort out their differences. Additional provisions include a requirement for the FDA to update its medical device cybersecurity guidelines every two years rather than four. It also includes an amendment that would waive annual establishment fees for small medical device makers. The bill will next be debated on the floor of the US Senate. Read more here… |
