News Briefs

News Briefs

January 15, 2021

On Jan. 15, CMS finalized a rule that compels Medicaid, CHIP and Affordable Care Act (ACA) exchange plans to streamline their prior authorization processes. The regulation, which the administration proposed in December (HPW 12/18/20, p. 1), would also require the affected plans to add new capabilities to the Patient Access APIs that they had to build in order to comply with a previously finalized data interoperability rule. Read more at https://go.cms.gov/2LDw8eL.

CMS on Jan. 14 finalized several provisions in the 2022 Notice of Benefit and Payment Parameters (NBPP), cementing controversial new regulations for the ACA exchanges. Payer trade groups criticized the draft rule on various points, particularly an unusually short comment period and a provision that would allow states to abandon a centralized health insurance exchange in favor of relying on brokers, agents and insurers (HPW 1/8/21, p. 5). While that provision was among those finalized, CMS said it “anticipates continuing to review comments and finalizing other proposed policies in a second final rule to be published at a later date.” Read more at http://go.cms.gov/3sku3Vs.

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On Jan. 15, CMS finalized a rule that compels Medicaid, CHIP and Affordable Care Act (ACA) exchange plans to streamline their prior authorization processes. The regulation, which the administration proposed in December (HPW 12/18/20, p. 1), would also require the affected plans to add new capabilities to the Patient Access APIs that they had to build in order to comply with a previously finalized data interoperability rule. Read more at https://go.cms.gov/2LDw8eL. ✦ CMS on Jan. 14 finalized several provisions in the 2022 Notice of Benefit and Payment Parameters (NBPP), cementing controversial new regulations for the ACA exchanges. Payer trade groups criticized the draft rule on various points, particularly an unusually short comment period and a provision that would allow states to abandon a centralized health insurance exchange in favor of relying on brokers, agents and insurers (HPW 1/8/21, p. 5). While that provision was among those finalized, CMS said it “anticipates continuing to review comments and finalizing other proposed policies in a second final rule to be published at a later date.” Read more at http://go.cms.gov/3sku3Vs.
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News Briefs

January 14, 2021

✦ The Trump administration is shifting gears with its COVID-19 vaccine rollout strategy amid increasing frustration over the slow pace of vaccine distribution, multiple news outlets reported. HHS Secretary Alex Azar told reporters during a press briefing on Jan. 12 that the administration now plans to allocate vaccine doses to states based on how quickly they can administer the shots, rather than their population, according to The Hill. The administration is also pushing states to administer vaccines to anyone aged 65 or over and anyone with an underlying health condition, the news outlet said. However, public health experts who spoke to Politico suggested that the allocation strategy shift won’t fix the problems that have so far beset the vaccine rollout, such as low uptake in underprivileged communities. Read more at https://bit.ly/3oI85cV and https://politi.co/38Eauzx.

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News Briefs

January 8, 2021

Three years after they unveiled a joint venture tasked with lowering the cost and improving the quality of employee health care, Amazon, JPMorgan Chase & Co. and Berkshire Hathaway are disbanding the company called Haven. CNBC broke the news on Jan. 4, citing people with direct knowledge of the fact that Haven employees were being informed that the venture will shut down by the end of February. The news outlet noted that many of Haven’s 57 workers were expected to be divided among the venture’s three founding companies. In May, Haven CEO Atul Gawande, M.D., stepped down from managing the nonprofit venture. “At the time the JV was formed in early 2018, there was much fanfare and significant stock impact to the managed care sector” (HPW 2/5/18, p. 1) amid concerns that Haven would disrupt the current system, Citi analyst Ralph Giacobbe advised investors in a Jan. 6 note. “In retrospect, the Haven disbanding isn’t overly surprising after three years without any major announcements or apparent breakthroughs in lower healthcare costs and improving outcomes.” Read more at https://cnb.cx/35iClU7.

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News Briefs

January 7, 2021

✦ Humana Inc. in a new lawsuit alleges that Kentucky violated its five Medicaid contracts by allowing Molina Healthcare, Inc. to acquire the Medicaid membership of Passport Health Plan, reports Louisville Business First. After reviewing a second round of bids, Kentucky Gov. Andy Beshear (D) and the Cabinet for Health and Family Services last May named the same five winners in the Medicaid contract awards originally made under former Republican Gov. Matt Bevin (RMA 6/4/20, p. 4). Incumbent bidder Passport, which at the time was on the brink of insolvency, was not chosen. Molina, which was selected for a new contract, acquired Passport’s approximately 315,000 Medicaid members in Kentucky on Sept. 1, 2020. But in a lawsuit filed Dec. 23, 2020, Humana questions whether the takeover entitled Molina to Passport’s membership for a new contract period and asserts that Passport “had no claim to its membership at all beyond its contract” that expired on Dec. 31, according to the business journal. Anthem, Inc., which also was not selected as one of the initial five MCOs, contested the awards and in October won a temporary injunction directing the state to make it the sixth participant. Visit https://bit.ly/3rXRV0U.

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News Briefs

January 1, 2021

✦ On Aug. 17, 2018, the FDA gave accelerated approval to Bristol-Myers Squibb Co.’s programmed death-1 (PD-1) inhibitor Opdivo (nivolumab) for the treatment of people with metastatic small cell lung cancer whose cancer has progressed after platinum-based chemotherapy and at least one other line of therapy (RSP 9/18, p. 8). That approval was based on surrogate endpoints from the Phase I/II CheckMate -032 trial. However, the subsequent trials CheckMate -451 and CheckMate -331 did not meet their primary endpoints of overall survival, so in consultation with the FDA, the company has withdrawn this indication from the U.S. market. Bristol-Myers is advising people being treated with Opdivo for this indication to consult with their health care provider. Visit https://bit.ly/3o2gNlN.

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News Briefs

December 23, 2020

On Dec. 22, Congress voted to repeal health insurers’ exemption from federal antitrust laws by amending the McCarran-Ferguson Act, which expressly delegated health insurance competition questions to states. The bill would allow the Federal Trade Commission and Dept. of Justice to take action under federal antitrust law if health insurance companies engage in anticompetitive practices. The bill does not prevent states from enforcing their own rules. However, a Dec. 2 letter signed by four state insurance commissioners, each of whom were appointed by Republican governors, announced the opposition of the National Association of Insurance Commissioners (NAIC) to the bill. The commissioners argued that “existing state consumer protection, antitrust, and unfair trade practice laws provide the necessary tools needed to help stop anti-competitive conduct. Adding a layer of federal review would only lead to increased costs, confusion, and possible conflicts in federal and state courts.” Matt Eyles, CEO of America’s Health Insurance Plans (AHIP), condemned the bill in a Dec. 22 statement, arguing it will “[add] administrative red tape and reduc[e] market competition while making health coverage less affordable for hardworking Americans.… It will unnecessarily add layers of bureaucracy, destabilize markets, create conflicting federal and state oversight requirements, and lead to costly litigation.” Read the bill at http://bit.ly/3nPmyDl and the NAIC letter at https://bit.ly/2WDRtqg.

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On Dec. 22, Congress voted to repeal health insurers’ exemption from federal antitrust laws by amending the McCarran-Ferguson Act, which expressly delegated health insurance competition questions to states. The bill would allow the Federal Trade Commission and Dept. of Justice to take action under federal antitrust law if health insurance companies engage in anticompetitive practices. The bill does not prevent states from enforcing their own rules. However, a Dec. 2 letter signed by four state insurance commissioners, each of whom were appointed by Republican governors, announced the opposition of the National Association of Insurance Commissioners (NAIC) to the bill. The commissioners argued that “existing state consumer protection, antitrust, and unfair trade practice laws provide the necessary tools needed to help stop anti-competitive conduct. Adding a layer of federal review would only lead to increased costs, confusion, and possible conflicts in federal and state courts.” Matt Eyles, CEO of America’s Health Insurance Plans (AHIP), condemned the bill in a Dec. 22 statement, arguing it will “[add] administrative red tape and reduc[e] market competition while making health coverage less affordable for hardworking Americans.… It will unnecessarily add layers of bureaucracy, destabilize markets, create conflicting federal and state oversight requirements, and lead to costly litigation.” Read the bill at http://bit.ly/3nPmyDl and the NAIC letter at https://bit.ly/2WDRtqg.
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