News Briefs

News Briefs

September 17, 2021

Three centrist Democrats on the House Energy and Commerce committee on Sept. 15 voted down language in a bill that would have enabled Medicare to negotiate drug prices. Reps. Scott Peters (Calif.), Kathleen Rice (N.Y.) and Kurt Schrader (Ore.) joined the committee’s Republicans to keep the measure from advancing. Committee Chair Rep. Frank Pallone (D-N.J.) made several public appeals in favor of drug price negotiation to the trio, who according to Politico all voted in favor of Medicare price negotiation in 2019. Despite the setback, price negotiation is far from dead, according to James Gelfand, executive vice president of public affairs at the ERISA Industry Committee. “My understanding is that the bill can be completely rewritten in the Rules Committee if need be,” Gelfand tells AIS Health via email. He adds that Democratic leaders “have to offer something to Rice…I don’t know exactly what yet. But they cannot afford to blow a $5-600 billion hole in the bill before it gets to the Senate.”

Three centrist Democrats on the House Energy and Commerce committee on Sept. 15 voted down language in a bill that would have enabled Medicare to negotiate drug prices. Reps. Scott Peters (Calif.), Kathleen Rice (N.Y.) and Kurt Schrader (Ore.) joined the committee’s Republicans to keep the measure from advancing. Committee Chair Rep. Frank Pallone (D-N.J.) made several public appeals in favor of drug price negotiation to the trio, who according to Politico all voted in favor of Medicare price negotiation in 2019. Despite the setback, price negotiation is far from dead, according to James Gelfand, executive vice president of public affairs at the ERISA Industry Committee. “My understanding is that the bill can be completely rewritten in the Rules Committee if need be,” Gelfand tells AIS Health via email. He adds that Democratic leaders “have to offer something to Rice…I don’t know exactly what yet. But they cannot afford to blow a $5-600 billion hole in the bill before it gets to the Senate.”

After a plan member filed suit against CVS Health Corp.’s Aetna, accusing the payer of discriminating against LGBTQ+ members in fertility care reimbursement, the health plan announced plans to change its coverage. According to the National Women’s Law Center (NWLF), whose lawyers filed the complaint, “the suit alleges that Aetna’s policy for coverage of IVF and IUI fertility treatments unfairly discriminates against LGBTQ couples by requiring them to pay out of pocket for 12 cycles of IUI before Aetna will provide them with coverage.” NWLF told Modern Healthcare that “we are pleased to learn that there is interest in resolving the matter.”

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News Briefs

September 17, 2021

Three centrist Democrats on the House Energy and Commerce committee on Sept. 15 voted down language in a bill that would have enabled Medicare to negotiate drug prices. Reps. Scott Peters (Calif.), Kathleen Rice (N.Y.) and Kurt Schrader (Ore.) joined the committee’s Republicans to keep the measure from advancing. Committee Chair Rep. Frank Pallone (D-N.J.) made several public appeals in favor of drug price negotiation to the trio, who according to Politico all voted in favor of Medicare price negotiation in 2019. Despite the setback, price negotiation is far from dead, according to James Gelfand, executive vice president of public affairs at the ERISA Industry Committee. “My understanding is that the bill can be completely rewritten in the Rules Committee if need be,” Gelfand tells AIS Health via email. He adds that Democratic leaders “have to offer something to Rice…I don’t know exactly what yet. But they cannot afford to blow a $5-600 billion hole in the bill before it gets to the Senate.”

After a plan member filed suit against CVS Health Corp.’s Aetna, accusing the payer of discriminating against LGBTQ+ members in fertility care reimbursement, the health plan announced plans to change its coverage. According to the National Women’s Law Center (NWLF), whose lawyers filed the complaint, “the suit alleges that Aetna’s policy for coverage of IVF and IUI fertility treatments unfairly discriminates against LGBTQ couples by requiring them to pay out of pocket for 12 cycles of IUI before Aetna will provide them with coverage.” NWLF told Modern Healthcare that “we are pleased to learn that there is interest in resolving the matter.”

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Three centrist Democrats on the House Energy and Commerce committee on Sept. 15 voted down language in a bill that would have enabled Medicare to negotiate drug prices. Reps. Scott Peters (Calif.), Kathleen Rice (N.Y.) and Kurt Schrader (Ore.) joined the committee’s Republicans to keep the measure from advancing. Committee Chair Rep. Frank Pallone (D-N.J.) made several public appeals in favor of drug price negotiation to the trio, who according to Politico all voted in favor of Medicare price negotiation in 2019. Despite the setback, price negotiation is far from dead, according to James Gelfand, executive vice president of public affairs at the ERISA Industry Committee. “My understanding is that the bill can be completely rewritten in the Rules Committee if need be,” Gelfand tells AIS Health via email. He adds that Democratic leaders “have to offer something to Rice...I don’t know exactly what yet. But they cannot afford to blow a $5-600 billion hole in the bill before it gets to the Senate.” ✦ After a plan member filed suit against CVS Health Corp.’s Aetna, accusing the payer of discriminating against LGBTQ+ members in fertility care reimbursement, the health plan announced plans to change its coverage. According to the National Women’s Law Center (NWLF), whose lawyers filed the complaint, “the suit alleges that Aetna’s policy for coverage of IVF and IUI fertility treatments unfairly discriminates against LGBTQ couples by requiring them to pay out of pocket for 12 cycles of IUI before Aetna will provide them with coverage.” NWLF told Modern Healthcare that “we are pleased to learn that there is interest in resolving the matter.”
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News Briefs

September 16, 2021

CMS will bar several Medicare Advantage Prescription Drug (MA-PD) plans from enrolling new beneficiaries for 2022 because they did not meet minimum medical loss ratio (MLR) requirements. According to a series of notices posted to the CMS Enforcement Actions page, CMS issued enrollment suspensions to the following organizations: MMM Healthcare, LLC, Triple-S Advantage, Inc., UnitedHealthcare of Arkansas, Inc., UnitedHealthcare of the Midwest, Inc., and UnitedHealthcare of New Mexico, Inc. Because the plans failed to meet the 85% MLR threshold for their Part D contracts for three consecutive years, they will be removed from the list of MA-PD plans during the upcoming Annual Election Period, CMS said.

CMS will bar several Medicare Advantage Prescription Drug (MA-PD) plans from enrolling new beneficiaries for 2022 because they did not meet minimum medical loss ratio (MLR) requirements. According to a series of notices posted to the CMS Enforcement Actions page, CMS issued enrollment suspensions to the following organizations: MMM Healthcare, LLC, Triple-S Advantage, Inc., UnitedHealthcare of Arkansas, Inc., UnitedHealthcare of the Midwest, Inc., and UnitedHealthcare of New Mexico, Inc. Because the plans failed to meet the 85% MLR threshold for their Part D contracts for three consecutive years, they will be removed from the list of MA-PD plans during the upcoming Annual Election Period, CMS said.

CMS is seeking to repeal a Trump-era rule that would have given national Medicare coverage for four years to a “breakthrough” device as soon as it receives FDA approval. The agency on Sept. 13 issued a Notice of Proposed Rulemaking (NPRM) that proposes to fully repeal the Medicare Coverage of Innovative Technology (MCIT) and Definition of “Reasonable and Necessary” final rule (86 Fed. Reg. 2987, Jan. 14, 2021). CMS said it is seeking comment on the proposed repeal and its plan to “conduct future rulemaking to explore an expedited coverage pathway for innovative technologies (balanced with evidence development to ensure beneficial health outcomes for beneficiaries) and a regulatory definition of the Reasonable and Necessary standard for Medicare coverage.” AdvaMed, the global trade association representing medical technology manufacturers, issued a statement calling the move the “wrong decision for countless Medicare patients” and “the wrong decision for American medical innovation.”

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News Briefs

September 16, 2021

CMS will bar several Medicare Advantage Prescription Drug (MA-PD) plans from enrolling new beneficiaries for 2022 because they did not meet minimum medical loss ratio (MLR) requirements. According to a series of notices posted to the CMS Enforcement Actions page, CMS issued enrollment suspensions to the following organizations: MMM Healthcare, LLC, Triple-S Advantage, Inc., UnitedHealthcare of Arkansas, Inc., UnitedHealthcare of the Midwest, Inc., and UnitedHealthcare of New Mexico, Inc. Because the plans failed to meet the 85% MLR threshold for their Part D contracts for three consecutive years, they will be removed from the list of MA-PD plans during the upcoming Annual Election Period, CMS said.

CMS is seeking to repeal a Trump-era rule that would have given national Medicare coverage for four years to a “breakthrough” device as soon as it receives FDA approval. The agency on Sept. 13 issued a Notice of Proposed Rulemaking (NPRM) that proposes to fully repeal the Medicare Coverage of Innovative Technology (MCIT) and Definition of “Reasonable and Necessary” final rule (86 Fed. Reg. 2987, Jan. 14, 2021). CMS said it is seeking comment on the proposed repeal and its plan to “conduct future rulemaking to explore an expedited coverage pathway for innovative technologies (balanced with evidence development to ensure beneficial health outcomes for beneficiaries) and a regulatory definition of the Reasonable and Necessary standard for Medicare coverage.” AdvaMed, the global trade association representing medical technology manufacturers, issued a statement calling the move the “wrong decision for countless Medicare patients” and “the wrong decision for American medical innovation.”

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CMS will bar several Medicare Advantage Prescription Drug (MA-PD) plans from enrolling new beneficiaries for 2022 because they did not meet minimum medical loss ratio (MLR) requirements. According to a series of notices posted to the CMS Enforcement Actions page, CMS issued enrollment suspensions to the following organizations: MMM Healthcare, LLC, Triple-S Advantage, Inc., UnitedHealthcare of Arkansas, Inc., UnitedHealthcare of the Midwest, Inc., and UnitedHealthcare of New Mexico, Inc. Because the plans failed to meet the 85% MLR threshold for their Part D contracts for three consecutive years, they will be removed from the list of MA-PD plans during the upcoming Annual Election Period, CMS said. ✦ CMS is seeking to repeal a Trump-era rule that would have given national Medicare coverage for four years to a “breakthrough” device as soon as it receives FDA approval. The agency on Sept. 13 issued a Notice of Proposed Rulemaking (NPRM) that proposes to fully repeal the Medicare Coverage of Innovative Technology (MCIT) and Definition of “Reasonable and Necessary” final rule (86 Fed. Reg. 2987, Jan. 14, 2021). CMS said it is seeking comment on the proposed repeal and its plan to “conduct future rulemaking to explore an expedited coverage pathway for innovative technologies (balanced with evidence development to ensure beneficial health outcomes for beneficiaries) and a regulatory definition of the Reasonable and Necessary standard for Medicare coverage.” AdvaMed, the global trade association representing medical technology manufacturers, issued a statement calling the move the “wrong decision for countless Medicare patients” and “the wrong decision for American medical innovation.”
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News Briefs

September 10, 2021

The Biden administration will send $452 million in ARPA funding “to support 13 states’ efforts to improve access to affordable, comprehensive health insurance coverage through section 1332 state-based reinsurance waivers,” per CMS. According to a CMS press release, the pass-through funding is intended to spur “stronger issuer participation in the individual market” in order to possibly “increase competition and translate to consumers having more opportunities to obtain affordable health insurance coverage.”

The Biden administration will send $452 million in ARPA funding “to support 13 states’ efforts to improve access to affordable, comprehensive health insurance coverage through section 1332 state-based reinsurance waivers,” per CMS. According to a CMS press release, the pass-through funding is intended to spur “stronger issuer participation in the individual market” in order to possibly “increase competition and translate to consumers having more opportunities to obtain affordable health insurance coverage.”

Centene Corp. promoted Sarah London to the post of vice chairman on its Board of Directors — a move that places London in the position to replace CEO Michael Neidorff, according to analysts. London’s previous role was president of Centene’s Health Care Enterprises division and executive vice president of Advanced Technology, per a Sept. 7 press release. “We view today’s announcement as perhaps the strongest signal yet of succession with Sarah London seemingly positioned to take the CEO spot when the time comes,” wrote Citi analyst Ralph Giacobbe on Sept. 7.

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News Briefs

September 10, 2021

The Biden administration will send $452 million in ARPA funding “to support 13 states’ efforts to improve access to affordable, comprehensive health insurance coverage through section 1332 state-based reinsurance waivers,” per CMS. According to a CMS press release, the pass-through funding is intended to spur “stronger issuer participation in the individual market” in order to possibly “increase competition and translate to consumers having more opportunities to obtain affordable health insurance coverage.”

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The Biden administration will send $452 million in ARPA funding “to support 13 states’ efforts to improve access to affordable, comprehensive health insurance coverage through section 1332 state-based reinsurance waivers,” per CMS. According to a CMS press release, the pass-through funding is intended to spur “stronger issuer participation in the individual market” in order to possibly “increase competition and translate to consumers having more opportunities to obtain affordable health insurance coverage.”
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