This Week – October 27, 2018

This Week in Washington, D.C.

  • ACG Urges CMS to Grant MIPS Exemptions for States Impacted by Hurricane Michael
  • New HHS Guidance Raises Issue of Pre-Existing Protections for GI Patients
  • Trump Administration Seeking to Lower Costs for Medicare Part B Drugs
  • National Youth Obesity Rates Held Steady in 2017, New Data Show

ACG Urges CMS to Grant MIPS Exemptions for States Impacted by Hurricane Michael

This week, your ACG Governors from Florida and Georgia urged CMS Administrator Seema Verma to grant CY 2018 MIPS reporting hardship exemptions for those ACG members impacted by Hurricane Michael.  ACG successfully advocated for similar hardship exemptions last year, and also shepherded a resolution through the American Medical Association House of Delegates meeting in November 2017.

ACG urged CMS to announce waivers for MIPS-eligible clinicians in these states for the CY 2018 reporting year, to facilitate their complete recovery from the devastation of Hurricane Michael.  In September, ACG Governors from North Carolina, South Carolina, and Virginia sent a similar letter to CMS Administrator Verma in response to Hurricane Florence.

The ACG Board of Governors will continue to advocate on behalf of clinical GI and your patients, including efforts to reduce the regulatory burdens of GI practices.

Read the letter to CMS here.

Remember to contact your ACG Governor on important state and local issues impacting you and your practice.

The ACG Board of Governors is one of the most unique aspects of the American College of Gastroenterology. Governors are ACG Fellows that are elected from the membership of a particular state or region. There are currently 77 Governors across seven different regions in the U.S. and abroad. The Board of Governors acts as a two-way conduit between College leadership and the membership at-large. This helps the College make certain it is meeting the evolving needs of the membership.

Contact your ACG Governor today!


From ACG Legislative and Public Policy Chair, Whitfield L. Knapple, MD, FACG

New HHS Guidance Raises Issue of Pre-Existing Protections for GI Patients

On Monday, CMS issued guidance for states who are interested in applying for federal waivers to create insurance products under the Patient Protection and Affordable Care Act (ACA).  The purported goal is to provide more flexibility and insurance options for state residents.

One concern, however, is that in order to increase flexibility, states may be allowed to waive certain insurance coverage protection mandated by the ACA, such as essential health benefits or guaranteed coverage for patients with pre-existing conditions.  These issues continue to be major campaign issues leading up to the November 2018 elections.

As background, the ACA permits a state to apply for a “State Innovation Waiver” (commonly referred to as a section 1332 waiver) to pursue innovative strategies for providing their residents with access to higher value, more affordable health coverage. In 2015, CMS published guidance explaining how the federal government would review state applications for 1332 waivers.  This week’s guidance changes this 2015 review process, stating that comprehensiveness and affordability of coverage under a waiver should instead, “focus on the nature of coverage that is made available to state residents (access to coverage), rather than on the coverage that residents actually purchase.”  According to CMS, “a major disadvantage of the 2015 interpretation was that it deterred states from providing innovative coverage that, while potentially less comprehensive than coverage established under the PPACA, could have been better suited to consumer needs and potentially more affordable and attractive to a broad range of its residents.”

According to the guidance, the federal government section 1332 waiver requirements will now be met if the state plan has made other coverage options available that state residents may prefer, so long as access to affordable, comprehensive coverage is also available.  Any changes sought by states won’t take effect until 2020.  Enrollment in 2019 plans opens November 1, 2018.

ACG is monitoring this guidance, as it may significantly impact patients with chronic GI conditions and the ability to afford health insurance, especially health insurance with adequate coverage and comprehensive treatment options for these chronic conditions.


Trump Administration Seeking to Lower Costs for Medicare Part B Drugs

On Thursday, CMS announced a pre-regulation (“Advance Notice of Proposed Rulemaking”) seeking input on a new “International Pricing Index” (IPI) payment model related to the costs of drugs administered in physician practices and hospitals.  CMS projects savings to total $17.2 billion over five years.

Specifically, CMS intends to test models such as reducing Medicare reimbursement for selected Part B drugs to more closely align with international prices, allowing private-sector vendors to negotiate prices for drugs, and changing the 4-6% drug add-on payment.

With this advanced noticed, CMS is considering a proposed rule in the spring of 2019. The potential IPI Model would start in spring 2020 and operate for five years, until the spring of 2025.

Background: Medicare currently pays for outpatient drugs in physician offices, hospital outpatient departments and certain other settings, based on drug manufacturers’ average sales prices (ASP) in the United States, plus a 6% add-on payment.  (Please note that this add-on payment is subject to the sequestration, which effectively reduces the add-on to +4.3%).  The dollar amount of the add-on payment increases as drug prices increase.

New Proposal: read the full blog here.


National Youth Obesity Rates Held Steady in 2017, New Data Show

On Tuesday, the Robert Woods Johnson Foundation released data concluding that nearly 1 in 6 young people in the United States were obese in 2017 — essentially the same rate as 2016.  The data came from the National Survey of Children’s Health, which collects health information on children from up to the age of 17. The survey, conducted by the U.S. Census Bureau, concluded that there are still major ethnic and racial disparities.  There remains significant disparities between states, as well. Mississippi is still leading the country with an obesity youth rate of 26.1%.  Utah has the lowest youth rate at 8.7%.  North Dakota was only one state that appeared to have a statistically significant decline in obesity: the rate fell from 15.8% in 2016 to 12.5% in 2017.  According to policy experts, the data has limitations.  One example is that the survey is not based on independently verified data, but parent-reported height and weight numbers, which are then used to calculate BMI.