A&B Healthcare Week in Review, January 28, 2017

I.Regulations, Notices, & Guidance

• On January 24, 2017, the Department of Health and Human Services (HHS) withdrew the following document, HHS Poverty Guidelines.
• On January 24, 2017, HHS withdrew the following document, Delegation of Authorities: Office of the National Coordinator for Health Information Technology.
• On January 24, 2017, HHS withdrew the following document, Content and Format of Substantial Equivalence Applications: Actions on Substantial Equivalence Reports.
• On January 24, 2017, HHS withdrew the following document, Declaration under the Public Readiness and Emergency Preparedness Act: Zika Virus Vaccines.

• February 7, 2017: The Department of Health and Human Services (HHS) announced a meeting of the Technical Advisory Panel on Medicare Trustee Reports. The Panel will likely hear presentations from two outside experts; one on prescription drugs spending and a second on spillover effects. In addition the HHS Office of the Actuary will present on issues the panel may wish to address. Additional presentations regarding long range growth, sustainability of provider payments under Affordable Care Act and Medicare Access and Chip Reauthorization Act (MACRA), methods for transitioning from short term (10 year) to long term (75 year) projections and methods and the presentation of uncertainty in the report may follow.
• February 9, 2017: The Center for Medicare & Medicaid Services (CMS) will host a webinar to discuss various aspects of the Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model final rule.
• February 13, 2017: HHS announced the next Meeting of the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030. The Committee will discuss the nation’s health promotion and disease prevention objectives and will provide recommendations to improve health status and reduce health risks for the nation by the year 2030.

II. Congressional Legislation & Committee Action

• On January 24, 2017, the Senate Finance Committee held a confirmation hearing of HHS Secretary Nominee, Representative Tom Price (R-GA).

• On January 24, 2017, the House Budget Committee held a hearing entitled, The Failures of Obamacare: Harmful Effects and Broken Promises. The witnesses included Grace-Marie Turner, President of the Galen Institute; Robert Book, Senior Director of Health Systems Innovation Network LLC; Edmund Haislmaier, Senior Research Fellow for health policy studies at the Heritage Foundation; and Linda Blumberg, Senior Fellow in the Urban Institute's Health Policy Center.
• On January 24, 2017, the House Ways and Means Subcommittee on Oversight held a hearing entitled, Examining the Effectiveness of the Individual Mandate under the Affordable Care Act. The witnesses included Thomas Miller, Resident Fellow, American Enterprise Institute; Mr. John Graham, Senior Fellow at the National Center for Policy Analysis; and Dr. John McDonough, Professor of Practice, Department of Health Policy & Management, Harvard TH Chan School of Public Health.

III. Reports, Studies, & Analyses  

• On January 23, 2017, the Office of Inspector General (OIG) released a report entitled, Review of Medicare Contractor Information Security program Evaluations For Fiscal Year 2015. PricewaterhouseCoopers (PwCs) evaluations of the contractor information security programs were adequate in scope and sufficiency. PwC reported a total of 149 gaps at the 9 MACs for FY 2015, which was 16 percent more than the number of gaps for the same 9 contractors in FY 2014. In this report, we define gaps as Medicare administrative contractors (MACs’) incomplete implementation of FISMA or CMS core security requirements. PwC categorized gaps into three categories: high, medium, and low risk.
• On January 23, 2017, the Government Accountability Office (GAO) released a report entitled, Federal Health Care Center: VA and DOD Need to Develop Better Information to Monitor Operations and Improve Efficiency. The report found that as the GAO has previously reported, leading practices for planning call for results-oriented organizations to develop plans that provide tools to assure accountability, such as time frames and interim milestones that could be used to monitor progress, hold staff accountable for achieving desired results, and make mid-course corrections, if needed. Although officials routinely track each improvement through twice monthly meetings, and use a spreadsheet to monitor status and next steps, they have not specified time frames and interim milestones. Without this information, officials cannot ensure that they will implement the recommended improvements in a timely and efficient manner.
• On January 23, 2017, the GAO released a report entitled, Veterans Health Administration: Management Attention Is Needed to Address Systemic, Long-standing Human Capital Challenges. The report found that attrition of medical center HR staff increased between fiscal years 2013 and 2015, due to HR staff transferring to other federal agencies. The Veterans Health Administration (VHA) officials note a lack of HR capacity has impacted their ability to recruit and hire critical clinical staff. Furthermore, inadequate oversight of medical center HR offices limits the Department of Veterans Affairs’ (VA) and VHA’s ability to monitor HR improvement efforts and ensure that HR staff apply policies consistently, such as for position classification. The report also found that the VHA reports skills gaps in its HR staff, but does not conduct comprehensive skills gaps assessments. Further, VHA has limited ability to monitor the effectiveness of HR training.
• On January 24, 2017, the Congressional Budget Office (CBO) released a report entitled, The Budget and Economic Outlook: 2017 to 2027. The report found that if current laws remained generally unchanged, deficits would follow an upward trajectory over the next decade, driving up federal debt. The CBO projects moderate economic growth during that period. A presentation summarizing the CBO’s baseline budget projections included in the report can be found here.
• On January 25, 2017, the OIG released a report entitled, Review of California Medicaid Managed-Care Program Potential Savings With Minimum Medical Loss Ratio. The report found that For the nine Medicaid managed-care organizations (MCOs) the OIG reviewed, the Medicaid program would not have realized savings in 2014 if the California Department of Health Care Services (State agency) had required its MCOs to meet a minimum medical loss ratio (MLR) standard, similar to the Federal standards for private health insurers and Medicare Advantage plans, and had required remittances when that standard was not met. Although the State agency did not require its MCOs to achieve a minimum MLR standard, the State agency achieved savings similar to the savings it would have achieved with an MLR requirement by placing limits on the administrative costs that MCOs could incur. Because the MLRs the OIG calculated for the nine MCOs were greater than 85 percent during 2014, the MCOs would not have had to issue remittances to the State agency.

IV. Other Health Policy News

• On January 23, 2017, the White House issued an Executive Order regarding the Patient Protection and Affordable Care Act. According to the White House, the Executive Order minimizes the economic burden of the Patient Protection and Affordable Care Act pending repeal. A copy of the Executive Order can be found here.
• On January 23, 2017, the White House issued a memorandum for the Heads of Executive Departments and Agencies entitled, Regulatory Freeze Pending Review. The memorandum asks Heads of the Executive Departments and Agencies to freeze new or pending regulations.

V. ACA Repeal News

• On January 23, 2017, Senator Bill Cassidy (R-LA) and Senator Susan Collins (R-ME) introduced an Affordable Care Act (ACA) replacement bill entitled, The Patient Freedom Act of 2017.
• On January 25, 2017, Senator Rand Paul (R-KY) introduced S. 222, the Obamacare Replacement Act. A section by section summary can be found here.