Week in Washington 020223

Week in Washington is brought to you by Michael Cohen, PhD. Tune in each week to read the latest on healthcare policy and get a glimpse of what’s on the horizon.

Week in Washington

02/02/2023

CMS Regs Galore

CMS released a number of important regulations this week.

• Medicare Advantage Risk Adjustment Validation Final Rule – CMS released a long-awaited final rule surrounding the RADV program for Medicare Advantage. The rule finalizes two key policies. 1) is that CMS will apply extrapolation beginning in PY 2018 and will not apply an adjustment factor (FFS Adjuster) in RADV results.
• Medicare Advantage and Part Advance Notice – The proposed rule is finalized as a proposal would make a number of large changes to MA payments, specifically regarding the Risk Adjustment model. It also includes key descriptions of some of the changes that the Inflation Reduction Act of 2022 will have to the Part D benefit. Wakely will be releasing a longer white paper on this regulation.

From CMS

PHE Coming to an End

The public health emergency (PHE) finally has an end date. It is now scheduled to end May 11. Most of the major health policy issues (Medicaid redetermination, telehealth) are uncoupled from the PHE ending but there’s a number of things that will be influenced when the PHE ends, such as:

• Medicare payment bump for patients with Covid-19.
• Certain requirements around out of network cost-sharing for MA beneficiaries.
• Required coverage of over the counter covid tests.

KFF has a good run down of all the impact at the end of the PHE[SS1] .

Covid Vaccine

The FDA panel authorized changing the primary Covid vaccine to the bivalent booster. It also hinted at a streamlined process that would allow for an annual Covid vaccine update. Pfizer expects sales of the vaccine to slip 30%, despite the large increase in unit price (i.e., expectation of a far larger reduction in purchases).

Prior Authorization

Axios reported that over 40 states are considering changes to laws to reduce the ability of health insurer use prior authorization. Several states are considering or have passed gold card type laws that give providers with a history of getting prior authorizations approved to be able to exempt from prior authorization.

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