Week In Washington: Regulations, Changing Personel, and News of Note

March 7, 2019

A few news of note this week

Scott Gottlieb Leaves FDA – Scott Gottlieb, one of the most influential policy makers in Washington, is stepping down from his role as head of the FDA. Gottlieb had spearheaded efforts to reduce teen usage of e-cigarettes and improve access to generic drugs. It is unclear who will replace Gottlieb and if the new appointee will continue Gottlieb’s push for generic drugs.

Mental Health Ruling: In a major ruling, a Federal judge ruled that UnitedHealthcare failed to provide sufficient access to treatment for mental illness and substance abuse. The ruling was based, in part, on United’s decision to not adhere to widely used clinical criteria (such as those adopted by the American Society of Addition Medicine). The decision is expected to be appealed. If upheld the ruling would put pressure on other issuers to improve mental health and addiction coverage.

Dialysis Changes Coming? Secretary Azar announced a forthcoming CMMI demonstration that will be designed to “develop new payment models for patients with end-stage renal disease and stage 4 and 5 kidney disease”. According to Politico, the demonstration the Administration will be pushing will be designed to encourage in-home dialysis treatment.

Cross-State Lines: CMS released a request for information (RFI) on how best to encourage selling insurance across state-boundaries. The RFI centered on how best to implement Section 1333 of the ACA which allows states to enter into “compacts” that allow issuers to sell across state lines. RFIs are typically precursors to forthcoming regulations.

State Watch

  • Georgia – Georgia is considering legislation to combat surprise out-of-network billing. The bill would require health insurers to pay full pre-insurance charges as well as out of network providers their full charge. If enacted, the changes could increase premiums in the state.

North Carolina- North Carolina is considering having its state health plans (i.e., health plans for the state’s teachers and other workers) starting in 2020 pay hospitals and doctors at a “set percentage above the Medicare rate” as part of a goal of reducing state costs. The move is expected to be challenged by North Carolina’s hospital system but if approved may be a model for other states to follow.