HHS Sec. Xavier Becerra is defending No Surprises Act-related regulations from growing criticism by providers and members of Congress, citing an HHS report on the cost and prevalence of surprise bills. Becerra said on Nov. 22 that providers who overcharge for services will simply have to change: “I don’t think when someone is overcharging, that it’s going to hurt the overcharger to now have to [accept] a fair price,” he told Kaiser Health News. “Those who are overcharging either have to tighten their belt and do it better, or they don’t last in the business. It’s not fair to say that we have to let someone gouge us in order for them to be in business.” The HHS report found that “surprise medical bills are relatively common among privately insured patients and can average more than $1,200 for services provided by anesthesiologists, $2,600 for surgical assistants, and $750 for childbirth-related care.” More than 150 members of Congress from both parties, many of them physicians, sent a letter to Becerra earlier this month protesting the latest rulemaking on the No Surprises Act. In addition, Texas’ largest provider organization filed suit to block the latest interim final rule.
CareSource, a Medicaid-focused Ohio carrier, will acquire the Columbus Organization, a provider of services for individuals with intellectual/developmental disabilities (IDD). According to a press release, the Columbus Organization serves 100,000 people across 13 states with care coordination, clinical staffing and quality improvement services. The organization has also assisted over 140 local agencies in 40 states and the District of Columbia. The Columbus Organization was previously owned by HeatlhEdge Investment Partners, a Tampa private equity firm. Terms of the deal were not disclosed.
The ERISA Industry Committee (ERIC) joined other plan sponsor groups in lobbying Congress to allow high-deductible plan members to use telehealth without meeting a deductible and remove limits on telehealth patients’ use of health savings accounts. In a letter to Reps. Susie Lee (D-Nev.) and Michelle Steel (D-Calif.), ERIC endorsed the Telehealth Expansion Act of 2021 (H.R. 5981), which would allow first-dollar coverage of telehealth services for employees enrolled in high-deductible plans.
AHIP, ERIC, the Blue Cross Blue Shield Association, and American Benefits Council all signed a letter calling on Congress to remove language in the Build Back Better Act that allows “Department of Labor to assess significant civil monetary penalties on group health plan sponsors, issuers, and administrators” that do not comply with mental health parity laws. The signees called on Congress to “amend the language to ensure adequate due process and ensure robust compliance assistance and opportunities to rectify identified issues before fines are imposed.”
In the third week of the annual open enrollment period for Affordable Care Act marketplace plans, approximately 810,00 people selected plans on HealthCare.gov. To date, about 2,435,000 people have enrolled in plans on the federal exchange, which is used by 33 states. The open enrollment period started on Nov. 1 and is set to run through Jan. 15. Signup data from states that run their own enrollment platforms typically is released at the end of open enrollment. Three new states — Kentucky, Maine and New Mexico — moved to state-based marketplaces for 2022.
A white paper from the Robert Wood Johnson Foundation and Urban Institute found that “if Medicare were to cover vision and hearing services, it would primarily benefit lower income enrollee groups who likely have considerable unmet needs for these services and the increase in overall Medicare spending would be relatively small.” The white paper found that, of the $8.4 billion spent by Medicare enrollees on vision services in 2020, $5.4 billion was paid out-of-pocket; for the $5.7 billion spent by Medicare enrollees on hearing, $4.7 billion was paid out-of-pocket. Unsurprisingly, given that dependence on out-of-pocket funds, “utilization of and expenditures on vision and hearing services both increased markedly with income.”
An investigation published by Kaiser Permanente in JAMA Network Open found that telehealth visits do not cause excess utilization. The researchers wrote that “adjusted rates of prescribing and nonmedication orders were significantly lower for telemedicine visits than for clinic visits, with slightly higher rates of follow-up office visits after telemedicine visits but no significant difference in rates of 7-day emergency visits or hospitalizations.” The researchers studied data gathered from 2016 to 2018, well before the telehealth surge brought on by the COVID-19 pandemic.
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