Health Plan Weekly

✦ CMS issued a proposed rule on June 17 aimed at making it easier for state Medicaid programs to enter into outcomes-based contracts with drug manufacturers. Among other policy revisions, the rule would allow manufacturers to report multiple “best prices” for a therapy under the Medicaid Drug Rebate Program if the prices are tied to a value-based payment arrangement. CMS Administrator Seema Verma touted the proposed rule as a way to lower prescription drug costs in general. “CMS’s rules for ensuring that Medicaid receives the lowest price available for prescription drugs have not been updated in thirty years and are blocking the opportunity for markets to create innovative payment models. By modernizing our rules, we are creating opportunities for drug manufacturers to have skin in the game through payment arrangement[s] that challenge them to put their money where their mouth is,” she said in a statement about the new proposal. Read the proposed rule at https://bit.ly/30X06jg.

✦ Despite calls for expanded testing to detect coronavirus cases and ensure Americans can safely return to work, some private health insurers may cover only those deemed medically necessary, Reuters reported. Such policies could limit testing to people who either have symptoms of COVID-19 or have been in close contact with someone who has, the article pointed out. Meanwhile, states including Georgia, North Dakota, Oklahoma, Tennessee and Washington have taken steps to ensure patients are protected from being balance billed for coronavirus tests, such as capping costs or more narrowly defining what insurers should pay for, Politico reported. Read more at https://reut.rs/3d9dFOQ and https://politi.co/2YKYJkM.

The Supreme Court’s June 15 ruling on LGBTQ+ workforce protections in Bostock v. Clayton County, Georgia, could supersede a recently finalized rule by HHS’s Office for Civil Rights (OCR) that stripped gender identity protections from anti-discrimination provisions in the Affordable Care Act (ACA), legal experts say. However, the same experts emphasize that the matter is still an open question and is likely to play out over time in lower courts.

In Bostock, the Court held that Title VII of the Civil Rights Act of 1964 protects employees from discrimination based on sexual orientation or gender identity. The case originated with Gerald Bostock, who sued his employer, Clayton County, when he was fired after mentioning that he was the member of a gay softball league.

Unsurprisingly, COVID-19 was a frequent topic of discussion during the 2020 America’s Health Insurance Plans Institute & Expo — an event held virtually because of the ongoing pandemic. Here’s a selection of what health care executives and thought leaders had to say about the impact of the crisis on their organizations and the industry:

“Mid-January was when we began to prepare, and we assumed it would come when we were seeing what was happening in China….[We] didn’t imagine that it would be in Seattle and that it would spin up in a particular nursing home, nor were we expecting that two of our employees would have close relatives who lived in that nursing home and lost them both. And that brought it home really early on and made it personal.”

Telehealth use has surged during the COVID-19 pandemic, and is likely to remain higher than it was before the crisis on a permanent basis. However, the difficult work of regulating and establishing rate structure for telehealth beyond the COVID-19 pandemic has only just started.

Experts tell AIS Health that Congress might make permanent some of the emergency changes to telehealth rules enacted to ensure Americans could still receive care while sheltering at home, likely as part of the next coronavirus emergency spending package that could come shortly before Congress’ August recess. On June 17, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing about how to consolidate the gains in telehealth made necessary by the pandemic.

In a deal that the companies say was validated by the challenges of the COVID-19 pandemic, HealthNow New York Inc. revealed on June 16 that it will become part of fellow Blue Cross Blue Shield licensee Highmark Inc.

“Conversations regarding this potential partnership with Highmark began months ago, but it’s fair to say that the recent impact of COVID-19 really shed light on the threats and the gaps in the broader health care delivery system,” David Anderson, president and CEO of HealthNow, said during a conference call with reporters. “This affiliation will further strengthen our company to respond to our members’ health care needs when additional unexpected pressures arise.”