How Medicare is changing in 2023

Presented by PhRMA: Delivered daily by 10 a.m., Pulse examines the latest news in health care politics and policy.

Nov 02, 2022 View in browser   By Daniel Payne and Krista Mahr Presented by Driving the Day The Centers for Medicare and Medicaid Services issued new Medicare rules. | Spencer Platt/Getty Images RULES GALORE (I) — On Tuesday, the Centers for Medicare and Medicaid Services released several final policies affecting sectors across the industry — and patients across the country. The policies will become effective on Jan. 1, 2023. Some highlights, winners and losers: — A new behavioral health push: The new rule loosens requirements on Medicare patients seeing a therapist or a counselor. It also allows opioid treatment via telehealth or mobile units to help expand access across the country. Another part of the policy will aim to integrate psychologists and psychiatrists in primary care settings. The mental health aspects of the new policy were a focus for the Biden administration's announcement of the new CMS rules — and it comes amid a backdrop of many members on the Hill being open to new legislation on the matter. — Cuts to the Physician Fee Schedule: CMS, as expected, finalized Medicare cuts to doctors through the Physician Fee Schedule. Providers are pushing Congress to stop the cuts, emphasizing the "significant medical inflation, along with staffing and supply chain shortages" that make the cuts increasingly concerning, according to the Surgical Care Coalition. The American Medical Association said the cuts represented "an ominous reality" that needed to be stopped. The Medical Group Management Association emphasized that getting rid of the cuts "cannot wait until next Congress." It puts the pressure on a lame-duck Congress to pass legislation stopping the cuts, likely in an end-of-year package. — A plan to boost ACOs: CMS is changing its Medicare Shared Savings Program in an effort to increase the number of members in Accountable Care Organizations (groups of providers coordinating care for increased efficiency) — a figure that has plateaued in recent years. By adjusting benchmarks and trying to mitigate provider risk, the administration hopes to push toward the goal of all traditional Medicare beneficiaries being in an ACO by 2030. Additionally, the final rule includes measures focused on patient equity in ACOs. The agency described the policies in the final rule as "some of the most significant reforms since the program was established in 2011." The National Association of ACOs welcomed the policy, thanking the agency for "improving accountable care models and speeding the movement toward value for all patients." WELCOME TO WEDNESDAY PULSE, where we were concerned to read about the frog pandemic — caused by a fungus that's infected about half of amphibians in the U.S. Have ideas to help the frogs (besides the "topical yogurt" being considered)? What about health news or tips? Drop us a line at dpayne@politico.com and kmahr@politico.com . TODAY ON OUR PULSE CHECK PODCAST , Katherine Ellen Foley talks with Ben Leonard about the FDA's tobacco regulatory decision-making process. Plus, Greer Donley, a professor specializing in reproductive health care at the University of Pittsburgh Law School, breaks down what the FDA's stance on doctors prescribing abortion pills to people who aren't yet pregnant means in practice. Listen to today's Pulse Check podcast   A message from PhRMA: The 340B program may be driving up costs for some patients. A new analysis finds average costs per prescription for a patient is more than 150% greater at 340B hospitals than at non-340B hospitals. It's time to fix the 340B program. Learn more.   At the Agencies RULES GALORE (II) — The remaining notable final rules released from CMS include: — 340B rates return: CMS is returning to its pre-2018 payment for drugs in the 340B program in 2023 at the average sale price plus 6 percent. A cut to nondrug services of just over 3 percent will make the measure budget neutral as required by law. The new rule comes after the Supreme Court's decision in American Hospital Association v. Becerra that found earlier payment cuts from 2018 unlawful. "We are very pleased to see that CMS has restored equity to the Medicare outpatient prospective payment system," said Maureen Testoni, president and CEO of 340B Health, a membership group representing hospitals that participate in the program. "We look forward to working with CMS on compensation for the hospitals that were financially harmed by the unlawful OPPS payment cuts in 2018 to 2022." — Rural Emergency Hospital designation: The final rule for a new Medicare payment designation was released. The final rule would offer hospitals that take on the designation a 5-percent boost in Medicare payments and a monthly facility payment of $272,866. Most hospitals have approached the new designation cautiously, with many saying it isn't right for them — given it requires giving up inpatient services. Others have noted the new rule is a step toward "right-sizing" the health system and allowing the most services to remain open in rural areas. "I believe CMS must continue to implement REH with minimal administrative burden and maximum flexibility for rural hospitals, while maintaining safe and high-quality care for patients," Sen. Chuck Grassley (R-Iowa) said in a statement this morning. "I will continue to work with stakeholders and CMS to ensure the law works for rural hospitals and communities as Congress intended." — Dental and colon cancer care expansion: The new rules also included finalizing policies that would allow Medicare Parts A and B to pay for dental care when it's integral to treating a medical condition. That includes payments in more circumstances for dental exams and treatment, particularly to prevent infections. At least one Democrat — Rep. Lloyd Doggett (D-Texas) — released a statement, keeping with his party's midterm message of expanding and maintaining Medicare benefits. The new rules also lower colorectal screening ages from 50 to 45, aligning with new U.S. Preventive Services Task Force guidelines. Medicare will also cover colonoscopies following noninvasive tests that yield positive results, with no out-of-pocket costs for either screening. Eye on the FDA Parents are still finding baby formula hard to come by. | Brandon Bell/Getty Images BABY FORMULA SHORTAGES PERSIST — Biden officials have acknowledged that supplies of baby formula have continued causing problems for parents, especially amid record inflation and rising food prices, POLITICO's Meredith Lee Hill reports . Eight months after a shuttered formula plant sparked shortages across the country, stores continue having problems keeping shelves stocked. Officials have blamed hoarding, supply chain problems and manufacturers making fewer varieties. "I know that there's obviously still a problem," said Stacy Dean, who oversees the Agriculture Department's federal nutrition program for low-income moms and babies that pays for more than half of the formula consumed in the U.S. The continued crisis presents another problem for Democrats heading into the midterms — particularly after the administration's highly publicized efforts to solve the problem when it first arose. Some Republican lawmakers threaten to cut funding from the FDA during the lame-duck session if the agency doesn't come up with a better explanation of its monthslong delays in addressing food safety concerns at the formula plant. FDA'S WARNING TO AMAZON AND WALMART — The FDA told Amazon and Walmart to stop selling products that contain non-steroidal anti-inflammatory drugs not listed among their product ingredients, POLITICO's Katherine Ellen Foley reports. In the past, the FDA has generally focused on manufacturers of products that don't comply with the agency's rules — but this time, it's also sending warnings to sellers. The letter, sent Oct. 28, said the companies were selling products that contained an anti-inflammatory compound not listed on the label.   A message from PhRMA:   Abortion EVADING ABORTION BANS — People in states with abortion restrictions are increasingly ordering drugs to end pregnancies, POLITICO's Ruth Reader reports . The new data shows a jump in orders from Aid Access, a Dutch telehealth provider that offers abortion pills, since the fall of Roe v. Wade this summer. The average daily orders from 30 states for abortion medication received by Aid Access increased to 213.7 from June 24, the day of the high court's decision, to the end of August. That's up from a daily average of 82.6 from Sept. 1, 2021, to May 1. Providers AHA EAGER TO HELP HHS POLICE INSURERS — The American Hospital Association sent a letter to the Biden administration Wednesday morning asking it to use open enrollment as an opportunity to scrutinize the "abuses" of commercial insurers. The group pointed to increasing insurance costs, prior authorization rules and shifting coverage as key issues that need attention. Names in the News FIRST IN PULSE: Zach Rothstein has been named the permanent executive director of AdvaMedDx. What We're Reading Kaiser Health News' Harris Meyer reports on the federal government's investigation into a hospital that allegedly denied an abortion to a woman experiencing a medical emergency. The Atlantic's Kieran Setiya writes about where patients go when doctors run out of answers about chronic pain.   A message from PhRMA: The 340B program grew, yet again, hitting a whopping $43.9 billion in sales at the discounted 340B price in 2021. But there has not been evidence of corresponding growth in care provided to vulnerable patients at 340B covered entities. And making matters worse, fresh data show that 340B may actually be driving up costs for some patients and our health care system as whole. The program of today is having the opposite effect of what Congress intended when they created 340B. That's a problem. It's time to fix the 340B program. Learn more.     Follow us on Twitter Tucker Doherty @tucker_doherty Dan Goldberg @dancgoldberg Erin Banco @ErinBanco Katherine Ellen Foley @katherineefoley Lauren Gardner @Gardner_LM Ben Leonard @_BenLeonard_ David Lim @davidalim Krista Mahr @kristamahr Megan Messerly @meganmesserly Alice Miranda Ollstein @aliceollstein Carmen Paun @carmenpaun Megan R. Wilson @misswilson Daniel Payne @_daniel_payne Ruth Reader @RuthReader   Follow us

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