Friday, January 31, 2020 - Yesterday, the Trump administration released a Medicaid block initiative called the “Healthy Adult Opportunity.” The initiative marks an important milestone in the GOP’s efforts to pursue block-grant funding for Medicaid. In 2017, the GOP’s ACA repeal plan included provisions to transition the program to a block grant. Last year, the Trump administration reintroduced Medicaid block grants and soon after began meeting with states to discuss options for transforming the program without Congressional approval.
The initiative would permit states to transition a portion of their Medicaid population to a block grant program under one of two options: Annual lump sum or per capita budget.
Thursday, December 19, 2019 – Yesterday, the Trump administration released two proposals to lower pharmaceutical prices in the U.S. Collectively, the proposals would effectuate the drug importation action plan released in July. Department of Health and Human Services (HHS) Secretary Alex Azar said the importation proposals “are a historic step forward in an effort to bring down drug prices at out of pocket costs.”
The first proposal, a notice of proposed rulemaking issued by the Food and Drug Administration (FDA), would create a pathway for states to import drugs from Canada through programs authorized by the agency. The second, contained in a draft guidance, is designed to help drugmakers reroute medicines intended for foreign markets to the U.S., potentially at a lower price.
On November 15, the Centers for Medicare & Medicaid Services (CMS) released two rules to carry-out President Trump’s Executive Order on Improving Price and Quality Transparency in American Healthcare. The first is a final rule that would require hospitals to publish payer-negotiated prices beginning in January 2021. The second is a proposed rule that would mandate insurers post online real-time cost to allow patients to get advanced estimates of their out-of-pocket costs before they see a doctor or go to the hospital.
On November 12, the Centers for Medicare & Medicaid Services (CMS) issued a notice of proposed rule-making requiring that states share provider-level information about their supplemental payment and financing agreements under Medicaid. The rule, entitled the “Medicaid Fiscal Accountability Rule (MFAR),” has three core objectives:
On Wednesday, July 17, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma published a blog in Health Affairs announcing that just 66 ACOs joined the Medicare Shared Savings Program (MSSP) for the July 1 start date – less than half the number of new ACOs that joined in 2018. There are now 518 ACOs in the MSSP compared to 561 last year. Of those ACOs, 41 are entirely new to the program and 25 are re-entering after a time of not participating.
On Wednesday, July 10 President Trump signed an Executive Order creating the Advancing American Kidney Health program. The order seeks to reduce the number of Americans developing end-stage renal disease (ESRD) by 25 percent by 2030 and have 80 percent of new ESRD patients either receiving dialysis at home or receiving a transplant in 2025.
HHS and CMS have launched a set of new payment models, dubbed the Primary Cares Initiative, that aim to transform primary care through value-based options. The new models will also test financial risk and performance-based payments for primary care practitioners and clinicians.
On Thursday, the Trump administration withdrew a drug rebate proposal that would have required pharmacy benefit managers (PBMs) to pass along rebate savings to consumers rather than keeping them as a profit for themselves.
On Wednesday, HHS and the FDA released a plan to lay the foundation to import certain low-cost drugs from Canada. Insulin, biological drugs, controlled substances, and intravenous drugs would not be included. According to HHS Secretary Alex Azar, who alluded to working on a proposal with President Trump just a day earlier, the plan represents a shift in agency thinking regarding importation from foreign countries.