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This Week in Health Care Reform: November 2nd, 2018

New rules are proposed bringing sweeping changes to drug pricing in Medicare and expanding telehealth elsewhere in the program; stakeholders continue to shine a spotlight on the health impacts of social isolation; and, expert voices speak out against the health insurance tax.

Week in Review

Medicare Rx: Late last week, the Administration unveiled a sweeping proposal aimed at overhauling how the Medicare program pays for certain drugs.  In essence, the plan would shift the current payment model for most drugs covered under Medicare Part B, which includes physician-administered medicines, to payment levels based on the International Pricing Index model – a move that would more closely align what we pay for these drugs in this country with the prices paid in other countries.  According to the Department of Health & Human Services (HHS), the move would be phased in over a five-year period and would apply to 50 percent of the country.  (HHS said it was considering a randomized approach to determining which geographies would participate.)  Officials projected that the proposed changes could save Medicare more than $17 billion and reduce the cost of certain drugs by as much as 30 percent.  While the announcement was met with some cautious optimism, opposition came from predictable corners.

Medicare Advantage Telehealth: Separately, the Centers for Medicare & Medicaid Services (CMS) also proposed new rules last week aimed at expanding in-home telehealth coverage in the Medicare Advantage program.  The change would allow Medicare Advantage beneficiaries to receive telehealth services in their homes, rather than from a health care facility, a benefit not currently available through traditional fee-for-service Medicare.  In announcing the proposed expansion, CMS said the changes were designed to eliminate geographical restrictions on telehealth access and give providers more opportunities to leverage connected care technologies.

Loneliness: Social isolation has been identified as a growing public health concern, especially as we’ve gained greater insights into how loneliness and connectedness affect our overall health.  In fact, a study released this week establishes just how important that relationship is, as researchers confirmed that loneliness is linked to an increased risk of developing dementia.  With that in mind, stakeholders have evolved their thinking to incorporate better addressing the issue in their clinical design in an effort to improve the social and physical well-being of vulnerable, at-risk populations

Stopping the HIT:
Voices from across the health care spectrum continue to marshal their energies, urging lawmakers to protect hard-working American families, small businesses, and seniors from the onerous burden of the health insurance tax (HIT).  While the HIT was suspended for next year, absent further Congressional action, it’s scheduled to return in 2020.  Earlier this summer, the House of Representatives passed legislation that would extend the moratorium on the HIT beyond 2019.  The Senate, however, has yet to take up HIT delay legislation of their own – but, there’s hope that they’ll do so during the upcoming lame duck session.  Ahead of those efforts, experts continue to make the case as to why stopping the HIT matters.

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