Legislative/Judicial/Regulatory Updates
 CMS released a proposed rule on Aug. 9 aimed at improving price transparency and lowering costs for Medicare beneficiaries. Provisions in the proposed rule would require hospitals to make information about standard charges, commonly used billing codes, and payer-specific negotiated costs for common services available to the public.
CMS issued a final decision on Aug. 7 allowing Medicare to cover a form of cancer treatment that uses a patient’s own genetically modified immune cells to fight disease.
CMS issued a statement on July 29 announcing that it will no longer approve requests by states to expand Medicaid to a limited population of adults with incomes above the federal poverty limit, rather than the full expansion group defined by the Affordable Care Act (ACA).
The U.S. District Court for the District of Columbia issued a ruling on July 29 vacating a New Hampshire requirement that non-disabled adults complete 100 hours of work or “community engagement” each month as a condition of eligibility for the state’s Medicaid program.
The U.S. District Court for the District of Columbia issued a ruling on July 19 allowing a Trump administration policy that expands the sale of short-term, limited duration insurance plans to remain in place.
The Internal Revenue Service (IRS) issued guidance on July 17 expanding the definition of preventive care to allow individuals enrolled in high-deductible health insurance plans to purchase drugs and medical equipment for chronic conditions such as hypertension and asthma without first having to pay down their deductibles.
The U.S House of Representatives passed a bill on July 17 that would repeal an excise tax (known as the Cadillac tax) on high-cost employer health insurance plans. The legislation, which was approved with limited debate and no amendments, passed on a vote of 419-6. The bill now goes to the U.S. Senate for consideration. Read the Academy alert.
The U.S. Government Accountability Office (GAO) issued an opinion on July 15 finding that Congress has the authority, under the Congressional Review Act, to review and potentially overturn guidance issued by the Trump administration in October 2018 intended to increase flexibility for states seeking Section 1332 waivers from certain requirements of the ACA.
CMS published several resources on July 15 to provide states with more information and clarity on the agency’s October 2018 guidance concerning Section 1332 waivers under the ACA. The materials released by CMS include a checklist for waiver applications, as well as waiver concept and application templates.
CMS released a proposed rule on July 15 that would overturn administrative requirements established in 2015, which mandated that states develop, submit, and regularly update an access monitoring review plan in order to ensure that their Medicaid programs provide sufficient access to care and services across geographic areas.
The Trump administration withdrew a proposed rule on July 10 that would have sought to exclude rebates on prescription drugs paid by manufacturers to pharmacy benefit managers (PBMs), Part D plans, and Medicaid managed care organizations from safe harbor protection under the Anti-Kickback Statute; and create a new safe harbor for prescription drug discounts offered directly to patients, as well as for fixed fee service arrangements between drug manufacturers and PBMs.
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