CMS to Begin Issuing Medicaid/CHIP Scorecard

The Centers for Medicare and Medicaid Services (CMS) announced the creation of a Medicaid and Children’s Health Insurance Program (CHIP) Scorecard. The publication will track Medicaid and CHIP quality metrics and federally reported measures in a scorecard format as a means to foster transparency and increase accountability for program outcomes and performance. Administrator Seema Verma says she intends the Scorecard to be used for tracking the best practices of high performing states. The site relies on states’ voluntary participation, consolidating data submitted by states in one location, posting CMS’ own performance data, and ranking states by performance. The metrics reflected in the first Scorecard include well child visits, mental health conditions, children’s preventive dental services, and other chronic health conditions. The Scorecard will not be used to penalize poor-performing programs. It is the first time that CMS is making public state and federal administrative performance metrics, like state/federal timeliness of managed care capitation rate reviews, time from submission to approval for Section 1115 demonstrations, and state/federal plan amendment processing times. CMS plans to update the Scorecard annually with new functionality and metrics, including opioid-related and home and community-based services-related quality metrics, along with the ability to compare spending patterns. It could also potentially be used to hold states more accountable in the future.

Drug Spending Rises, Despite Decrease in Prescriptions

The HHS Office of the Inspector General (OIG) released new data indicating that Medicare spending on brand-name drugs rose by 62 percent between 2011 and 2015, despite the fact that the number of brand-name drug prescriptions in Medicare Part D decreased over the same time period. The increase does take into account discounts and rebates paid by manufacturers to insurers and pharmacy benefit managers (PBMs). Medicare spending increased from $49 billion in 2011 to $80 billion in 2015, while the number of prescription fell 17 percent and the total amount of rebates doubled during the five-year period. The report also finds that seniors’ out-of-pocket (OOP) costs are increasing. Part D beneficiaries spent 40 percent more on brand-name drugs from 2011 to 2015 and the percentage of beneficiaries with OOP costs of $2,000 or more per year doubled. The average OOP cost per brand name drug rose by 40 percent, from $161 to $225. In addition, the average unit cost of brand-name drugs increased by 29 percent.

Reduction in HACs Saves Lives, Reduces Costs

The Agency for Healthcare Research and Quality (AHRQ) has released new data indicating that the Partnership for Patients campaign was successful in averting deaths and avoiding costs. The campaign to improve hospital safety and disseminate best practices was launched in 2011, alongside ACA provisions to penalize hospital-acquired conditions (HACs) and the launch of other quality improvement efforts. The federal data indicates that the Partnership helped save 8,000 lives and $3 billion in health care costs between 2014 and 2016.

GAO Medicaid MCO Report Finds Improper Payments

The Government Accountability Office (GAO) is recommending that CMS take action to address improper payments in the Medicaid program. The GAO issued a new report at the request of the House Energy and Commerce Committee which found that the agency’s current efforts to estimate the Medicaid improper managed care payment rate do not account for overpayments and unallowable costs. The managed care component of the Payment Error Rate Measurement (PERM) review only measures capitated payments, and therefore does not account for the totality of integrity risks in Medicaid managed care. The GAO’s audits and investigations, which only involved a small fraction of the managed care organizations (MCOs) in operation, identified $68 million in overpayments and unallowable costs that were not included in PERM estimates. The Department of Health and Human Services agreed with the GAO recommendation.

Upcoming Congressional Meetings and Markups

Senate Health, Education, Labor, and Pensions Committee hearing “The Cost of Prescription Drugs: Examining the President’s Blueprint ‘American Patients First’ to Lower Drug Prices;” 10:00 a.m., 430 Dirksen Bldg.; June 12

Senate Finance Committee Open Executive Session to Consider an Original Bill Entitled Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018; 2:00 p.m., 215 Dirksen Bldg.; June 12

House Veterans’ Affairs Health Subcommittee legislative hearing on H.R. 2787; H.R. 3696; H.R. 5521; H.R. 5693; H.R. 5864; H.R. 5974; Draft bill, the Veterans Serving Veterans Act; and Draft bill, to improve the productivity and management of VA health care facilities; 3:00 p.m., 334 Cannon Bldg.; June 13

House Energy and Commerce Oversight and Investigations Subcommittee hearing “The State of U.S. Public Health Biopreparedness: Responding to Biological Attacks, Pandemics, and Emerging Infectious Disease Outbreaks;” 9:00 a.m., 2123 Rayburn Bldg.; June 15

Senate Health, Education, Labor, and Pensions Committee hearing “Effective Administration of the 340B Drug Pricing Program;” 10:00 a.m., 430 Dirksen Bldg.; June 19

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