RISE summarizes recent headlines that impact the U.S. health system, Medicare, Medicare Advantage, and Medicaid.

Feds propose rules to promote transparency in air ambulance costs, agent and broker compensation

The U.S. Departments of Health and Human Services (HHS), Labor, and the Treasury, along with the Office of Personnel Management (OPM), announced proposed rules that would require plans, issuers, and providers of air ambulance services to submit detailed data regarding air ambulance services specified in the reporting requirements of the No Surprises Act.

 The rules additionally outline the Centers for Medicare & Medicaid Services’ (CMS) authority to fully enforce Title I (the No Surprises Act) and Title II (Transparency) of Division BB of the Consolidated Appropriations Act of 2021, in states that do not have the authority to enforce or fail to substantially enforce one or more of the provisions and would help consumers understand the compensation being paid to agents and brokers who help them select health insurance. This is the latest regulatory action in a series of rulemaking implementing the No Surprises Act.

 “The air ambulance industry is a highly consolidated market that often leads to surprise bills for patients,” HHS Secretary Xavier Becerra said in the announcement. “Today’s proposed rules are part of the Biden-Harris Administration’s agenda to protect patients from unreasonably high costs and make health care more affordable. These rules would allow HHS to collect data to analyze the industry’s market trends and costs and provide critical information that will address exorbitant air ambulance expenses.”

 The median cost for air ambulance transportation ranges from over $36,000 to $40,000. Air ambulance providers are not allowed to send surprise bills to Medicaid or Medicare patients. For patients with private insurance, however, an HHS Assistant Secretary of Planning and Evaluation (ASPE) report estimates that more than 50 percent of air ambulance trips are out-of-network. This inherently results in surprise billing, although exactly how much of the cost is passed on to patients remains unclear.

The first rule in this series of rulemaking made clear that the No Surprises Act bans surprise bills for patients who use out-of-network air ambulance services and limits the amount they pay out-of-pocket starting next year. 

 RELATED: HHS unveils interim rule aimed at putting an end to surprise medical bills for all consumers

The latest proposed rules also detail the process that CMS would use to determine if states are substantially enforcing new surprise billing and other consumer protections. These proposed rules would ensure CMS can take action against providers and facilities to further protect consumers from surprise bills in states that fail to substantially enforce these requirements.

The proposed rules also would further increase transparency by requiring certain health insurance issuers to inform consumers of how agents or brokers who assist consumers with enrollment in individual health insurance coverage and short-term, limited-duration insurance are compensated, including both direct and indirect compensation provided for such enrollment.

KFF analysis: Preventable COVID-19 hospitalizations cost $5B

A surge in COVID-19 hospitalizations among people who have not been vaccinated in August  has added billions of dollars in preventable costs to the nation’s health-care system, according to an updated Kaiser Family Foundation analysis

The report estimates that the preventable costs of treating unvaccinated patients in the hospitals total $3.7 billion in August, almost twice the estimates for June and July combined. The total preventable costs for those three months now stand at an estimated $5.7 billion.

As of early September 2021, 25 percent of adults over the age of 18 in the U.S. remain unvaccinated for COVID-19. As a result of lagging vaccinations and the more infectious delta variant, COVID-19 cases, hospitalizations, and deaths are on the rise again.

According to the KFF analysis of data from the Department of Health and Human Services and the Centers for Disease Control and Prevention, there were 32,000 preventable COVID-19 hospitalizations in June, 68,000 preventable COVID-19 hospitalizations in July, and another 187,000 preventable COVID-19 hospitalizations among unvaccinated adults in the U.S. in August, for a total of 287,000 across the three months. Assuming each of these preventable hospitalizations cost roughly $20,000, on average, that would mean these largely avoidable hospitalizations have already cost billions of dollars since the beginning of June.

The analysis is available on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.

Commonwealth Fund: American seniors have suffered the most economically due to COVID-19

The COVID-19 pandemic has thrown a harsh light on the economic vulnerability of older U.S. adults, especially people of color, according to a new Commonwealth Fund issue brief that analyzes findings from its 2021 International Health Policy Survey of Older Adults.

The survey, conducted with research firm SSRS and the Commonwealth Fund’s international patients, took place between March and June 2021 and included more than 18,000 adults age 65 and older in 11 high-income countries.

Among the key findings:

  • Compared to their counterparts in the other survey countries, older adults in the U.S. have suffered the most economically from the COVID-19 pandemic, with more losing a job or using up all or most of their savings.
  • Latino/Hispanic and Black older adults in the U.S. have been far more likely than white older adults to experience significant negative economic consequences.
  • COVID vaccination rates for older adults were highest in countries where vaccines were most widely available when the survey was fielded. In the United Kingdom, nearly all older adults (97 percent) had already been vaccinated. The U.S. had the largest percentage of older adults who were not planning to get vaccinated.

The findings were released on the heels of a new report from the Bill & Melinda Gates Foundation that found 31 million people all over the world  have been pushed into extreme poverty due to COVID, a regression that has reversed previous progress made by four years. 

SAMHSA awards $123M in grants to combat the country’s overdose epidemic

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced it will award more than $123 million in funding through six grant programs to provide multifaceted support to communities and health care providers as the United States continues to combat the overdose epidemic. The grants reflect the agency’s and White House administration’s mission to connect people who have substance use disorders (SUD) to culturally appropriate, evidence-based treatments and supports.

According to the U.S. Centers for Disease Control and Prevention, the 12 months ending January 2021 recorded more than 94,000 fatal overdoses, an almost 31 percent increase over those recorded in the 12 months ending January 2020.

“Americans battling substance use disorders, and their families, deserve easily accessible, culturally appropriate, and effective treatment options and recovery supports,” HHS Secretary Xavier Becerra said in the announcement. “We remain committed to nourishing the programs that help communities address the alarming increase in overdose-related deaths by increasing awareness and access to prevention, treatment, and recovery supports.”

SAMHSA is awarding funding for the Medication Assisted Treatment for Prescription Drug and Opioid Addiction (MAT-PDOA) program; Tribal Opioid Response Grants (TOR); Screening, Brief, Intervention, and Referral to Treatment (SBIRT); Strategic Prevention Framework for Prescription Drugs (SPF Rx); First Responder-Comprehensive Addiction and Recovery Act Grants (FR-CARA); and Providers Clinical Support System (PCSS-Universities).