RISE reviews recent headlines in the news that impact Medicare and Medicare Advantage.

House reps introduce legislation to overturn Sunset Rule

Reps. Raja Krishnamoorthi (D-Ill.) and Anna Eshoo (D-Calif.) last week introduced a resolution through the Congressional Review Act (CRA) to overturn the controversial Sunset Rule, a measure the Trump administration finalized the day before President Biden’s inauguration. The rule adds automatic expiration dates to more than 18,000 regulations issued by the Department of Health and Human Services (HHS) and its sub-agencies, including the Centers for Medicare & Medicaid Services and the Food and Drug Administration starting in five years unless the agency conducts an intensive review of each regulation.

In an announcement, Krishnamoorthi said the rule was ill-advised, disruptive,  and designed to create havoc in government agencies. HHS has since delayed the effective date of the Sunset Rule after several health care groups filed a lawsuit against the rule, which it described as a ”ticking timebomb.”

“If it’s allowed to come into effect, the Trump Administration’s Sunset Rule would force public health officials to divert time, funding, and attention from the current crisis in order to prevent essential public health protections from unnecessarily expiring,” said Krishnamoorthi in the announcement. 

The CRA contains procedures for both committee consideration and floor consideration of a CRA disapproval resolution in the Senate, but Congress is running out of the time to act. Lawmakers can only approve resolutions introduced during the first 60 legislative days of a new Congress.  

OIG: MAOs miss opportunities to use ordering provider identifiers

A new Office of Inspector General (OIG) report has determined that there are unrealized opportunities for Medicare Advantage Organizations (MAOs) to use National Provider Identifiers (NPIs) for ordering providers to help protect the Medicare Advantage program against fraud and abuse. The OIG conducted an online survey from February to March 2020 and received responses from 179 MAOs. This is the second OIG issue brief that analyzes data from this survey; the first was released in August 2020 and focused on the extent to which MAOs collected ordering NPIs and submitted these identifiers to the Centers of Medicare & Medicaid Services’ MA Encounter Data System. The latest report indicates that almost half of the MAOs that lack ordering NPIs on at least some MA encounter records raised concerns that this hinders their data analysis for program integrity. Among MAOs that collect any ordering NPIs, most use these NPIs to conduct oversight activities such as analyses that detect potential fraud schemes. But one in five of these MAOs does not perform program integrity oversight using ordering NPIs, despite having the data to do so. Furthermore, when MAOs collect ordering NPIs on MA encounter records, most do not validate these NPIs against CMS' NPI registry. These findings indicate that there are unrealized opportunities for MAOs to use ordering NPIs to protect the MA program against fraud and abuse. The OIG recommends that CMS encourage MAOs to perform program integrity oversight using ordering NPIs. However, CMS neither concurred nor nonconcurred with this recommendation and stated that it would consider whether additional education is needed for MAOs regarding the role that ordering NPIs can play in program integrity oversight. 

BMA releases 2021 MA enrollment heatmap: Florida, Hawaii lead in enrollment

Better Medicare Alliance has unveiled its 2021 Medicare Advantage (MA) enrollment map that features MA enrollment figures in states, Congressional districts, and counties nationwide. The map is populated with 2021 enrollment data from the Centers for Medicare & Medicaid Services , which BMA says demonstrates the continued strength of MA across the country as enrollment grows to more than 26 million beneficiaries.

According to the map, the top states for MA enrollment include Florida (48.7 percent), Hawaii (47.6 percent), Oregon (47.1 percent), Michigan (45.9 percent) and Alabama (45.6 percent). The data also show that 90 Congressional districts have now reached 50 percent or higher enrollment in MA, up from last year’s total of 64 districts.

HHS announces reduced costs, expanded access for marketplace health coverage

The Department of Health and Human Services (HHS) reports additional savings and lower health care costs are available for consumers on HealthCare.Gov due to the American Rescue Plan increasing tax credits available to consumers and helping to reduce premiums and giving consumers access to affordable health care coverage. HHS also announced an additional $50 million to bolster the special enrollment period (SEP) outreach campaign, which will run through August 15. The Biden administration established the SEP due to the COVID-19 public health emergency. So far, more than 528,000 Americans have signed up for health insurance since the SEP began, HHS announced.