RISE reviews the latest headlines that impact Medicare and Medicare Advantage.

MedPAC pushes back against AHIP’s blog post on Medicare Advantage spending

The Medicare Payment Advisory Commission disputes a recent blog post from America’s Health Insurance Plans (AHIP), which it says provides an inaccurate description of how MedPAC compares spending in the Medicare Advantage (MA) program to Medicare fee-for-service (FFS spending). The AHIP blog questioned MedPAC’s assessment that when compared, Medicare spends more overall for enrollees in MA than the program would have spent for similar beneficiaries enrolled in traditional FFS Medicare.

The MedPAC post, which it calls “For the Record,” defends its analysis of MA spending by describing the method it used to make the comparison, which concludes that Medicare spending for MA beneficiaries exceeds that for comparable FFS beneficiaries.

“This conclusion does not imply that MA plans are inefficient,” MedPAC staff write in the blog post. “In fact, MedPAC has long acknowledged the value of the MA program and the greater efficiency in care delivery associated with MA plans, as demonstrated in their bids. Despite greater efficiency, MedPAC continues to find that Medicare pays more for beneficiaries enrolled in MA compared to similar beneficiaries enrolled in FFS, which reflects program rules and other institutional features. Given the fiscal pressures facing the Medicare program, it is essential that Medicare pay plans appropriately so that the Medicare program and taxpayers can share in the greater efficiency in care delivery associated with MA plans. MedPAC aims to support a continued vibrant MA program that benefits Medicare beneficiaries and the Medicare program and taxpayers.”

HHS sued over ‘ticking timebomb’ Sunset rule

A recently filed lawsuit seeks to vacate the controversial 2021 “Sunset Rule,” proposed by the Trump administration the day after the November election and 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. The groups note that the review would require the agency to take attention away from COVID-19.

“The Sunset Rule sets off a ‘ticking time bomb’ that will eliminate thousands of existing regulations that govern our health care system, food safety protocols, public health measures, social services, and so much more,” the groups said in an announcement. “Yet, despite the rule’s sweeping effects, it was jammed through in the 11th hour of a lame-duck administration with scarce opportunity for the public to voice concerns and no attempt to consult with America’s tribal communities. Simply put: HHS’s Sunset Rule is ill-conceived, impractical, and unlawful. Unless it is immediately halted, millions of Americans, including more than 36 million children, will be hurt by the resulting regulatory chaos, uncertainty, and elimination of key protections.”

To avoid the mass elimination of regulations, HHS estimates it will need to perform more than 3,400 reviews over the next five years. But that would mean redirecting resources away from other efforts, including work to combat the COVID-19 pandemic, the coalition said. Parties affected by HHS regulations will likewise be forced to redirect vast resources to try to understand which regulations will be scrapped and to respond in real-time.

The lawsuit alleges that the Sunset Rule violates both the Administrative Procedure Act and the Regulatory Flexibility Act. Among the violations, the Sunset Rule failed to name which regulations will expire and provided an insufficient 30-day notice-and-comment period.

New COVID funding to help close gaps in care for underserved populations

In addition to plans to sign into law the $1.9 trillion American Rescue Plan Act of 2021, the Biden administration announced this week it would invest $250 million to encourage COVID-19 safety and vaccination among underserved populations. The U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) will provide health literacy grants to localities, who will partner with community-based organizations to reach racial and ethnic minority, rural, and other vulnerable populations. Racial and ethnic minority populations experience higher rates of cases, hospitalizations, and deaths related to COVID-19. Social determinants of health, such as housing, education, and work conditions, contribute to these disparities. Underlying chronic conditions, such as kidney disease, diabetes, and obesity, are more prevalent among minority populations and increase the risk of severe COVID-19 illness.

The new initiative, Advancing Health Literacy to Enhance Equitable Community Responses to COVID-19, is expected to fund approximately 30 projects in urban communities and 43 projects in rural communities for two years. Cities, counties, parishes, or other similar subdivisions may apply for the funding. OMH will accept applications for this new initiative through April 20.