RISE summarizes recent regulatory-related headlines.
Senate Finance Committee chair continues to question MA marketing tactics
Senator Finance Committee Chair Ron Wyden, D-Ore., this month sent letters to five third-party marketing organizations seeking information on their data collection and enrollment targeting of seniors looking at Medicare Advantage (MA) plans. The letters are part of the committee’s ongoing investigation into deceptive marketing practices for MA plans.
The letters, sent to the company heads of eHealth, GoHealth, Agent Pipeline, SelectQuote, and TRANZACT, seek information on how the companies use insurance agents, lead generators, and other data to target, market to, and direct seniors toward certain MA plans. Last fall, the Finance Committee held a hearing to examine the upcoming Medicare Advantage enrollment period and developments in marketing rules. Earlier last year, Wyden pushed for stronger marketing rules from the Centers for Medicare & Medicaid Services (CMS), which were successfully finalized.
“Seniors are being bombarded by well-intentioned brokers and bad actors who use various ploys to sell Medicare plans such as providing misleading information about plan options, and misrepresenting themselves as from the Medicare program,” Wyden wrote in the letters. “Witnesses confirmed the widespread sale and transfer of seniors’ personal information between third-party marketing organizations (TPMOs) and lead generators. The largely unregulated sale of seniors’ information to lead generators and TPMOs has led to a race to the bottom as unscrupulous actors put their own financial interests ahead of seniors’ health needs.”
HHS announces new actions to protect, expand access to contraception
The Department of Health and Human Services has issued new guidance to help group health plans and issuers comply with the requirements to cover contraception without cost-sharing. The actions follow President Biden’s executive order to strengthen access to affordable, high-quality contraception and family planning services, at a time when women are facing more barriers than ever to reproductive health access in the wake of the Supreme Court’s decision to overturn Roe v. Wade.
In a letter to Medicare plans, health insurance issuers, and State Medicaid and CHIP programs about upholding their obligations under federal law, HHS Secretary Xavier Becerra wrote: “From day one, the Biden-Harris Administration has made clear that women should have access to the healthcare they need, including contraception and other family planning services. I’m writing to reaffirm that access to reproductive health care is a core priority of the U.S. Department of Health and Human Services.”
HHS, along with the U.S. Departments of Labor and the Treasury, also issued new Frequently Asked Questions (FAQs) on how plans and issuers can comply the requirement under the Affordable Care Act to cover contraception without cost-sharing.
The updated FAQs outlines a new pathway for plans and issuers to meet existing obligations under federal law by covering, at no cost, a broader range of FDA-approved contraceptive drugs and certain devices. This new guidance comes in response to reports that many plans and issuers continue to impose barriers to contraceptive coverage, such as requiring patients to satisfy step therapy protocols, imposing unduly burdensome administrative requirements, or requiring cost-sharing for services that are integral to the application of the preventive service provided.
WHO releases guidance on use of generative AI in health care
The World Health Organization (WHO) has released guidance on the ethics and governance of large multi-model models (LMMs)—a type of fast growing generative artificial intelligence (AI) technology with applications across health care.
The guidance outlines over 40 recommendations for consideration by governments, technology companies, and health care providers to ensure the appropriate use of LMMs to promote and protect the health of populations. LMMs are unique in their mimicry of human communication and ability to carry out tasks they were not explicitly programmed to perform. They have been adopted faster than any consumer application in history.
Generative AI technologies have the potential to improve health care but only if those who develop, regulate, and use these technologies identify and fully account for the associated risks,” said Dr. Jeremy Farrar, WHO chief scientist, in the announcement. “We need transparent information and policies to manage the design, development, and use of LMMs to achieve better health outcomes and overcome persisting health inequities.”
RISE will take a deep dive into artificial intelligence in health care during a virtual summit, 11 a.m. to 4:30 p.m. EST, Tuesday, February 27 and Wednesday, February 28. Click here for the agenda, list of speakers, and registration information.
KFF: 11 health cost and affordability trends to watch in 2024
A quarter of Americans say they or a family member struggled to pay their medical bills in the past year and voters told a KFF poll that health care affordability was an important election issue.
A new KFF brief describes the health cost and affordability issues and trends that could reemerge this year, ranging from recent or proposed prescription drug pricing and transparency requirements to changes in how medical debt is treated on credit reports. They include:
- Site-neutral payment reforms
2. Price transparency requirements and what they could mean for costs
3. Prescription drug pricing policies and the implications for spending and affordability
4. Policy changes that could affect pharmacy benefit managers, the so-called prescription drug middlemen
5. New drugs and therapies that could influence health spending and outcomes
6. What virtual care expansion means for costs, access, and affordability
7. State cost control measures and spending
8. Recent surprise billing protections and their effects on private insurance premiums
9. Policies addressing out-of-pocket health costs and consumer medical debt
10. Shifts to value-based payment and the impact on health care costs
11. Antitrust agencies’ efforts to address consolidation in health care markets