RISE summarizes the latest headlines that impact the health care industry.

HHS overturns Trump policy, reinstates transgender health care protections

The Department of Health and Human Services (HHS) this week overturned a Trump administration policy that had removed discrimination protections for transgender individuals under the Affordable Care Act. HHS announced that the Office for Civil Rights will enforce prohibitions on discriminations based on sex, including sexual orientation and gender identity. The update was made in response to the U.S. Supreme Court’s decision in Bostock v. Clayton County and subsequent court decisions.

“The Supreme Court has made clear that people have a right not to be discriminated against on the basis of sex and receive equal treatment under the law, no matter their gender identity or sexual orientation. That’s why today HHS announced it will act on related reports of discrimination,” said HHS Secretary Xavier Becerra in the announcement. “Fear of discrimination can lead individuals to forgo care, which can have serious negative health consequences. It is the position of the Department of Health and Human Services that everyone–including LGBTQ people–should be able to access health care, free from discrimination or interference, period.”

Indeed, discrimination in health care impacts health outcomes. Research shows that one quarter of LGBTQ people who faced discrimination postponed or avoided receiving needed medical care for fear of further discrimination.

In June, HHS under the previous administration finalized a rule to “restore the rule of law” and revise Section 1557 of the Affordable Care Act, which bans discrimination in health care and rolled back protections for transgender people. The rule would protect males or females from health care discrimination but not those who are gay or transgender. Section 1557 applies to those who receive federal funding from HHS, the Health Insurance Marketplace, and health programs administered by HHS. The decision sparked backlash and a lawsuit.  

“The mission of our Department is to enhance the health and well-being of all Americans, no matter their gender identity or sexual orientation. All people need access to health care services to fix a broken bone, protect their heart health, and screen for cancer risk,” said Dr. Rachel Levine, assistant secretary for health, in Monday’s announcement. “No one should be discriminated against when seeking medical services because of who they are.” 

1M Americans sign up for ACA coverage during SEP

More than one million Americans have signed up for coverage on HealthCare.gov during the Special Enrollment Period (SEP) established as the result of the COVID-19 Public Health Emergency, according to HHS Secretary Xavier Becerra.

The SEP began Feb. 15 and is open through Aug. 15. The 2021 SEP, along with the additional financial assistance afforded by the American Rescue Plan, offers individuals and families an opportunity to take advantage of reduced premiums, increased savings, and quality, affordable health coverage through HealthCare.gov.

“This milestone reinforces what we know to be true, there is a real demand for quality, affordable health care across the United States. Now, thanks to the American Rescue Plan, millions of Americans are seeing reduced monthly premiums and lower out-of-pocket costs,” he said in a statement.

Study: Telemedicine will save health care industry 21B globally by 2025

A new study by Juniper Research has found that telemedicine will save the health care industry $21 billion in costs by 2025, an increase from $11 billion in 2021. This represents a growth rate of more than 80 percent in the next four years. The research identified teleconsultations as a key service that will enable these savings. However, study authors cautioned that savings would be restricted to developed nations where access to required devices and internet connectivity is prevalent. As a result, it predicted that over 80 percent of savings will be attributable to North America and Europe by 2025.

FDA gives go-ahead for kids ages 12 to 15 to receive Pfizer vaccine

The U.S. Food and Drug Administration (FDA) has expanded the emergency use authorization for the Pfizer-BioNTech COVID-19 Vaccine for the prevention of COVID-19 to include adolescents 12 through 15 years of age. The expansion is a “significant step in the fight against the COVID-19 pandemic,” said Acting FDA Commissioner Janet Woodcock, M.D., in the announcement.

From March 1, 2020 through April 30, 2021, approximately 1.5 million COVID-19 cases in individuals 11 to 17 years of age have been reported to the Centers for Disease Control and Prevention. “Having a vaccine authorized for a younger population is a critical step in continuing to lessen the immense public health burden caused by the COVID-19 pandemic,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. “With science guiding our evaluation and decision-making process, the FDA can assure the public and medical community that the available data meet our rigorous standards to support the emergency use of this vaccine in the adolescent population 12 years of age and older.”

The available safety data to support the vaccine expansion in adolescents down to 12 years of age include 2,260 participants ages 12 through 15 years old enrolled in an ongoing randomized, placebo-controlled clinical trial in the United States. Of these, 1,131 adolescent participants received the vaccine and 1,129 received a saline placebo. More than half of the participants were followed for safety for at least two months following the second dose.

CMS takes steps to grow COVID-19 vaccine confidence and uptake among the country’s most vulnerable populations

The Centers for Medicare & Medicaid Services (CMS) on Tuesday issued a rule that will ensure long-term care (LTC) facilities, and residential facilities serving clients with intellectual disabilities, educate and offer the COVID-19 vaccine to residents, clients, and staff. 

The rule also requires LTC facilities to report weekly COVID-19 vaccination status data for both residents and staff. The new vaccination reporting requirement will not only assist in monitoring uptake among residents and staff but will also aid in identifying facilities that may be in need of additional resources and/or assistance to respond to the COVID-19 pandemic.

“These new requirements reinforce CMS’ commitment of ensuring equitable vaccine access for Medicare and Medicaid beneficiaries,” said Lee Fleisher, M.D., CMS chief medical officer and director of CMS’ Center for Clinical Standards and Quality, in a statement. “Today’s announcement directly aids nursing home residents and people with intellectual or developmental disabilities who have been disproportionately affected by COVID-19. Our goal is to increase COVID-19 vaccine confidence and acceptance among these individuals and the staff who serve them.”

CMS also said it is seeking comment on opportunities to expand these policies to help encourage vaccine uptake and access in other congregate care settings, such as psychiatric residential treatment facilities, group homes and assisted living facilities.

AMA issues strategic plan to fight racism and advance health equity

The American Medical Association (AMA), the nation’s largest professional association of physicians, on Wednesday released an 86-page report that outlines its three-year roadmap to initiate and aggressively push racial justice and advance health equity. In the announcement, the 174-year-old association said it recognizes the harmful effects of its past and wants to chart a path that targets systematic inequities in the health care system and other institutions. The report acknowledges the historic “roots of white patriarchy and affluent supremacy” within the AMA. Indeed, the AMA states it “cannot deny that AMA’s past silence on certain health system and policy-related issues has contributed to and had a negative impact on historically marginalized and minoritized communities, and exclusion in medicine more broadly.”

The groundwork for the plan began in 2019 when the AMA Center for Health Equity was launched as a result of a resolution passed by the AMA’s House of Delegates. Its urgency is underscored by ongoing circumstances, including inequities exacerbated by the COVID-19 pandemic, ongoing police brutality, and hate crimes targeting Asian, Black, and Brown communities.

To help rectify the injustices, the five-step action plan will:

  • Embed racial and social justice in AMA enterprise, culture, systems, policies, and practices
  • Build alliances, share power with historically marginalized and minoritized physicians and other stakeholders
  • Ensure equitable structures and opportunities in innovation
  • Push upstream to address all determinants of health and root causes of inequities
  • Foster pathways for truth, racial healing, reconciliation, and transformation for AMA’s past

“This strategic plan represents a step forward in a much longer journey to ground the AMA, health care, and our nation’s health care system around equity with a vision of achieving optimal health for all,” said AMA President-Elect Gerald E. Harmon, M.D., in an announcement. “As leaders in medicine, we commit to accountability toward the goal of eliminating inequities—systemic, preventable, and unjust differences—in the health of our patients. Fulfilling the AMA’s mission of promoting the art and science of medicine and the betterment of public health requires us to use our resources, influence, and power to push toward a more equitable future, which also means reversing the historic harms we caused and forging paths towards truth, reconciliation, racial healing, and transformation.”

OIG: Medicare could have saved up to $20M if CMS prevented payments for medically unnecessary cholesterol blood tests

A newly released audit from the Office of Inspector General (OIG) found that payments made to providers for direct low-density lipoprotein (LDL) cholesterol tests that were billed in addition to lipid panels did not comply with Medicare requirements. The audit covered Medicare Part B payments of about $35 million for direct LDL tests that were billed in addition to lipid panels for the same beneficiary on the same date of service and that had dates of service from 2015 through 2019 (audit period).

While it may be medically necessary for a provider to perform both tests for the same beneficiary on the same date of service under certain circumstances,  CMS and Medicare contractors explained that these circumstances should happen with only limited frequency. The OIG audit determined that some providers billed LDL tests in addition to lipid panels for the same beneficiary on the same date of service more than 75 percent of the time. In total, the OIG identified $20.4 million of Medicare payments made to at-risk providers for direct LDL tests. If CMS had oversight mechanisms to prevent such payments, OIG determined Medicare could have saved up to $20.4 million during the audit period.