Sellers Dorsey Digest

Federal Updates

News

Nursing Homes Look to International Nurses, Job Quality to Help Meet Staffing Minimums

• On April 22, the Biden Administration released a final rule that will require long-term care facilities to meet staffing minimums. The final rule requires nursing homes to provide at least 3.48 hours of care per resident per day. According to the industry, chronic understaffing may make it difficult to reach full compliance with the minimum staffing requirements. Nursing homes may consider hiring internationally trained nurses to help meet the staffing minimum, but face barriers with employment-based immigration quotas that are intended to protect the American workforce and long wait times for a visa. However, other experts argue that the solution will be found in improving job quality and attracting more people to the career with increased compensation, training, and opportunities for career growth. CMS announced a $75 million national job marketing campaign to support the final regulations which includes tuition reimbursement and other financial incentives for nurses to work in long-term care facilities. The tuition assistance and other financial incentives will start being distributed in 2025 (Modern Healthcare, April 26).

FDA Introduces Innovative “Home as a Health Care Hub” to Advance Health Equity and Technology

• On April 23, the FDA’s Center for Devices and Radiological Health (CDRH) announced a new endeavor to expand the incorporation of medical tools and digital health technologies into the home setting. CDRH partnered with an architectural firm to develop a prototype “home in virtual reality” to demonstrate in-home health solutions for providers, device developers, and policymakers. This initiative aims to positively impact minority populations and individuals living in rural communities who have been disproportionately impacted by physician shortages and access issues. The initial prototype will be developed for use in diabetes care with the FDA planning to collaborate with patient groups, healthcare providers, and medical device manufacturers to expand to other care models in the future (Inside Health Policy, April 24).

Federal Studies and Reports

White Paper Releases Strategies for Gene Therapy Coverage

• On April 23, the Institute for Clinical and Economic Review (ICER) published a white paper in collaboration with the NEW Drug Development Paradigms (NEWDIGS) program at the Tufts Medical Center. As 85 new gene therapies across more than 12 therapeutic areas could receive regulatory approval by 2032, the paper presents market strategies and policy solutions the government could use to create a balance between incentives for innovation and access to gene therapies for patients. Policymakers may potentially need to choose from options including value-based pricing, outcome-based payment arrangements, warranties, subscription-based insurance models and a federal “carve-out” coverage benefit so that the government can pay for the new gene therapies (Inside Health Policy, April 25).

State Updates

News

Montana Medicaid Director Stepping Down

• Montana Medicaid Director, Mike Randol, has submitted his resignation and will be stepping down effective May 10, 2024. Randol worked at the Montana Department of Public Health and Human Services (PHHS) for almost two years and announced plans to move back to the private sector. The current administrator of the Behavioral Health and Developmental Disabilities Division, Rebecca de Camara, will step up as the acting Medicaid Director effective May 13, 2024. In hiring a new Medicaid director, PHHS “will both consider internal candidates and launch a national search” (Montana Free Press, April 25).

Payers Seek Procurement Rebid in Texas

• Eight payers in Texas have filed protests after the Health and Human Services Commission accidentally sent confidential Medicaid bid documents to several consulting firms before the winners were announced in March. The payers filed protests over what they claim is a breach of the procurement process that resulted in an unfair advantage to other payers “for the largest state contracts in Texas” (Modern Healthcare, April 30; Health Payer Specialist, April 29).

Alabama House & Senate Hear from Two Southern States that have Expanded Medicaid

• On April 24, the Alabama House and Senate committees held a joint session to hear from representatives from North Carolina and Arkansas who came to speak to them about the effects Medicaid expansion has had on their economy and their residents, as well as any challenges they experienced along the way. Currently, Alabama’s Medicaid program is available to children, the elderly, and individuals with disabilities. Paul Lee (R-Dothan), spoke to how they’re looking for something unique that will fit Alabama to aid those who are currently uninsured and ensure affordable healthcare. If expansion were to happen, this would mean that those making up to 138% of the FPL would receive benefits, extending coverage to approximately 100,000 people (WSFA 12 News, April 26; Alabama Reflector, April 25).

New York to Enforce Restrictions Around Weight Loss and Muscle Building Supplements

• On April 24, a federal judge in New York rejected a preliminary injunction request filed by the Council for Responsible Nutrition (CRN) to postpone the effective date of a 2023 state law that limits the sale of weight loss and muscle building supplements to individuals over the age of 18. However, in denying the preliminary injunctive relief, the judge ruled that the CRN has standing to continue to pursue its case involving the constitutionality of the state law. Stakeholders that help individuals struggling with eating disorders supported the law and similar legislation in other states, especially since the Dietary Supplement Health and Education Act of 1994 doesn’t require supplement manufacturers to get approval before marketing their products. CRN released a statement disagreeing with the ruling concerning the preliminary injunction denial and stating that the law negatively impacts people under the age of 18 who have eating disorders and infringes on their constitutional rights. The law took effect on April 22, 2024 (Inside Health Policy, April 24).

SPA and Waiver Approvals

SPAs

• Payment SPAs
  • Colorado (CO-24-0008, effective January 1, 2024): Updates the Historical Data Period that is referenced within current and future performance years for physician services in the Alternative Payment Model 2. It additionally removes any obsolete dates within the payment methodology.
  • North Carolina (NC-24-0001, effective January 1, 2024): Updates the payment rates for Adult Assertive Community Treatment Team (ACTT) services.
  • North Carolina (NC-24-0010, effective January 1, 2024): Updates payment rates for Peer Support Services.
  • North Carolina (NC-24-0011, effective January 1, 2024): Updates payment rates for Psychosocial Rehabilitation Services.

Private Sector Updates

News

New Walgreens Center for Cell and Gene Therapies

• Walgreens Boots Alliance, Inc. is opening a new center intended to connect patients to emerging cell and gene therapies for complex, chronic conditions such as cystic fibrosis, Crohn’s disease, and cancer. The Pittsburgh-based center is intended to act as a hub for drug manufacturers, treatment centers, and insurance companies. Manufacturers will send treatments to the facility and Walgreens will conduct the necessary checks for correct drug distribution. Also, the company can work with all customers since they are not affiliated with a pharmacy benefit manager. Walgreens also announced that they are consolidating their specialty pharmacy assets into one unit, totaling about $24 billion in revenue (Modern Healthcare, April 25).

Medicaid Payers See Revenue Growth Despite Unwinding

• According to Kaiser Health News, Molina Healthcare, Centene, and UnitedHealthcare have seen an increase in their revenue ranging from 3% to 18% from Medicaid managed care program services for 2022 to 2023. This increase comes despite the unwinding and redetermination process that began a year ago resulting in millions across the country losing their Medicaid coverage. Reports indicate that the momentum has also continued into 2024 for the most part (Health Payer Specialist, April 29).

Kaiser Permanente Discloses Breach That Affects 13.4 Million Individuals

• On April 12, Kaiser Permanente disclosed a breach to the HHS’ Office of Civil Rights. Kaiser stated that personal data such as addresses and Social Security numbers were not compromised, but personal IP addresses and their interaction with Kaiser websites and mobile applications were likely exposed. The breach impacted approximately 13.4 million current and former members and patients of Kaiser Permanente (Health Payer Specialist, April 29).

Sellers Dorsey Updates

Leesa Allen Highlighted in Fierce Healthcare to Share Insights on CMS Managed Care Rule

• Sellers Dorsey Managing Director, Leesa Allen, was highlighted in a recent Fierce Healthcare article where she shares her insights on the newly released CMS Medicaid Managed Care Rule. With significant experience and expertise as a former state Medicaid Director, Leesa provided her thoughts around the challenges Medicaid agencies will face in bringing managed care contracts and agency operations into compliance with the new rule. Click here to learn more and read the full article.