• On Friday, HHS announced the selection of preliminary next-generation COVID vaccine candidates and the awarding of more than $500 million for Project NextGen, to begin planning for use of these vaccines and treatments in clinical trials. The three companies with distinct vaccines announced will receive the following amounts: $8.5 million to CastleVax for a vector-based intranasal vaccine candidate, $10 million to Codagenix for a live-attenuated intranasal vaccine candidate, and $10 million to Gritstone Bio for a self-amplifying mRNA vaccine candidate. To support these and future Project NextGen clinical trials, the Biomedical Advanced Research and Development Authority (BARDA) will award more than $240 million for investments in “cold-chain sample management, genomic sequencing, and increased central laboratory capacity for sample testing.” Lastly, BARDA will award more than $241 million to support the development of new technologies that will “have the potential to enable shorter development timelines for monoclonal antibodies through mRNA, increased efficiency in virus testing, and alternate routes for vaccine administration” (HHS, October 13).
• Lawmakers are set to consider around two dozen healthcare bills to increase patient access and reduce administrative burden for providers. The hearing in the Energy & Commerce Committee is set for Thursday, October 19 and will focus on healthcare bills related to access, provider payment, and quality performance. Medicare payment reform and accountability are key goals for the Committee. Two panels of witnesses, including experts from Medicare and the Government Accountability Office will testify during the hearing. The bills address issues such as the Medicare physician geographic index, prescription drug access, and lab services. An extension for incentive payments for alternative payment models and a five-year cap on the incentive payments are also being considered. Other bills concern Merit-Based Incentive Payment System (MIPS) adjustments and telehealth privacy concerns for providers (Inside Health Policy, October 13).
• From October 15 to December 7, enrollees in either traditional Medicare or Medicare Advantage plans can change their coverage, being able to switch between either of the two Medicare coverage options. The second enrollment period will take place from January 1 to March 31, 2024 to allow enrollees of Medicare Advantage plans to change their plan or switch back to traditional Medicare fee for service. Enrollees applying for the first time generally apply within a few months of their 65^th birthday, whether it’s an open enrollment period or not (KFF Health News, October 16).

Waivers

• 1915(c) Appendix K
  • Alaska
    • Effective July 1, 2023, the state will revise the hourly unit for acuity rates from 12- to 8-hour blocks. This applies to residential habilitation services (IDD, APDD, and CCMC waivers), temporarily amending services and expanding certifications to serve highly acute individuals with complex needs that would not otherwise be able to be served by existing services available in the community.
  • Missouri
    • Effective July 1, 2023, the maximum lifetime limitation will temporarily increase for the Community Transition service. These services are non-recurring, set-up expenses for eligible individuals who are transitioning to a living arrangement in a private residence. This increase is required due to the increase in essential household transition expenses as a result of the PHE. The state is also updating the Group Home and Individual Supported Living rate methodologies for other services identified in the waiver.

SPAs

• Three Alabama hospitals will stop providing obstetrics and birthing services by mid-November. This change will leave Shelby and Monroe counties with no hospitals where pregnant individuals are able to give birth, with the third hospital closure leaving a predominantly Black neighborhood in Birmingham with no available maternity unit. After these birthing units close, pregnant individuals in Shelby County will have to travel approximately 17 miles, while those in Monroe County could face drives of between 35 and 100 miles to a labor and delivery unit. In Alabama, more than 33% of counties are maternity care deserts, meaning there are no obstetrics units, birth centers, OB-GYNs, or certified nurse midwives. Additionally, the state has the fourth-highest maternal mortality rate in the country and the third-highest infant mortality rate according to the most recent data from 2021. Alabama is not the only state to have lost obstetrics departments in hospitals this year, following California, Idaho, Massachusetts, and Tennessee (NBC, October 15).
• Twenty-three rural critical access hospitals in North Dakota have formed a clinically integrated network, allowing these facilities to reduce costs through group purchasing, aggregating shared services, and collaborating to add specialty care while negotiating leverage with commercial insurers and being able to provide services to individuals in their own communities. The Rough Rider High-Value Network plans to focus on primary care and chronic care management and make investments in telehealth, quality improvement, credentialing, and information technology which become much more affordable when divided amongst 23 network members (Modern Healthcare, October 12).
• Vermont is now joining several states in seeking a federal waiver to enable Medicaid coverage in the last 90 days of incarceration for eligible individuals. This historic exclusion of inmates has led to healthcare gaps for released prisoners and potentially increases the risk of overdose and recidivism following release. Additionally, providing Medicaid coverage for this population could ease the financial burden on the state for prison healthcare by shifting some of the cost to the federal government. According to various stakeholders both inside and outside of the state agency, Vermont’s eligibility process is currently not able to suspend Medicaid eligibility rather than terminating eligibility when someone is incarcerated.  However, the state is working to procure a new IT system with the hopes of streamlining eligibility determinations and suspensions in conjunction with the waiver application (VT Digger, October 13).
• On October 13, California Governor Gavin Newsom signed a new law that will raise the minimum wage for healthcare workers to $25 per hour over the next decade. This law comes after several city councils in California have passed local laws to raise the minimum wage for healthcare workers. This wage increase has been a point of negotiation between Kaiser Permanente and labor unions representing about 75,000 workers (AP News, October 13).

News

• Amazon is aiming to expand its healthcare presence with telehealth options and focused efforts on reducing the cost of care through acquisitions. The company’s most recent acquisition, One Medical, is a primary care provider, reflecting Amazon’s stated desire to reduce costs to consumers by emphasizing primary care services. Amazon is continuing to expand its healthcare offerings by partnering with health systems, payers, and government agencies. According to Amazon Health Services’ Senior Vice President, Neil Lindsay, the company wants to address social determinants of health, including food policy and urban design, as well as achieve payment reform and accessibility. Arianna Huffington, CEO of Thrive Global, believes that Amazon’s customer-centric approach has a chance to impact people’s habits and create positive change (Health Payer Specialist, October 13).
• In California, Kaiser Permanente reached an agreement with unions, representing 85,000 healthcare workers, over new contract terms that include raising all union wages in the state to $25 an hour and to $23 an hour in other states. The higher wages in California are mandated under a new state law requiring a minimum $25 per hour wage. Ratification of the new contract by union members will begin October 18 (Health Payer Specialist, October 16).
• In response to the rising prior authorization demands, many providers are currently lobbying Congress, investing in new technology, and renegotiating contracts with insurers. Providers are questioning whether new policies to lift precertification requirements will reduce administrative burden or if insurers are mostly trying to forestall government intervention. In April, CMS published a final rule requiring Medicare Advantage insurers to honor prior authorization approvals for the full course of a patient’s treatment and to accept those carried over from enrollee’s previous insurers for 90 days. However, providers argue that this policy won’t affect many patients since switching carriers during treatments tends to be unusual. As a result, some providers are considering leaving Medicare Advantage completely, in part due to prior authorizations (Modern Healthcare, October 16).

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