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As we enter the new year, there are good reasons to hope the U.S. may soon round the corner on COVID-19. In the meantime, though, we all still need to follow the guidelines of our public health authorities: stay home if sick, practice social distancing, avoid indoor settings, wear masks, and wash our hands. Please protect yourself and those around you, and please join HFA in extending our gratitude to the health care workers, first responders, grocery store staff, sanitation workers, postal and delivery service personnel, and everyone else who helped us get through 2020. Here鈥檚 to a return to healthier times in 2021!聽

A year like none other has come to an end. In true 2020 fashion, December health news was tumultuous and COVID-centric. But December also brought glimmers of hope, with the approval and initial rollout of COVID vaccines. As we move into a hopefully brighter 2021, here are some of the policy developments that HFA followed over the past month.

Economic stimulus and COVID relief.聽聽Congress passed a long-awaited COVID relief measure in mid-December, coupling $900 billion in stimulus and relief programs with legislation to fund the federal government for the remainder of the fiscal year. President Trump initially (and unexpectedly) withheld his signature, demanding changes to the stimulus package, but eventually reversed himself and signed the massive聽bill聽into law on Dec. 27.聽

Among other things, the聽relief package:

  • Provides a temporary additional $300/week in unemployment benefits (through mid-March), and extends two pandemic-related federal unemployment programs created last spring in the CARES Act;
  • Provides direct one-time stimulus payments of up to $600/person, depending on income;聽
  • Extends eviction protections and rental relief programs; and
  • Allocates additional funding to the Paycheck Protection Program, available to qualifying small businesses.聽

The omnibus bill also includes provisions addressing two key policy priorities for the bleeding disorders community. The bipartisan聽Hemophilia Skilled Nursing Facilities Access Act聽was incorporated into and passed as part of the overall larger bill. This legislation will remove obstacles that to date have prevented Medicare patients with hemophilia from getting care in skilled nursing facilities, by ensuring that SNFs are appropriately reimbursed for the clotting factor administered to their patients. The Hemophilia Skilled Nursing Facilities Access Act was聽supported聽by NHF, HFA, the Coalition for Hemophilia B, the Committee of Ten Thousand, and the Hemophilia Alliance.聽聽聽

In addition, the omnibus legislation includes long-sought patient protections against聽surprise medical billing. Effective January 1, 2022, the law will bar providers from charging patients more than their standard in-network cost-sharing, for emergency care and for out-of-network care (emergency or non-emergency) provided at in-network facilities. The surprise billing fix has been聽hailed聽as a huge win for consumers.聽

Quick hits:

  • December was a busy month for rulemaking.聽聽聽
    • HFA submitted comments on the Notice of Benefit and Payment Parameters for 2022, a rule governing Exchange and employer-sponsored health plans.聽Past years鈥 versions of the NBPP聽have addressed health insurers鈥 use of accumulator adjusters (a strategy that limits the value to consumers of drug copay assistance programs). The 2022 NBPP is聽silent聽on the issue of accumulators. HFA and allied patient groups called on the U.S. Department of Health and Human Services to support patients鈥 ability to benefit from copay assistance programs.聽HFA and NHF聽also urged HHS to take additional steps to improve bleeding disorders coverage in Exchange plans, e.g., by strengthening network adequacy provisions and drug coverage standards.聽聽
    • The U.S. Centers for Medicare and Medicaid Services published a聽final rule聽intended to address value-based purchasing arrangements by state Medicaid programs. One part of the new rule changes the way in which drug manufacturers have to account for their copay assistance programs, basically holding manufacturers responsible for insurer-imposed copay accumulators. Patient groups (including HFA) had expressed concern that the rule could harm patients by discouraging drug manufacturers from offering copay assistance programs. This part of the rule does not go into effect until January 1, 2023; HFA will continue to monitor its implementation.聽
    • CMS published a proposed rule regarding聽prior authorization聽processes used in certain Medicaid programs, state Children鈥檚 Health Insurance Programs, and Exchange health plans. HFA along with NHF commended the agency鈥檚 efforts to reduce barriers to care 鈥 but urged CMS also to standardize and streamline prior authorization processes for prescription drugs (excluded from the scope of the proposed rule).聽聽
    • HFA and NHF also commented on an聽interim final rule聽interpreting Medicaid coverage requirements under the Families First Coronavirus Response Act. Our comments stressed that CMS must adhere to the statute in laying out states鈥 responsibilities to maintain continuous coverage for Medicaid beneficiaries, including those whose Medicaid eligibility is linked to their receipt of SSI benefits.
  • December was a busy month in the courts.
    • In a unanimous ruling (Rutledge v. PCMA),聽the Supreme Court affirmed that states have authority to regulate pharmacy benefits managers, even when the PBMs are connected with employer-sponsored health plans. (Such plans are typically governed by a federal law, ERISA, that preempts state regulation.) The news was welcomed by states: more than 30, to date, have passed laws regulating the conduct of PBMs.
    • Two federal courts issued orders against enforcement of the Trump Administration鈥檚 鈥渕ost favored nations鈥澛drug pricing rule, which was slated to go into effect beginning January 1, 2021. The courts ruled that the Administration improperly sidestepped notice and comment requirements in rushing the rule into effect.聽聽
    • HFA joined more than one dozen other patient groups in an聽amicus brief聽challenging a 2020 rule that rescinded antidiscrimination protections under section 1557 of the Affordable Care Act.聽
  • The 2021 open enrollment period for purchasing health insurance on the ACA Exchange has ended in 40 states but聽continues in 10 states plus the District of Columbia. Recognizing the important role that the聽ACA has played in keeping people covered聽amid the COVID-related economic downturn, advocates have urged the incoming Biden Administration to consider re-opening the open enrollment period in the Federally-Facilitated Exchanges.

 


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