CONGRESS
Jet Fumes. Having watched the signing of the poorly named Inflation Reduction Act by President Biden, Congress headed home.
THE WHITE HOUSE.
End of the PHE. ((TALK (-), HIMS (-), TDOC (-), GDRX (-)) CMS is apparently asking providers to prepare for the end of the public health emergency and the end of certain waivers and flexibilities. At the federal level, the end of the PHE and those associated waivers and flexibilities means reestablishing certain billing and coding procedures, safety measures and eligibility requirements such as a 3-night hospital stay prior to a SNF admission.
At the state level, many waivers and flexibilities allowed physicians and other clinicians to practice across state lines, especially through telehealth platforms. This flexibility has allowed platforms like TALK, HIMS, GDRX and even, TDOC to flourish. It has also pressured what was already a limited labor supply with a more attractive work environment and the possibility of stock options.
The result has been a bit of a free-for-all, raising concerns about easily written scripts with few questions about drug interactions or medical history. State Medical Boards have voiced objections to relaxation of rules that short circuit the establishment of a physician/clinician patient relationship.
As nearly everyone agrees that stand-along tele-behavioral health is better than nothing, it is still a far cry from good policy. States, though certainly not all of them, are likely to revert to pre-pandemic policies that require active state licensure to treat with the possibly exception of places like the Tri-states area where reciprocity would probably make a lot of sense.
The most likely tele-behavioral outcome is that articulated through Congressional telehealth hearings; tele-behavioral health will augment – not replace - an in-person patient/clinician relationship.
Medicaid Off-Ramp ((ANTM (+), MOH, (+), CNC (+), UHH (+)) The slow pace of health care suggests that if CMS is only beginning to nag providers in August, the PHE has a few more quarters of shelf life.
Indeed, as we made our way around Nashville this week on a tour of private health care companies, we discern an end to the PHE is not nigh. Consensus appears to be focused on late 1Q 2023 or, more likely given when most states end their fiscal years, the end of 2Q 2023.
States are dragging their feet. They like the 6.9% FMAP and have no desire to see their uninsured rates tick up in advance of November elections. The MCOs are the biggest beneficiaries of the slow-walk. Many of the 10M (we estimate about ½ to 2/3) people that went on Medicaid in the wake of massive lay-offs in the spring of 2020, have found other coverage through their employer or via the ACA exchanges.
As Medicaid is always the secondary payer, the MCOs have been receiving PMPM payments that are nearly all margin. The bull case is that the MCOs will convert members determined ineligible beginning, now, in Spring 2023 to ACA exchange plans. The problem with that argument is that many of these ineligible beneficiaries already have found coverage.
A contributing problem is that many states believe the law, absent more specific and prescriptive guidance, prohibits them from support a program of near de facto conversion.
The MCOs should enjoy it while they can.
More Return to Normal. Amid a remote managed restructuring, the CDC released new guidance on COVID that looks a lot like the much-maligned Great Barrington Declaration – focused protection of the vulnerable while acknowledging prior infection can confer immunity and vaccines do little to stop transmission of infection.
More here.
Recent Events
Upcoming Events
Covid Vaccine Evidence: What We Know, What We Don’t with Dr. Tracy Beth Hoeg.
Dr. Hoeg is a physician in private practice in Northern California. She holds a PhD in epidemiology and in addition to her other professional responsibilities, is a consultant to the Florida Department of Health.
This interview will be pre-recorded so feel free to send question to me directly.
Have a great weekend.
Emily Evans
Managing Director – Health Policy
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