News & Updates
Inside Health Policy: W&M Passes Bills Codifying Trump-Era HRA Rule, IRS Disease Management Guide
The legislation passed the committee with a vote of 34-6, to the delight of the Smarter Health Care Coalition, which consists of employers, insurers and other stakeholders that support more value-based insurance designs.
“Employers and health plans overwhelmingly began offering more chronic disease prevention pre-deductible after publication of Notice 2019-45. We urge swift passage of H.R. 3800, which codifies this important progress,” said Katy Spangler, co-director of the Smarter Health Care Coalition.
Inside Health Policy: Coalition To IRS: Expand Services HDHPs-HSAs Cover Pre-Deductible
The coalition of diverse health care stakeholders working to promote value-based insurance design wants IRS and Treasury to expand the list of chronic disease management services that HDHP-HSA plans can cover prior to the deductible -- and it highlights recent surveys showing a majority of insurers and employers offered pre-deductible coverage for certain items after IRS issued guidance on those in 2019. The Smarter Health Care Coalition (SHCC), which includes employers, insurances, drugmakers, and consumer groups, specifically wants the administration to now let high-deductible health plans linked to health savings accounts (HDHP-HSAs) cover mental health and substance abuse services pre-deductible.
“Given the mental health crisis that has emerged alongside the ongoing COVID-19 pandemic, the time is now for action to empower employers and health plans to address rising incidence of chronic mental illness,” the coalition writes in a Nov. 29 letter to IRS Commissioner Charles Retting and Treasury Secretary Janet Yellen.
Letter to the Administration Raising Awareness about the Overwhelming, Positive Response to Notice 2019-45
On November 29, 2021, the Coalition sent a letter to the Administration to provide very encouraging data about the number of health plans and employers that have changed their plan benefit designs in response to the IRS Notice 2019-45 guidance. As a result of this overwhelming, positive response, the Coalition urges the Administration to expand the list of items and services that may be covered under the preventive care safe harbor to include additional high-value, low-cost drugs and services used to prevent complications of other chronic conditions, especially those that would prevent exacerbation of mental and behavioral health conditions, helping millions of Americans improve their mental and physical health.
Read the full letter here.
HSA-Eligible Health Plans Embrace Changes to Better Serve Americans With Chronic Health Conditions
A new survey conducted by AHIP and the Smarter Health Care Coalition (SHCC) found that most health insurance providers and many large employers have taken advantage of new regulatory flexibility to cover more chronic disease prevention services on a pre-deductible basis. The survey, which assessed health insurance provider uptake and changes in the benefit design for Health Savings Account (HSA)-eligible high-deductible health plans (HDHPs), also noted that diabetes and heart disease are the two most commonly targeted conditions for reducing or eliminating cost sharing.
Letter of Support for Vaccine Bills in Response to Energy and Commerce Health Subcommittee Hearing
On July 2, The Coalition sent a letter of support for two vaccine bills which would make it easier for more people in Medicare and Medicaid to learn about and gain access to high value vaccines. The letter, intended to share the family physician perspective, came in response to an Energy and Commerce Health Subcommittee hearing held in June: “A Booster Shot: Enhancing Public Health Through Vaccine Legislation”. Specifically, the letter supports two bills:
Letter to HHS Secretary Xavier Becerra
On April 19, 2021, the Coalition sent a letter to Secretary Becerra recommending that HHS exercise existing authority to:
Eliminate Medicare payment for services rated “D” by the US Preventive Services Task Force, per Section 4105 the Affordable Care Act
Add flexibility to the Center for Medicare and Medicaid Innovation (CMMI) V-BID Demonstration to allow Medicare Advantage organizations to reduce payments or increase cost-sharing for “D” rated, harmful preventive services, per Section 3021 of the Affordable Care Act
Further exercise CMMI authority to build a new, multi-state demonstration project to reduce low-value care in commercial, Medicare, and Medicaid populations.
Letter to President-Elect Biden's Transition Team
On Monday, December 21, the Coalition sent a letter to President-Elect Biden's transition team applauding the campaign’s focus on health care and the coronavirus (COVID-19) pandemic, and further urging the incoming administration to prioritize eliminating barriers that prevent people from accessing high-value health care, especially as the COVID-19 pandemic continues. The Coalition specifically urges the Administration to advance the following priorities:
Implement patient support programs to encourage COVID vaccine uptake.
Improve social determinants of health through health benefits.
Reduce low-value and harmful care.
Remove barriers imposed on Health Saving Account-eligible high deductible health plans(HDHPs).
Biden-Sanders Unity Task Force Recommendations
On Wednesday, July 8, the Biden-Sanders Unity Task Force released a 110-page document detailing recommendations for key issues, including health care. The Smarter Health Care Coalition applauds the inclusion of value-based insurance design in proposed reforms to the ACA marketplaces and the Medicare Advantage VBID program.
Page 93: “Provide free or low-cost prescription prescription drugs proven effective in treating for chronic illness (i.e., adopt a “Value-Based Insurance Design” benefit)}
Page 95: Redesign the Medicare V-BID benefit to provide free or low-cost Rx drugs of proven benefit for chronic illness
Although the mentions are not detailed, the Center for Value-Based Insurance design stated “this development builds upon the strong bipartisan support of V-BID implementation, including the Affordable Care Act and COVID-19 legislation, as well as current HSA reform and VBID-X policies.” The Coalition has been heavily engaged in efforts to bolster COVID-19 response in particular, by advocating for HSA reform to protect those with chronic conditions from high out-of-pocket costs.
If you have any questions or comments, please contact Michael Budros (mbudros@healthsperien.com).
Part D Senior Savings Model Announcement
On Tuesday, May 26, CMS announced that senior citizens who use insulin for diabetes and are enrolled in Medicare Advantage and certain Part D pharmaceutical plans will see co-pays drop by 66% in 2021 and capped at $35. This is an issue that we at the Coalition have advocated strongly for and we applaud CMS and the Trump Administration for their efforts to alleviate some of the burden on the senior population. Read more here.
Michael Chernew Appointed MedPAC Chair
May 2020 — Michael Chernew, PhD, Co-Founder of the University of Michigan Center for Value-Based Insurance Design, and a close ally of the Coalition was appointed as the chair of MedPAC. The Coalition has worked closely with Dr. Chernew in the past, and we look forward to our continued work with him in his new role. Read the press release here.
Telehealth Expansion Act Included in Coronavirus Aid, Relief, and Economic Security Act, H.R. 748
On March 25, the Senate released updated language for the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), which included S. 3539, the Telehealth Expansion Act, a bill recently introduced by Senator Steve Daines.
Read our press release on the inclusion of the Telehealth Expansion Act here.
Comment Letter on the Inclusion of V-BID X in the Proposed Notice of Benefits and Payment Parameters (NBPP) for 2021
On March 2, 2020, the Coalition submitted comments to CMS on the inclusion of V-BID X in the proposed Notice of Benefits and Payment Parameters for 2021.
Response to Senator Alexander: Health Care Cost Recommendations to HELP Committee
In March 2019, The Coalition submitted a letter to Senator Alexander in response to his letter asking stakeholders to submit comments on how the US can contain health care costs. Our response follows VBID principles and aligns with the Coalition’s 2019 strategic plan:
Increase Access to High-Value Care for Chronically Ill Patients with Health Savings Account (HSA)-qualified HDHPs.
Extend the flexibilities available under the Medicare Advantage (MA) V-BID Demonstration permanently to MA plans.
Address Wasteful Spending by Disincentivizing Low-Value and Harmful Care.