Today, the Department of Health and Human Services proposed revisions to the complicated Obama era Affordable Care Act Section 1557 non-discrimination rule. The rule change will be controversial but I doubt that few will oppose this sensible change:

The proposed revisions would eliminate $3.2 billion in unneeded paperwork burdens imposed by the 2016 rule. Covered entities report that the 2016 rule requires them to send billions of “tagline” notices each year informing patients and customers of their ability to have “significant documents” translated in at least 15 languages. When HHS adopted the 2016 rule, it projected notice and taglines costs of about $7.2 million in the first five years. Because the 2016 rule did not fully account for printing and mailing costs associated with these notices and taglines, it underestimated the burden of these requirements by over three billion dollars over five years. Instead of requiring regulated health companies to mail billions of paper taglines to mostly English speakers, the money saved could be used to more effectively address individual needs of non-English speakers such as by providing increased access for translators and interpreters.

The above HHS link provides links to the text of, and a fact sheet on, the proposed rule. The proposal will be open for public comment for sixty days after publication in the Federal Register.

The Wall Street Journal reported this morning that

President Trump is expected to release an executive order as early as next week to mandate the disclosure of prices in the health-care industry, according to people familiar with the discussion. The order could direct federal agencies to pursue actions to force a host of players in the industry to divulge cost data, the people said. The administration is also looking at using agencies such as the Justice Department to tackle regional monopolies of hospitals and health-insurance plans over concerns they are driving up the cost of care, according to two people familiar with the discussions. The White House declined to comment on its plans.

Time will tell.

Following up on yesterday’s announcement of a HIPAA Privacy and Security Rule alleged violation settlement with a business associate, HHS issued a new Fact Sheet on Direct Liability of Business Associates under HIPAA, a law that was enacted in 2009. Reminders are helpful. Health Data Management discusses implications of the settlement here.

Health Data Management also calls attention to an HHS Office of Inspector General report finding that Medicare accountable care organizations with robust health information technology tools provide better patient care.

“ACOs that used a single electronic health record system across their provider networks were able to share data in real time,” states the OIG’s report. “A small number of ACOs had access to robust health information exchanges, which gave ACOs access to patient data even when patients saw providers outside the ACOs’ networks. Most of the ACOs we visited use data analytics to inform their care coordination by identifying and grouping patients according to the potential severity and cost of their health conditions.”

In a good news / bad news story, the Boston Globe’s STAT reports this afternoon that

the Food and Drug Administration on Friday approved the first gene therapy for a type of spinal muscular atrophy, a lifesaving treatment for infants that will also be the most expensive drug in the world. Known as Zolgensma, the gene therapy treats children under 2 years of age with spinal muscular atrophy, an inherited neuromuscular disease that causes progressive loss of muscle function. The most severe form of SMA causes infants to die or rely on permanent breathing support by the age of 2. The disease is caused by a defect in a gene that makes SMN, a protein necessary for the survival of motor neurons. Zolgensma uses a re-engineered virus to deliver a functional copy of the defective gene so that SMN protein can be produced. Novartis is pricing Zolgensma at $2.125 million, or an annualized cost of $425,000 per year for five years, the company said.

This is another reason why it makes sense for small and even mid-sized health plans to consider purchasing specific risk stop loss insurance.

Becker’s reports that the measles outbreak has spread to 25 states in the United States for a total of 880 cases. The Health Affairs Blog offers an article explaining why linking adult vaccines and quality is a public health imperative. 

There are currently 13 recommended vaccines on the adult immunization schedule and many additional adult vaccine candidates in the pipeline. Despite proven efficacy and favorable recommendations from the Advisory Committee on Immunization Practices, availability and accessibility of vaccines alone are insufficient to encourage uptake. 

Traditional policy levers such as school-entry requirements and the Vaccines for Children program have successfully improved vaccination rates in pediatric populations. For adult populations, however, complex challenges have driven the need for stakeholders to explore alternative solutions. As the country innovates in the areas of health care payment and delivery, quality measurement tied to payment presents a promising lever to drive adult immunization uptake and achieve national population health targets.