Yesterday, pursuant to the President’s recent health quality and pricing transparency executive order, the Centers for Medicare and Medicaid Services published a proposed hospital price transparency rule for calendar year 2020 that
implements Section 2718(e) of the Public Health Service Act [part of the Affordable Care Act] and improves upon prior agency guidance that required hospitals to make public their standard charges upon request starting in 2015 (79 FR 50146) and subsequently online in a machine-readable format starting in 2019 (83 FR 41144).. Section 2718 is entitled “Bringing Down the Cost of Health Care Coverage.” Section 2718(e) requires each hospital operating within the United States to establish (and update) and make public a yearly list of the hospital’s standard charges for items and services provided by the hospital, including for diagnosis-related groups established under section 1886(d)(4) of the Social Security Act. In the proposed rule, we propose the following: (1) definitions of “hospital”, “standard charges”, and “items and services”; (2) requirements for making public a machine-readable file online that includes all standard charges [redefined to include both gross charges / rack rate and negotiated rates with health plans] for all hospital items and services; (3) requirements for making public payer-specific negotiated charges for a limited set of ‘shoppable’ services [serves that are scheduled in advance] that are displayed and packaged in a consumer-friendly manner; and (4) monitoring for hospital noncompliance and actions to address hospital noncompliance (including issuing a warning notice, requesting a corrective action plan, and imposing civil monetary penalties), and a process for hospitals to appeal these penalties.
Modern Healthcare observes that several hospital systems already offer online personalized lookups of out of pocket costs for “shoppable” services. This approach preserves the confidentiality of the negotiated insurer rates.
Speaking of hospitals, Medpage Today offers a clickable slideshow of U.S. News and World Report hospital rankings which were published this week. The top three overall are the Mayo Clinic, Mass General, and Johns Hopkins.
Today, CMS announced that “the average basic premium for Medicare Part D prescription drug plans, which cover prescription drugs that beneficiaries pick up at a pharmacy, is projected to decline. Over the past three years, average Part D basic premiums have decreased by 13.5 percent, from $34.70 in 2017 to a projected $30 in 2020.”
Speaking of pharmacy benefits, the Associated Press is reporting
The government’s employee health plan [our beloved FEHBP] will tighten its rules for covering prescription opioid painkillers starting this fall, the Trump administration said Monday.The announcement by a senior administration official was part of a White House drug policy briefing. The official spoke on condition of anonymity under the media coverage rules established for the event. *** Under the new policy, initial prescription [for acute pain issues] will be a for 7-day supply, instead of 30 days, the official said. Patients will be able to get up to three refills of 7-days apiece. Formal re-authorization that involves consulting a clinical professional will be required every 28 days.
The FEHBlog expects that these standards generally are in effect in the FEHBP already.
In other news, Fierce Healthcare informs us that CVS Health announced an expansion of its Transforming Diabetes program that several FEHB plans use.