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EmblemHealth Legislative Update for the Week of November 7th, 2022

November 10, 2022

Federal News

Physicians Request Congressional Action After Release of Medicare Payment Rule

On Nov. 1, the Centers for Medicare & Medicaid Services (CMS) issued the 2023 Medicare Physician Fee Schedule Final Rule. The rules finalized last week would reduce Medicare physician payments by an average of 4.5%.  

Physician groups strongly criticized CMS and urged Congress to act before the end of the year to reverse the cuts. Congress is likely to return during the week of Nov. 11 for a lame duck session after the midterm elections and many expect increased Medicare physician payments to be included in a funding bill that must be enacted before mid-December to keep the federal government open.

New Report Recommends Solutions to Rising Employer Health Care Costs

On Oct. 27, the highly respected Bipartisan Policy Center (BPC) issued recommendations to improve employer-sponsored health insurance. Almost 160 million Americans receive health benefits through their employer. “While there have been changes to the health care system since the Affordable Care Act in 2010, more must be done to help contain health care costs,” BPC’s press release states. “Policymakers have an opportunity to improve employer-sponsored insurance so employers can offer more affordable, comprehensive coverage to their employees.”

The report’s recommendations address the following four areas:

  • Transparency: The report recommends establishing a federal all-payer claims database and penalizing health care providers who fail to disclose their prices.
  • Self-Funded Plans: Many Americans receive health benefits from large employers that “self-fund” coverage instead of purchasing plans in the commercial market. These employers may use third-party administrators (TPAs), often insurers, to help operate their plans. The report recommends that the U.S. Department of Labor (DoL), which regulates self-funded plans through the Employee Retirement Security Act of 1974 (ERISA) law, hold TPAs more accountable for negotiating low prices with health care providers. The report also recommends DoL establish national Centers of Excellence to improve quality in ERISA plans.
  • Competition: The report recommends Congress prohibit anticompetitive hospital contracting provisions and more strongly enforce provider consolidation rules.    
  • Other Actions: Other actions recommended by BPC include requiring employer-sponsored plans to offer more “affordable coverage” and permitting employers to buy into state employee health benefit plans.

State News

New York: State Announces Settlement in Opioid Suit

On Nov. 3, New York State Attorney General Letitia (Tish) James announced a settlement in which Teva Pharmaceuticals will pay the state up to $523 million after a jury convicted the company of helping to cause the opioid crisis. “Teva knowingly and intentionally misled New Yorkers and the American people about the deadly dangers of opioids, and last year, a jury found them responsible for the devastation and destruction they have caused,” James wrote. “This is a landmark day in our battle against the opioid crisis, and I am proud to be able to deliver critical funding and resources to the communities Teva and other companies ravaged with their rampant misconduct.” 

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