Insights & Analysis
There’s one constant in healthcare: change. Count on us to break down the trends so you can stay up to date. Follow our take on each piece of this deep, intertwined, and often perplexing industry to find opportunities and practical approaches to move healthcare forward.
CMS to Phase In Drug Utilization Payment Cut in Final ESRD Rule; Net Update to Base Rate 0.0% in CY 2014
On Nov. 22, CMS released its final Calendar Year (CY) 2014 End Stage Renal Disease (ESRD) PPS rule, finalizing a 2014 base per treatment rate of $239.02, reduced slightly from $240.36 in CY 2013.
FDA Issues Warning Letter to 23andMe Genomic Service; Other LDTs on the Radar?
On Nov. 22, FDA issued a warning letter to 23andMe, Inc., asking them to immediately discontinue the marketing of their saliva collection kit and Personal Genome Service (PGS) Kit.
Centralized Review of Investigational Device Exemptions at CMS-An IDEa Whose Time Has Come
Since Avalere last discussed Investigational Device Exemptions (IDEs), IDE regulatory and reimbursement policy landscape at FDA and CMS have issued some predicted changes; FDA has issued new draft guidance documents while CMS included many of these changes in their 2013 proposed physician payment rule.
Avalere Analysis Projects Potential for Increased Subsidized Exchange Enrollment
NEWS RELEASE -- A new Avalere Health analysis shows that, as of November 2, 30 percent of exchange applicants are eligible for federal subsidies to reduce their monthly insurance premiums and out-of-pocket costs for medical care, far below the 84 percent of enrollees who are ultimately expected to qualify for financial assistance.
Congress Passes Drug Quality and Security Act; Includes Both Compounding and Track & Trace Provisions
On Nov. 18, the Senate passed the Drug Quality and Security Act, roughly two months after it passed the House in September, seeking to clarify laws related to human drug compounding and to strengthen the prescription drug supply chain by creating a national system.
SGR Repeal Momentum Increases, Path Forward Remains Unclear
As 2013 comes to a close, Congress and physicians continue to discuss the impeding payment cliff physicians will face Jan. 1, 2014, due to the Sustainable Growth Rate (SGR) formula.
CMS Opens NCA for Transcatheter Mitral Valve Repair Procedures; Comments Due Dec. 18
On Nov. 18, CMS opened a national coverage analysis (NCA) for Transcatheter Mitral Valve Repair (TMVR) devices.
USPSTF Revisits Controversial Mammography Screening Recommendations
On Nov. 14, the U.S. Preventive Services Task Force (USPSTF) released a draft research plan for Public Comment on "Screening for Breast Cancer," which intends to re-evaluate the effectiveness of routine mammography screening in women age 40 and older.
Final Rule on 2008 Mental Health Parity Law Finally Released, Affecting Individual and Small Group Plans and Codifying Consumer Protections
On Nov. 8, HHS and the Departments of Labor and Treasury jointly released a final rule implementing the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
Avalere Suggests Vermont May Need to Increase Funding For Single-Payer Plan
Avalere Health says the state of Vermont may need between $1.9 billion and $2.2 billion to finance the single-payer plan contemplated by Act 48 - otherwise known as Green Mountain Care.
2014 Associate/Senior Associate Recruitment Program
Avalere is seeking qualified candidates at the Associate and Senior Associate level as part of its annual recruitment program.
Fewer Than 27,000 Federal Exchange Enrollees at End of First Month of Open Enrollment, HHS Reports
On Nov. 13, HHS released the health insurance exchange enrollment figures for the first month of open enrollment, beginning Oct. 1; only 106,185 individuals have selected and enrolled in exchange plans.
Avalere Analysis: State-Based Exchanges Average 3 Percent of Expected Enrollment
An analysis from Avalere Health finds that 12 state-based exchanges1 have enrolled about 3 percent of their expected 2014 exchange participants. Together, the 12 states have enrolled 49,100 people in exchanges based on data released by the states, as of Nov. 10. By the end of 2014, Avalere projects these states will account for 1.4 million exchange enrollees.
Arkansas’ Premium Assistance Model Prioritizes Plan Participation Over Price
In September, Arkansas received approval from the federal government to expand Medicaid using a premium assistance model or "private option" for 2014 through 2017.
Final NCD for VADs Largely Consistent With Draft Decision
On Oct. 30, CMS released a final decision memo on ventricular assist devices (VADs) used for bridge to transplant (BTT) and for destination therapy (DT).
Texas Enrollees Could Be 9 Percent of Enrollment in Exchange Market
With a population of more than 26 million people, Texas is important to achieving the Obama administration's desired exchange enrollment.
Join Avalere experts Kathy Hughes and Richard Chapman at ISPOR Dublin This Week
Avalere experts to present at ISPOR Dublin's Poster and Workshop sessions.
CMS Publishes Final Program Integrity Rule
On Oct. 24, CMS released its final program integrity standards rule, detailing: advance payments of the premium tax credit (APTCs) and cost-sharing reductions (CSRs); the premium stabilization programs; issuers offering coverage in the Federally Facilitated Marketplace; and standards for enrollee satisfaction survey vendors.
HHS: Exchange Plans Not Federal Programs
On Oct. 30, HHS sent a letter to Rep. McDermott, R-Wash., indicating that it does not consider qualified health plans (QHPs) purchased through insurance exchanges to be federal healthcare programs.
CMS Releases 2014 Benefit Parameters for Medicare Parts A and B; Part B Premium and Deductible to Remain The Same
On Oct. 28, CMS released the calendar year (CY) 2014 benefit parameters for Medicare Parts A and B, which cover hospital inpatient and all outpatient drugs and services, and begins Jan. 1, 2014.