By Rachel Roubein – 02/27/18 06:10 PM EST via TheHill.com

Top Republicans and Democrats on the House Ways and Means Committee are requesting information from critical stakeholders on how to prevent and treat opioid addiction in Medicare, as the panel seeks to craft bipartisan legislation to curb the opioid epidemic.

Specifically, they’re asking insurers, benefit managers, providers and prescribers to submit information on how the Medicare program can help stem the opioid epidemic — noting that one in three beneficiaries in Medicare’s prescription drug program received a prescription opioid in 2016.

Chairman Kevin Brady (R-Texas) and ranking member Richard Neal (D-Mass.) — along with Health Subcommittee Chairman Peter Roskam (R-Ill.) and the top Democrat, Sandy Levin (Mich.) — sent the request Tuesday.

By March 15, they’re asking the stakeholders to provide information on overprescribing, data tracking, treatment, communication and education.

The Ways and Means Committee is one of several groups of lawmakers examining measures to clamp down on the opioid epidemic, which saw rates of overdose deaths jump nearly 28 percent from 2015 to 2016.

The House Energy and Commerce Committee is holding its first of three hearings Wednesday to discuss legislation. On the other side of the Capitol, a bipartisan group of eight senators introduced Tuesday a follow up to the Comprehensive Addiction and Recovery Act passed in 2016, dubbed “CARA 2.0.”

By Leo Shane III via militarytimes.com

WASHINGTON — State Department officials will make their first pitches for their fiscal 2019 agency budgets this week, even as lawmakers are still working out the details of the current fiscal year.

Secretary of State Rex Tillerson will make two appearances before Congress on Tuesday and Wednesday to talk about reorganization of the department, the president’s plans for future funding and criticism of the downsizing of some State Department missions.

Similar military budget hearings were also expected to begin this week, but several were postponed due to scheduling issues. Pentagon officials will be on Capitol Hill in force in weeks to come to lobby for a sizable increase in spending authority in the months ahead.

Also this week, the major veterans groups begin their legislative presentations to the House and Senate Veterans’ Affairs Committees. The American Legion and Disabled American Veterans will be the first to make their presentations on Capitol Hill, with about 20 more expected in coming weeks.

By JoNel Aleccia via khn.org

California voters passed a law two years ago that allows terminally ill people to take lethal drugs to end their lives, but controversy is growing over a newer rule that effectively bans that option in the state’s eight veterans homes.

Proponents of medical aid-in-dying and residents of the Veterans Home of California-Yountville — the largest in the nation — are protesting a regulation passed last year by the California Department of Veterans Affairs, or CalVet, that requires that anyone living in the facilities must be discharged if they intend to use the law.

That’s a position shared by most — but not all — states where aid-in-dying is allowed. As more U.S. jurisdictions consider whether to legalize the practice, the status of terminally ill veterans living in state-run homes will loom large.

“It would be a terrible hardship, because I have no place to go,” said Bob Sloan, 73, who suffers from congestive heart failure and other serious cardiac problems. He said he intends to seek medical aid-in-dying if doctors certify he has six months or less to live.

“I’m not going to be a vegetable,” said Sloan, a Vietnam War-era veteran who moved into the Yountville center five years ago. “I’m not going to end up living in so much pain it’s unbearable.”

A CalVet official said the agency adopted the rule to avoid violating a federal statute that prohibits using U.S. government resources for physician-assisted death. Otherwise, the agency would jeopardize nearly $68 million in federal funds that helps run the facilities, said June Iljana, CalVet’s deputy secretary of communications.

California is not alone. Three other states where aid-in-dying is legal — Oregon, Colorado and Vermont — all prohibit use of lethal medications in state-run veterans homes.

In Montana, where aid-in-dying is allowed under a state Supreme Court ruling, officials didn’t respond to multiple requests about whether veterans would be able to use the law in the residences. However, Dr. Eric Kress, a Missoula physician who prescribes the lethal medication, says he has transferred patients to hospice, to relatives’ homes, even to extended-stay hotels to avoid conflict.

In Washington, D.C., where an aid-in-dying law took effect last summer, the Armed Forces Retirement Home won’t assist patients in any way. Those who wish to use the law would be referred to an ethics committee for individual consideration, spokesman Christopher Kelly said in an email.

Only Washington state has a policy that allows veterans to remain in government-run residences if they intend to ingest lethal medications.. At least one veteran has died in a state-run home using that law, said Heidi Audette, a spokeswoman for the state’s Department of Veterans Affairs.

Paul Sherbo, a spokesman for the U.S. Department of Veterans Affairs, said the choice is up to the states.

“VA does not mandate how states comply with federal law,” Sherbo said in an email. “There are a number of ways individual states can choose to handle such situations and still be in compliance.”

To date, none of the 2,400 residents of California’s veterans homes has formally requested medical aid-in-dying, said Iljana. That includes the more than 900 residents of the Yountville center, located about 60 miles north of San Francisco.

“We would respectfully and compassionately assist them in transferring to a hospice, family home or other location,” Iljana said in an email. “We will readmit them immediately if they change their minds.”

But Kathryn Tucker, executive director of the End of Life Liberty Project, an advocacy group that supports aid-in-dying, said that CalVet is interpreting the federal regulations too broadly and denying terminally ill veterans the right to choose a “peaceful death” through medical assistance.

“Nothing exists in the federal statute’s language that would prohibit a resident from receiving aid-in-dying services at state homes, so long as they are not provided using federal funds or employees,” she said.

Ed Warren, head of the Allied Council, a group representing veterans at the Yountville site, co-signed a letter to CalVet officials protesting the ruling.

“My point of view is that it is inhumane to expect people in the last stages of dying to go through the hullabaloo of leaving their homes,” he said.

In Washington state, a 60-year-old man diagnosed with terminal chronic obstructive pulmonary disease, or COPD, died in June 2015 after ingesting lethal drugs at the Washington Soldiers Home in Orting, where he lived.

“It was all done very much in the open,” said Chris Fruitrich, a volunteer with the group End of Life Washington, which assisted the man.

There has been no indication that the policy jeopardizes the nearly $47 million the agency receives each year in federal funds, said Audette, the state VA spokeswoman.

In California, additional protests have centered on allegations that CalVet suppressed information about the aid-in-dying law.

Critics at the Yountville home contend that CalVet passed the discharge rule quietly, with little public input. Then the agency refused to broadcast a public meeting about medical aid-in-dying on KVET, the center’s state-run, closed-circuit television station.

Iljana said the broadcast of the Aug. 21 meeting, led by Tucker and Dr. Robert Brody, also a supporter of aid-in-dying, violated state rules that prohibit using public resources to promote political causes.

“Free speech is great and criticizing the government is great, but not using the government’s own resources and paid staff to advocate for a change in the law,” Iljana wrote in an email to prohibit the broadcast.

That decision, however, prompted Jac Warren, 81, who has been KVET’s station manager for eight years, to resign last month in protest, citing censorship.

“What is at issue is whether a state may completely suppress the dissemination of concededly truthful information about entirely lawful activity,” Warren wrote in an email to CalVet.

The hour-long meeting, attended by about 50 people, was not propaganda, Tucker said, but “an educational event with information provided by an attorney and a physician who both specialize in their respective fields in end-of-life care.”

Bob Sloan, who works as an engineer at KVET for a $400 monthly stipend, disagreed with the decision not to broadcast the meeting on the system that serves residents of the Yountville home.

Sloan said he knows other residents who would like to be able to use California’s aid-in-dying law if their illnesses progress.

“The only other option that people have in this state is committing suicide,” he said. “If I can’t find some way of doing it legally, I’ll do it illegally.”

KHN’s coverage related to aging and improving care of older adults is supported in part by The John A. Hartford Foundation.

[Update: An earlier version of this story said an Aug. 21 meeting held regarding aid-in-dying violated state rules. In fact, officials said that broadcasting the meeting using state resources would have resulted in a violation.]

By Nathaniel Weixel – via TheHill.com

The Trump administration is facing a crucial test of how much flexibility they are willing to give states to remake their Medicaid programs.

Federal officials have already given the green light to two states to impose work requirements on Medicaid recipients, and at least eight other states are hoping to follow.

But a handful of other states want to go even further by putting a lifetime cap on how long people can be enrolled in the Medicaid program.

No state has ever put a limit on how long a person can receive Medicaid benefits. But given that the Trump administration has already shown a willingness to approve conservative policies like work requirements, premiums and lockout periods for Medicaid, many experts and advocates think lifetime limits could also win approval.

Critics of lifetime limits say they would fundamentally shift Medicaid from a health care safety net program for the poor and sick to a welfare program.

“It’s clear that [the administration] view[s] Medicaid not as a health insurance program. They are hopeful to get as many people off the program and off public assistance as possible,” said Jessica Schubel, a senior policy analyst at the Center on Budget and Policy Priorities.

The Trump administration has made state innovation a priority and has promised to fast-track Medicaid waivers, especially those that will impose work requirements on beneficiaries.

To date, five states — Maine, Arizona, Utah, Wisconsin and Kansas — have applied for waivers from the Department of Health and Human Services to put a cap on how long Medicaid beneficiaries can receive health benefits.

The waivers vary, but the proposals are generally tied to work requirements. Utah and Arizona both seek a maximum of five years eligibility. In Arizona, the five-year window would only apply when a beneficiary doesn’t meet the work requirement.

Utah’s request makes a deliberate link between benefit limits and welfare.

“This limit frames public healthcare coverage for adults as temporary assistance (similar to Temporary Assistance for Needy Families (TANF)), with the expectation that they do everything they can to help themselves before they lose coverage,” the application says.

The lifetime cap proposals reflect the administration’s view that only the “able-bodied” will be impacted. In all the requests, children, pregnant women and people with disabilities would be exempt from coverage limits.

The Department of Health and Human Services doesn’t comment on outstanding waiver requests, but Seema Verma, administrator of the Centers for Medicare and Medicaid Services, has made clear her view that Medicaid should only be for the most vulnerable citizens.

“True compassion is lifting Americans most in need out of difficult circumstances,” Verma said in a recent Washington Post column.

“This administration stands for a policy that makes Medicaid a path out of poverty by empowering states to tailor programs that meet the unique needs of their citizens,” she wrote.

Conservatives have long argued that spending on entitlement programs like Medicare, Medicaid and Social Security needs to be curtailed before the costs overwhelm the federal budget.

Share to Facebook
Share to Twitter
Share to Google+

Trump officials face decision on lifetime limits for Medicaid
© Getty Images

The Trump administration is facing a crucial test of how much flexibility they are willing to give states to remake their Medicaid programs.

Federal officials have already given the green light to two states to impose work requirements on Medicaid recipients, and at least eight other states are hoping to follow.

But a handful of other states want to go even further by putting a lifetime cap on how long people can be enrolled in the Medicaid program.

No state has ever put a limit on how long a person can receive Medicaid benefits. But given that the Trump administration has already shown a willingness to approve conservative policies like work requirements, premiums and lockout periods for Medicaid, many experts and advocates think lifetime limits could also win approval.

Critics of lifetime limits say they would fundamentally shift Medicaid from a health care safety net program for the poor and sick to a welfare program.

“It’s clear that [the administration] view[s] Medicaid not as a health insurance program. They are hopeful to get as many people off the program and off public assistance as possible,” said Jessica Schubel, a senior policy analyst at the Center on Budget and Policy Priorities.

The Trump administration has made state innovation a priority and has promised to fast-track Medicaid waivers, especially those that will impose work requirements on beneficiaries.

To date, five states — Maine, Arizona, Utah, Wisconsin and Kansas — have applied for waivers from the Department of Health and Human Services to put a cap on how long Medicaid beneficiaries can receive health benefits.

The waivers vary, but the proposals are generally tied to work requirements. Utah and Arizona both seek a maximum of five years eligibility. In Arizona, the five-year window would only apply when a beneficiary doesn’t meet the work requirement.

Utah’s request makes a deliberate link between benefit limits and welfare.

“This limit frames public healthcare coverage for adults as temporary assistance (similar to Temporary Assistance for Needy Families (TANF)), with the expectation that they do everything they can to help themselves before they lose coverage,” the application says.

The lifetime cap proposals reflect the administration’s view that only the “able-bodied” will be impacted. In all the requests, children, pregnant women and people with disabilities would be exempt from coverage limits.

The Department of Health and Human Services doesn’t comment on outstanding waiver requests, but Seema Verma, administrator of the Centers for Medicare and Medicaid Services, has made clear her view that Medicaid should only be for the most vulnerable citizens.

“True compassion is lifting Americans most in need out of difficult circumstances,” Verma said in a recent Washington Post column.

“This administration stands for a policy that makes Medicaid a path out of poverty by empowering states to tailor programs that meet the unique needs of their citizens,” she wrote.

Conservatives have long argued that spending on entitlement programs like Medicare, Medicaid and Social Security needs to be curtailed before the costs overwhelm the federal budget.
Sponsored Content
An Incredible $200 Intro Bonus Just For Using This Card
Sponsored By NextAdvisor

“The thought that a program designed for our most vulnerable citizens should be used as a vehicle to serve working age, able-bodied adults … does not make sense,” Verma said in a speech late last year.

Advocates promise a legal fight, and say lifetime limits go against the entire purpose of Medicaid.

“This strikes me as lawsuit bait. I suspect this could be a bridge too far,” said Jocelyn Guyer, a consultant with Manatt Health. “Work requirements are also a sweeping change, and this is a step beyond. This seems like it would be asking for more litigation and controversy and trouble.”

Advocates for Medicaid also argue that coverage limits would be a huge administrative burden, and that there’s no evidence they even work.

Lifetime limits “won’t take away the need for care,” said Jerry Vitti, CEO of Healthcare Financial, a health care advocacy company. “You’re not lifting someone up by lowering their health status.”

Advocates also argue that the administration is encouraging states to break the law. ObamaCare allowed states to expand Medicaid to anyone making up to 138 percent of the federal poverty level — about $16,600 this year.

Republicans believe the expansion discourages “able bodied” people from working because it provides free health care. Legislation that congressional Republicans pursued unsuccessfully last year would have repealed ObamaCare and rolled back the Medicaid expansion.

“This is clearly an attack on the [Medicaid expansion] population. What could not be done legislatively is being done administratively,” Vitti said.

Some Medicare beneficiaries would pay more for their prescription drugs under President Donald Trump’s budget even as the sickest patients save thousands of dollars, a complex trade-off that may make it harder to sell Congress on the plan in an election year.

In budget documents, the administration said its proposals strike a balance between improving the popular “Part D” prescription benefit for the 42 million seniors enrolled, while correcting design flaws that increase program costs for taxpayers. Health and Human Services Secretary Alex Azar is expected to testify on the proposal later this week in Congress.

Trump has made bringing down drug costs a top priority, but his administration’s plan would create winners and losers. The high cost of medicines is the leading health care concern among consumers.

Independent experts said the administration’s plan will help beneficiaries with the highest prescription drug costs, an estimated 1 million of the sickest patients, those whose individual bills reach a total of more than $8,418 apiece.

But about 4.5 million seniors in the group just behind them could end up spending more of their own money. That’s because the budget proposes a change in how Medicare accounts for manufacturer discounts received by patients whose total bills range between $3,750 and $8,418. They could wind up paying about $1,000 more.

A senior Senate Democrat said the Trump plan missed the mark.

“Instead of picking winners and losers and leaving big pharma unscathed, the president should follow through on his promise to lower high drug prices by getting Republicans in Congress to work with Democrats on behalf of Americans who are getting clobbered at the pharmacy counter,” Sen. Ron Wyden, D-Ore., said in a statement. Wyden is the ranking Democrat on the Finance Committee, which oversees Medicare.

“The package reduces costs for some but increases costs for others, and the effect on premiums is not clear,” said Tricia Neuman, a Medicare expert with the nonpartisan Kaiser Family Foundation. Also unclear is how the Trump plan interacts with changes to the Medicare prescription plan enacted by Congress just last week.

Medicare’s prescription drug benefit is delivered through private insurance plans. Here’s more detail on the trade-off for beneficiaries:

— The budget eliminates cost sharing for Medicare beneficiaries who reach the program’s “catastrophic” coverage threshold, currently $8,418 in total costs. Instead of paying 5 percent of the cost of their medications, the sickest patients would pay nothing. They’d be the winners.

— A second group just behind the sickest patients would lose ground financially. Currently Medicare counts manufacturer discounts received by patients in this group to calculate total spending that determines when they qualify for catastrophic coverage. That practice would stop, meaning beneficiaries would have to spend more of their own money to reach the threshold for the richer catastrophic coverage.

“It’s complicated,” said Joe Baker of the Medicare Rights Center. “The winners in this proposal are people with very high drug spending. The people who are the losers here are the people who are stuck in the middle.”

In other Medicare drug changes, the budget calls for requiring insurers to share manufacturer rebates with patients, and it expands coverage for medications to treat substance abuse.