Complications: Health Policy Unraveled McGuireWoods Consulting

Medicaid is complicated.
In this episode of Complications: Health Policy Unraveled, host Stephanie Kennan discusses the newly finalized regulations concerning Medicaid, specifically as they pertain to the Managed Care Rule. These new regulations aim to increase transparency and improve access in states' Medicaid programs. Key points discussed include: changes in state-directed payments to ensure they are reasonable, enhanced requirements for reporting and evaluation, alterations in the medical loss ratio, imposition of enrollee protections, and improvements in the quality of care through careful evaluation and public comments.
Tune in as Stephanie helps simplify the complexities of the new Medicaid rules.
Meet Your HostName: Stephanie Kennan 
Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consulting
Specialty: Stephanie Kennan helps clients navigate the legislative and executive branches of the federal government to solve problems involving a variety of healthcare policy issues. Her work focuses on providers, medical device manufacturers, drug manufacturers and associations concerned about Medicare and Medicaid reimbursement.
Connect: LinkedIn
Episode Highlights[0:24] Broad overview of new “Managed Care Rule”
[2:17] New Rule implements transparency measures related to state-directed Medicaid payments
[4:20] States must report more specific data related to medical loss ratio
[5:07] Medicaid enrollees will receive more protections, including reduced appointment wait times and secret-shopper surveys of Medicaid services
[6:37] New Rule seeks to improve quality of care by requiring public comment on rule changes and external quality of care reports.
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Subscribe to Complications: Health Policy Unraveled in your preferred podcast app and never miss a healthcare update by subscribing to host and JD Supra’s #1 healthcare author Stephanie Kennan’s Washington Healthcare Update at www.mwcllc.com

The Center for Medicaid & Medicare Services (CMS) recently released new guidelines that will affect the Medicare drug price negotiation process beginning in 2026.
In this episode of Complications: Health Policy Unraveled, host Stephanie Kennan provides a summary of the new CMS guidelines, including the new requirements for drug manufacturers and Part D dispensing entities, the timeline for negotiating new drug prices, and some of the challenges in navigating these new guidelines. Tune in to learn more about these new CMS guidelines.
Meet Your HostName: Stephanie Kennan 
Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consulting
Specialty: Stephanie Kennan helps clients navigate the legislative and executive branches of the federal government to solve problems involving a variety of healthcare policy issues. Her work focuses on providers, medical device manufacturers, drug manufacturers and associations concerned about Medicare and Medicaid reimbursement.
Connect: LinkedIn
Episode Highlights[0:30] An overview of the new CMS drug price negotiation guidelines
[1:21] The limited effect of the Inflation Reduction Act on Medicare drug price negotiations
[1:39] The process of negotiating new maximum fair prices for drugs between Medicare and drug manufacturers.
[3:18] How the new guidelines mandate patient access to drugs
[5:28] Using a Medicare Transaction Facilitator to ensure the guidelines are followed by engaging in an exchange of information between drug manufacturers and CMS
[7:02] CMS’s procedures for receiving feedback on certain features of the new guidelines
ContactConnect with us on Facebook, Twitter, LinkedIn, YouTube.
Subscribe to Complications: Health Policy Unraveled in your preferred podcast app and never miss a healthcare update by subscribing to host and JD Supra’s #1 healthcare author Stephanie Kennan’s Washington Healthcare Update at www.mwcllc.com 

Recently, some consumers have found that their health plans had been changed without their knowledge, impacting their coverage and their finances. 
In this episode of Complications: Health Policy Unraveled, host Stephanie Kennan explores unauthorized plan switching related to Affordable Care Act health plans. Consumers are being unknowingly switched to different health plans, resulting in coverage disruptions, financial losses, and even loss of access to care. Misleading ads and unethical practices by some call centers combined with changes in enrollment periods are exacerbating the issue, leading to lawsuits and regulatory concerns. Despite efforts by federal and state regulators, challenges remain in detecting and addressing these unauthorized switches effectively. Tune in to learn more about the latest scam targeting low income individuals seeking medical coverage.
Meet Your HostName: Stephanie Kennan 
Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consulting
Specialty: Stephanie Kennan helps clients navigate the legislative and executive branches of the federal government to solve problems involving a variety of healthcare policy issues. Her work focuses on providers, medical device manufacturers, drug manufacturers and associations concerned about Medicare and Medicaid reimbursement.
Connect: LinkedIn
Episode Highlights[0:40] A recent Kaiser Family Foundation report identified incidents in which consumers learned that their health plans had unknowingly been changed, affecting their health coverage and finances.
 [1:12] A lawsuit has been filed in the Southern District of Florida against call centers who allegedly paid for individuals’ information and then switched their health insurance policies without their knowledge, resulting in additional costs or coverage issues for consumers.
[2:44] It appears this scam began as a way to target those seeking coverage during a special enrollment period for low income individuals.
[3:16] It is currently unknown how many complaints have been filed with CMS, but the issue has certainly ramped up in the last year and is mostly concentrated on the federal healthcare.gov website.
[4:08] Enrollment has been a top priority for the health insurance marketplace, so finding a way to stop bad actors while still encouraging new consumers presents a challenge.
[4:28] The complaint process, which would initiate an investigation, is cumbersome, not centralized between state and federal agencies, and confusing for many.
ContactConnect with us on Facebook, Twitter, LinkedIn, YouTube.
Subscribe to Complications: Health Policy Unraveled in your preferred podcast app and never miss a healthcare update by subscribing to host and JD Supra’s #1 healthcare author Stephanie Kennan’s Washington Healthcare Update at www.mwcllc.com

The Congressional Review Act has been used to overturn 20 rules since it was enacted. Will a Biden administration healthcare rule be next?
In this episode of Complications: Health Policy Unraveled, host Stephanie Kennan explores the intricacies of the Congressional Review Act (CRA) and its significance for healthcare policy. She explains how the CRA empowers Congress to review and potentially overturn federal agency rules through its “lookback” provision, particularly during administration transitions. Through a detailed examination of the CRA's complex mechanisms and timelines, Stephanie provides listeners with valuable insights into navigating the intricacies of healthcare policy amidst legislative challenges and regulatory changes.
Meet Your HostName: Stephanie Kennan 
Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consulting
Specialty: Stephanie Kennan helps clients navigate the legislative and executive branches of the federal government to solve problems involving a variety of healthcare policy issues. Her work focuses on providers, medical device manufacturers, drug manufacturers and associations concerned about Medicare and Medicaid reimbursement.
Connect: LinkedIn
Episode Highlights[0:32] Because of the Congressional Review Act’s “lookback” provision, certain healthcare-related rules may soon face being overturned.
[1:11] The CRA was enacted in 1996 to prevent “midnight rulemaking,” when presidential administrations enact rules late in their term or as they’re leaving office.
[1:32] Agencies must report new rules to Congress who, with a joint resolution of disapproval, can overturn the rule or prevent it from ever going into effect. This process has been used to overturn 20 rules since its enactment.
[2:15] The CRA applies to final rules, including major and non-major rules, and could potentially be used for agency actions not typically subject to notice-and-comment rulemaking.
[2:29] Agencies must submit their rules to the GAO, which frequently helps clarify when agency actions meet the CRA definition of a rule, though these opinions can subject even unsubmitted agency action to a possible joint resolution of disapproval.
[4:04] A joint resolution of disapproval can only be used to invalidate one rule at a time and must be introduced within 60 days of when Congress receives the rule, which can lead to confusion as to when the period actually expires.
[5:01] While the lookback provision is intended to ensure Congress will have a full period to consider each agency action, in practice, the specifications as to committee votes, motions, and timing can create a headache.
[6:34] A rule subject to an enacted joint resolution of disapproval cannot later be reissued in “substantially the same form,” though that phrase is left undefined.
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Subscribe to Complications: Health Policy Unraveled in your preferred podcast app and never miss a healthcare update by subscribing to host and JD Supra’s #1 healthcare author Stephanie Kennan’s Washington

Congress has a number of important healthcare issues currently pending, but whether any get resolved before the end of the term is still to be seen.
In this episode of Complications: Health Policy Unraveled, Stephanie Kennan explores key healthcare policy issues before Congress, including PBM reform, healthcare transparency, cybersecurity, insulin pricing, protection of health data, and budget appropriations. 
Meet Your HostName: Stephanie Kennan 
Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consulting
Specialty: Stephanie Kennan helps clients navigate the legislative and executive branches of the federal government to solve problems involving a variety of healthcare policy issues. Her work focuses on providers, medical device manufacturers, drug manufacturers and associations concerned about Medicare and Medicaid reimbursement.
Connect: LinkedIn
Episode Highlights[0:36] Though both the House and Senate have been working on PBM reform for years, including pushing legislation through committees, it continues to be excluded from any healthcare packages.
[1:50] In attempts to increase healthcare transparency, Congress now requires insurers to publish price lists but legislation aimed at improving upon these measures have been stalled.
[3:15] The newly introduced Healthcare Cybersecurity Improvement Act would provide accelerated payments to healthcare providers in the event of a cyber breach so long as they meet cybersecurity standards.
[5:13] Biden’s 2022 Inflation Reduction Act lowered the cost of insulin, but Congress is poised to institute more sweeping reforms after manufacturers began capping costs and creating savings programs.
[5:51] Legislation is pending in both the House and the Senate that would prohibit the control of biotechnology by foreign adversaries so as to protect Americans’ genetic information.
[6:48] Budget and appropriations are also on the forefront of Congress’s mind at the moment and may involve healthcare ramifications, such as raising the age of Social Security and overhauling Medicare.
ContactConnect with us on Facebook, Twitter, LinkedIn, YouTube.
Subscribe to Complications: Health Policy Unraveled in your preferred podcast app and never miss a healthcare update by subscribing to host and JD Supra’s #1 healthcare author Stephanie Kennan’s Washington Healthcare Update at www.mwcllc.com

Artificial intelligence continues to be a focus for Congress and federal agencies. Are you keeping up with the latest developments that impact the healthcare sector?
In episode 22 of Complications: Health Policy Unraveled, host Stephanie Kennan provides updates on legislative and regulatory affairs concerning artificial intelligence. With the formation of the House Task Force on Artificial Intelligence, recent congressional hearings, and regulatory changes, the federal government is still dialed in on how to properly regulate and utilize artificial intelligence in a variety of sectors, including healthcare. 
Meet Your HostName: Stephanie Kennan 
Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consulting
Specialty: Stephanie Kennan helps clients navigate the legislative and executive branches of the federal government to solve problems involving a variety of healthcare policy issues. Her work focuses on providers, medical device manufacturers, drug manufacturers and associations concerned about Medicare and Medicaid reimbursement.
Connect: LinkedIn
Episode Highlights[00:39] In a bipartisan initiative, the House of Representatives has announced the formation of the Task Force on Artificial Intelligence which will be tasked with producing a report on guiding principles, risks and benefits of AI, and the effectiveness of current regulation.
[02:37] On February 8th, the Senate Finance Committee held a hearing on the potential applications of AI in healthcare, including ways to mitigate bias against certain patients by AI systems, though some senators worry legislation is being rushed.
[04:25] Representative Ted Lieu introduced the HEALTH AI Act which would require the NIH to establish a grant program to fund generative AI research, notably on how AI can reduce disparities in healthcare outcomes.
[05:15] DHHS recently made a technical correction to its previously proposed rule to enhance interoperability of electronic health information, HTI 1, causing new notice-and-comment period woes.
[06:20] In February, CMS issued an FAQ on Medicare Advantage Organizations and Medicaid Plans that addressed whether MA plans can use AI algorithms in making coverage decisions. 
ContactConnect with us on Facebook, Twitter, LinkedIn, YouTube.
Subscribe to Complications: Health Policy Unraveled in your preferred podcast app and never miss a healthcare update by subscribing to host and JD Supra’s #1 healthcare author Stephanie Kennan’s Washington Healthcare Update at www.mwcllc.com