HHS Finalizes Rule on Insurer Price Transparency

WASHINGTON — Private health insurers will have to start posting their prices publicly within the next several years according to a final rule issued Thursday by the Department of Health and Human Services (HHS).

“This shadowy system” of healthcare pricing “has to change; the patient has to be in control,” HHS Secretary Alex Azar said on a phone call with reporters. “That means giving them the right to know what they’re going to owe for a healthcare service before they ever get it.” Right now, however, “patients don’t have the information they need to shop around and get a good deal … and have an informed conversation with their doctor about what makes sense for them.”

The final rule — which was issued by HHS together with the Labor and Treasury departments — would require almost all private health insurance plans to give the 200 million Americans they cover real-time access to information about negotiated prices and cost-sharing, beginning with a list of the 500 most “shoppable” services in 2023, Azar said. This list would be expanded to include all healthcare services in 2024. “This is information that patients typically receive after they get those services, through an EOB [Explanation of Benefits] form,” but now they could get it ahead of time.

Through a shopping tool available through their plan or insurance company, consumers will be able to see the negotiated rate between their doctor and their plan or insurer, as well as the most accurate out-of-pocket cost estimate possible based on their health plan for procedures, drugs, durable medical equipment, and any other item or service they may need, HHS said in a press release. “Consumers will also have access to accurate price and plan information that allows them to shop and compare costs between individual doctors before receiving care, so they can choose a healthcare provider that offers the most value and best suits their medical needs.”

In 2022, a year before the real-time access provision takes effect, insurers will be required to publish their negotiated rates in data files that will be searchable by patients, employers, researchers, and app developers who could then develop tools to help patients choose their providers. “The vast majority of patients don’t have easy access to this information today,” said Azar.

“In one study when prices for imaging were made transparent, the prices dropped almost 20%,” he said. “You should have the right to know what a healthcare service is going to cost, and the right to know what it’s going to cost you out-of-pocket. That’s what today’s rule will do.”

For each insurer, three data files will be available: one with prices for in-network providers and services, one with prices for out-of-network providers and services, and another for in-network prices for all prescription drugs.

HHS giving insurers a lot of time to comply with the new rule “reflects that there’s a lot of work involved, but that work is only necessary because entrenched special interests in the healthcare system have for

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HHS Loosens Restrictions on COVID Relief Fund Spending

Responding to the concerns of physician and hospital associations and some members of Congress, the Department of Health and Human Services (HHS) has backed off from recent reporting requirements for groups that have received payments from the Provider Relief Fund (PRF), a $175 billion fund established by the CARES Act. However, it’s unclear whether HHS’ new approach will satisfy healthcare providers.

In an October 22 policy statement and guidance that significantly revised the content of guidance released on September 19, HHS explained that it had imposed the reporting requirements to prevent PRF payments from making some providers more profitable in 2020 than they were before the coronavirus pandemic.

HHS’ September guidance “has generated significant attention and opposition from many stakeholders and members of Congress,” the department said. “There is consensus among stakeholders and members of Congress who have reached out to HHS that the PRF should allow a provider to apply PRF payments against all lost revenues without limitation.”

The American Group Medical Association (AMGA) sent HHS a letter on October 21, the day before the policy change, in which it explained what’s at stake. Earlier guidance from the department, AMGA noted, had indicated that the providers could calculate COVID-related lost revenues by using “any reasonable method.” That included basing the calculation on the difference between budgeted and actual revenue in 2020.

The September guidance document, in contrast, said that providers had to calculate their lost revenues by computing the negative change in their net operating income from 2019 to 2020.

“Earlier guidance allowed our members to use ‘any reasonable method’ to determine their expenses and losses due to COVID-19,” the letter said. “Now, HHS is changing that calculation to one that will not capture the extent of their losses. AMGA members are still facing severe financial headwinds as they continue to deal with new COVID outbreaks and a difficult economic outlook. Changing the rules in the middle of this pandemic just adds to our members’ existing burdens. HHS should reinstate the earlier standard.”

The October update of the guidance, however, does not do that. Instead, HHS said, “Recipients may apply PRF payments toward lost revenue, up to the amount of the difference between their 2019 and 2020 actual patient care revenue.”

AMGA spokesman Matt Clark told Medscape Medical News that because AMGA members had not yet been asked for their reaction to the new policy, the association could not comment on it.

The Medical Group Management Association (MGMA), which agreed with AMGA’s objections, also had no substantive comment. “This latest update is definitely welcome, but it’s complicated, and we have to analyze it to determine whether it meets our concerns or whether it still needs improvement,” said Mollie Gelburd, associate director of government affairs for MGMA, in an interview with Medscape Medical News.

Getting Down to Nuts and Bolts

Under both sets of reporting requirements, physician practices that received more than $10,000 in PRF payments must report their healthcare-related expenses attributable to the coronavirus that haven’t been reimbursed by

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Santa actors were offered early vaccine as part of scrapped federal PSA campaign: HHS

Oct. 25 (UPI) — Federal health officials in a scrapped $250 million promotional campaign offered professional Santa Claus actors early access to a vaccine for COVID-19 in exchange for participating in pro-vaccine public service announcements, the Department of Health and Human Services said Sunday.

Santa Claus actors, as well as those playing Mrs. Claus and Christmas elves, were to be hired as part of a cancelled celebrity campaign to promote getting vaccinated, an HHS official told the New York Times.

The campaign was envisioned by President Donald Trump’s then-appointee Michael Caputo, a former HHS assistant secretary, who has been on medical leave since September after being diagnosed with cancer and posting conspiracy theories on his Facebook page, including a video accusing the Centers of Disease Control and Prevention of harboring a “resistance unit” seeking to undermine Trump.

The office of HHS Secretary Alex M. Azar said this week that the program had been cancelled. The Santa “collaboration will not be happening,” a spokesperson told the Wall Street Journal.

In late August, as the coronavirus pandemic peaked across parts of the United States, Caputo and the agency approached Ric Erwin, chairman of the Fraternal Order of Real Bearded Santas, to ask if members would participate in TV, radio, social media and podcast ads and live events in 35 cities.

The campaign was titled “Covid 19 Public Health and Reopening America Public Service Announcements and Advertising Campaign” designed to “defeat despair, inspire hope and achieve national recovery,” the Wall Street Journal reported.

The Santa group agreed to participate and asked to be given the vaccine early, as Santa actors had been vaccinated early in 2009 for H1N1.

The actors who play Santa are in an “at risk” category because of their “advanced age” and “underlying health issues,” Erwin wrote in a newsletter for Santa actors.

“Furthermore, health care officials all concurred that our high rate of interpersonal contact with young children (who are notorious vectors for disease dissemination) further highlighted our need for the vaccine,” he added.

Christmas seasonal workers are watching their livelihoods disappear as stores like Macy’s have cancelled in-person visits with Santa Claus, Mrs. Claus and their elves. Some tech-savvy Santas have offered a Zoom alternative or pre-recorded video messages.

Caputo told Erwin in August that the vaccine was likely to be approved in the late fall and that Santas and other seasonal workers would have it by Thanksgiving, the Wall Street Journal reported.

“If you and your colleagues are not essential workers, I don’t know what is,” Caputo said on a call, which was recorded by Erwin. “I cannot wait to tell the president,” Caputo added. “He’s going to love this.”

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42 states, territories in upward trajectory of new COVID-19 cases: HHS memo

Only nine jurisdictions are improving. Just five jurisdictions are at a plateau.

Forty-two states and territories are in an upward trajectory of new COVID-19 cases, while only nine jurisdictions are improving, according to an internal Health and Human Services memo obtained by ABC News.

Just five jurisdictions are at a plateau.

There were 5,530 deaths recorded from Oct. 16 to Oct. 22, marking a 15.1% increase in new deaths compared with the previous week, according to the memo.

The national test-positivity rate increased from 5.1% to 5.9% in week-to-week comparisons.

Across the country, 24% of hospitals have more than 80% of their ICU beds filled. That number was 17 to 18% during the summertime peak.

In Florida, new cases are up 30% among high school students compared to two weeks ago, and up 42% among young adults ages 18 to 24, the memo said.

In Kentucky, new deaths have been increasing over the last two weeks. Kentucky reported its second-highest daily fatality count on Wednesday, the memo said.

The state is preparing its surge capacity as hospitalizations rise.

Mississippi reported a 26.2% increase in cases over the last week, according to HHS.

COVID-19 related hospitalizations in Mississippi are up 24% since last week, with COVID-19 ICU hospitalizations up 7%.

The Mississippi Band of Choctaw Indians, who primarily live in Neshoba County, are disproportionately affected by the virus. The tribe reported 22 new cases this past week with

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All seniors could get COVID-19 vaccine by end of January, HHS head says

All seniors, health care workers, first responders and vulnerable individuals could be vaccinated against COVID-19 by the end of January, the U.S. Department of Health and Human Services (HHS) Secretary Alex Azar told reporters Wednesday (Oct. 21) during a news briefing

But this ambitious timeline rests on a critical factor: enough data to know that the vaccine is safe and effective. Not even the drug companies conducting late-stage phase 3 clinical trials know yet if their candidate vaccines meet those standards.

The question of “when” we will know whether those vaccines are safe and effective “will really be dependent on events in the trial. That’s outside of anyone’s control,” Azar said. In order to understand whether or not a potential vaccine is protective against COVID-19, enough people enrolled in the trial need to be exposed naturally to the virus. 

Related: The most promising coronavirus vaccine candidates

Pharmaceutical giant Pfizer, which is testing one of the leading vaccine candidates in the U.S., expects to have enough safety and efficacy data by the third week of November. Assuming the results are positive, the company will at that point apply for emergency use authorization (EUA) in the U.S., according to a statement published online Oct. 16 by the company’s Chief Executive Officer Albert Bourla.

But even if vaccines are approved, it’s not clear how long it will take to manufacture and distribute them to everyone in the U.S. As part of the government’s Operation Warp Speed, many of the leading vaccine candidates are already being manufactured prior to trial results. These vaccines will be ready to be distributed before they are given approval, Azar said.

By the end of the year, officials expect that there will be enough FDA-authorized vaccine to be able to vaccinate the most vulnerable individuals, Azar said. “Then by the end of January, we expect we’ll have enough to vaccinate all seniors as well as our health care workers and first responders. And by the end of March to early April, enough vaccine for all Americans who would want to take a vaccine.” However, he did not mention children, an age group on which the leading vaccines have not yet been tested and who will thus likely receive a vaccine much later.

Trust roadblocks

“Having a vaccine ready is one thing, being able to deliver it is yet another,” said Dr. William Schaffner, an infectious-diseases specialist at Vanderbilt University in Tennessee. “I think that process will take much longer than this timeline.”

One of the reasons for that is public skepticism on the safety and efficacy of COVID-19 vaccines, which runs high especially in African American and ethnic communities that have been disproportionately affected by the virus, Schaffner told Live Science. Surveys have shown that as many as half of Americans do not trust these vaccines, he said. That’s because “this whole process is so politicized, unfortunately.”

When a vaccine is approved, assuming that it meets the standards of efficacy and safety and has been thoroughly vetted by

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