Complications: Health Policy Unraveled
Tired of being baffled by healthcare policy? McGuireWoods Consulting presents Complications: Health Policy Unraveled, your solution to the policy puzzle. With our host, Stephanie Kennan, discover the ins and outs of healthcare policy and gain insights crucial for providers and investors. Let's simplify the complex together. Follow us in your favorite 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 www.mwcllc.com. And if you found this podcast valuable, please share it with your colleagues and leave us a review. We always appreciate your feed...
Understanding Medicare’s Negotiated Drug Prices: What Are The Real Savings?
In mid-August, the Biden administration announced it had completed negotiations for the first 10 drugs in Medicare’s price program and that the new prices will be implemented in 2026. The achievement marks decades of effort and is a stellar achievement for the Democrats and the administration.
But Medicare already receives discounts and rebates on drugs, so it’s unclear what the savings will really be off the list price. And, as Stephanie Kennan points out, it is also unclear how much of any savings will filter through to patients because their costs will be determined by their insurance plan...
How the Inflation Reduction Act Is Affecting Medicare Part D Drug Costs
In an ironic move, it’s likely that Medicare Part D insurance premiums will rise next year even as a 2022 law sought to lower costs for patients, but the administration is planning on implementing a program to stabilize the market.
Under the 2022 law, insurers must now make up the difference between costs formerly covered by patients and are raising drug premiums to compensate, explains host Stephanie Kennan. Join her as she explains the changes facing insurers and the efforts the government is making to stabilize the market during the transition brought about by the 2022 Inflation Reduction Act.
<...Rejecting a Psychedelic Drug for PTSD Treatment: Why and What’s Next
A revolution in the use of psychedelic drugs to treat mental health issues experienced a setback in early August when the FDA declined to approve MMDA as a treatment for post-traumatic stress disorder.
Host Stephanie Kennan provides important context to the FDA’s decision, which came as the agency has faced criticism for approving therapies without convincing evidence. She outlines the fallout, including a peer-reviewed journal’s decision to retract three papers about MMDA-assisted psychotherapy. She also looks ahead, explaining that, while this first attempt for MMDA stalled, other companies are working on their own applications.
Mee...
Reforming the Medicare Physician Fee Schedule: Controversy and Urgency
Congress is teeing up discussions on a controversial issue that strikes at the heart of the Medicare system: how physicians are paid.
Lawmakers are weighing changes to the Medicare Physician Fee Schedule for the first time since 2015, and host Stephanie Kennan lays out the landscape. She provides background on the pay schedule, describes reforms under consideration, and explains why physicians and other stakeholders are warning about a gap between rising costs and physician payments – which could impact care.
Meet Your Host
Name: Stephanie Kennan
Title: Senior Vice President, Federal Public Affairs at...
How Site-Neutral Payment Reform Divides Policymakers and Hospitals
“Site-neutral” is a short name for a proposal that has bipartisan interest in Congress, but is being fiercely fought by hospitals.
Host Stephanie Kennan explores the divisive issue of site-neutral payment reform, an approach to healthcare spending that would align Medicare payments for outpatient services across care settings. Amid growing bipartisan interest and pressure to rein in healthcare costs, Congress has proposed reforms such as the Medicare Patient Access to Cancer Treatment Act. But hospitals are fighting it because of the potential to reduce revenue and, they worry, decrease healthcare access in rural and low-income communities.
Tune...
A Closer Look: NIH Reform Recommendations In Congress
The National Institutes of Health (NIH) has been under scrutiny since COVID-19, so it is not surprising that members of Congress have released NIH reform initiatives.
In this episode of Complications: Health Policy Unraveled, host Stephanie Kennan provides a summary of NIH reform recommendations, starting with the white paper released by Republican Senator Bill Cassidy, which suggests reform priorities around transparency and research grants. Stephanie also breaks down the broader NIH Energy and Commerce Framework released by House Energy and Commerce Chair Kathy McMorris, which recommended comprehensive NIH reform in several areas, including mission and leadership, financial...
340B ACCESS Act Aims to Clarify Contract Pharmacy Role in Drug Discount Program
“The 340B Drug Discount Program is the second largest government pharmaceutical program based on net drug spending and is only behind Medicare Part D. It's been the subject of a lot of legislation and hearings in Congress because of its growth and because of the confusion over contract pharmacies.”
In this episode of Complications: Health Policy Unraveled, host Stephanie Kennan discusses the latest on the 340B Drug Discount Program, which since 1992 has provided low income and uninsured patients increased access to drugs by requiring manufacturers to provide outpatient drugs to eligible healthcare organizations at a discount.
Tune...
Supreme Court to Hear Arguments on Medicare’s Disproportionate Share Hospital Payments
In 2022, the Supreme Court of the United States heard arguments related to Medicare’s Disproportionate Share Hospital Payments. Now that issue is before the court again.
In this episode of Complications: Health Policy Unraveled, host Stephanie Kennan discusses an upcoming SCOTUS case involving hospitals and the Department of Health and Human Services (HHS). The hospitals argue that HHS in not following the 2022 SCOTUS decision related to how patients receiving SSI are counted. The hospitals argue that the manner in which HHS counts patients has resulted in funding cuts and puts some hospitals in jeopardy of not being eli...
New Medicaid Rule Promotes Transparency and Should Improve Quality of Care
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...
New CMS Guidelines for Drug Price Negotiation
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 Host
Name: Stephanie Kennan
Title: Senior Vice President, Federal P...
Switcheroo Scams: Stopping Unauthorized Health Plan Switching
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, c...
“Looking Back” on the CRA’s Impact on Healthcare Rules
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 chal...
What's Left on Congress' Healthcare To-Do List
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 Host
Name: 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...
Navigating AI in Healthcare: Legislative and Regulatory Updates
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 Host
Name: Stephanie Kennan
Ti...
Chevron, Abortion, and Misinformation: What’s On The SCOTUS Docket and Implications for the Healthcare Sector
What does fishing have to do with healthcare? Currently before SCOTUS is Loper Bright Enterprises, a case involving federal oversight of herring fishing which could impact the government's regulatory power broadly and thus, the healthcare sector.
In episode 21 of Complications: Health Policy Unraveled, host Stephanie Kennan explores Loper Bright Enterprises and other cases before the U.S. Supreme Court with wide-ranging implications for healthcare policy. From challenges to regulatory power and abortion laws, to debates over the FDA's actions and free speech on COVID-19, this episode delves into cases raising complex legal issues that will shape the fu...
AI Dilemmas: Congress’s Proposed Legislation and the Future of AI Governance
AI is dividing members of Congress based on how they feel it should be regulated. As a result, Congress may concede regulatory power to the Biden Administration, which has proven more efficient in developing regulatory framework for AI.
In episode 20 of Complications: Health Policy Unraveled, host Stephanie Kennan discusses AI-related congressional actions from last year and what’s on the horizon for this year. Walking through proposed pieces of legislation in both the House and the Senate, Stephanie highlights areas of Congressional focus in the AI sphere. However, since it’s an election year, Congress will likely find...
Regulating Artificial Intelligence: Transparency, Safety, and Equity
With the recent exponential growth of artificial intelligence technologies, the Biden administration is trying to help guide the nation in the development and deployment of safe, secure, and transparent AI technologies across all sectors, including healthcare.
In episode 19 of Complications: Health Policy Unraveled, host Stephanie Kennan explores the recent regulatory activity related to artificial intelligence. In October 2023, President Biden issued an executive order on the safe, secure, and trustworthy development and use of AI, which would establish a coordinated approach to its implementation in the federal government. Likewise, in December 2023, HHS released its first rule related to A...
Overhauling Medicare Advantage: Proposed Changes for 2026
“Medicare Advantage has come under scrutiny related to mental health providers in their networks and related to broker's fees.” Proposed changes seek to remedy that.
In episode 18 of Complications: Health Policy Unraveled, host Stephanie Kennan details the changes to Medicare Advantage Plans recently proposed by the Senate Finance Committee and CMS. The Senate Finance Committee’s changes are aimed at ensuring accuracy among provider directories. CMS wishes to redefine “compensation” so as to ensure brokers are directing enrollees to the plan best-suited for the patient, not the plan that gives the broker the biggest bonus. The proposed changes wo...
Standardize and Streamline: CMS Proposes Standards for Qualified Health Plans and the Exchanges
Change is on the horizon for the health plan marketplace.
In episode 17 of Complications: Health Policy Unraveled, host Stephanie Kennan describes the new standards proposed by the Centers for Medicare and Medicaid Services for qualified health plans in health insurance marketplaces. These changes include bringing state marketplaces in line with the federal health plan marketplace. Proposed changes are meant to increase eligibility, transparency and availability of services. Stephanie discusses the changes we can expect to come to the health insurance sector in 2025. Tune in to the episode to learn more.
Meet Your Host
N...
Unraveling End-of-Year Healthcare Policy: Congress' Agenda and Challenges
As we come to year-end, healthcare policy is in flux.
In episode 16 of Complications: Health Policy Unraveled, host Stephanie Kennan discusses the possible absence of an end-of-year healthcare package due to the appropriations process deadlines. She also discusses some of the initiatives Congress wants to do when they can do a healthcare package. Bills that could reshape the PBM industry significantly are stalled, and other issues that need to be addressed include site-neutral payment reforms, pending physician fee cuts, and behavioral health reforms. The episode wraps up with the announcement of several Congressional retirements affecting the healthcare p...
Supporting Healthcare for Homeless: CMS Allows Reimbursement for “Street” Medicine
The Centers for Medicare & Medicaid Services (CMS) has made a small change that has a large impact.
In episode 15 of Complications: Health Policy Unraveled, host Stephanie Kennan discusses the updated CMS billing policy, which now allows insurers to pay street medicine providers for their services. This move gives providers the flexibility to see homeless patients outside a traditional facility and seeks to address the healthcare needs of the ever-increasing number of homeless people across the country. Currently pending in the House is a bipartisan bill that would expand access to street medicine for homeless individuals across the...
Medicare Premium Increases: What to Expect for 2024
The Centers for Medicare & Medicaid Services (CMS) has announced that Medicare premiums are expected to increase in 2024.
In episode 14 of Complications: Health Policy Unraveled, host Stephanie Kennan breaks down all the expected Medicare premium increases and what’s behind these rate hikes. Because the Supreme Court held that cuts to drug reimbursements to 340B Hospitals are unlawful, CMS now plans to repay the $9 billion to these hospitals, raising premium rates. The increases can also be attributed to expected expansions in access to Alzheimer’s care. Tune in to this episode to learn how your insurance premiums may be a...
DEA Extends Telehealth Prescribing Flexibilities for Controlled Substances
The regulatory landscape for telehealth prescribing of controlled substances is evolving.
In episode 13 of Complications: Health Policy Unraveled, host Stephanie Kennan covers the DEA's recent extension of pandemic-era telehealth prescribing flexibilities for controlled substances through 2024, marking the second extension. Originally set to expire in May, these extensions followed extensive public input, including 38,000 comments and two telemedicine listening sessions. Advocates, including healthcare organizations and Congress members, stress the importance of telehealth for addressing issues like opioid use disorders. The DEA is currently reviewing feedback, leaving the final rules to be determined. Stay tuned for updates on this dynamic...
Navigating the No Surprises Act: Challenges and Controversies
The No Surprises Act has had some difficulties in the implementation process, and those difficulties are raising issues.
In episode 12 of Complications: Health Policy Unraveled, host Stephanie Kennan provides an update on the No Surprises Act, a law passed by Congress in December 2020 to protect patients from excessive surprise medical bills. The law partially went into effect in the beginning of 2022 for those in individual and group health plans. Stephanie discusses the challenges and issues faced during its implementation, including legal battles, concerns about the arbitration process, and the impact on small medical practices. The debate over...
Prescription Drug Costs in Focus: PBM Reform on the Horizon
Pharmacy benefit managers (PBMs) continue to be a topic which causes angst in Congress. However, PBM reform is not far off, and is likely to come before the end of the year.
In episode 11 of Complications: Health Policy Unraveled, host Stephanie Kennan discusses the bipartisan introduction of the Patients Before Middlemen Act in the Senate, which is aimed at realigning incentives that help lower prescription drug costs for Medicare Part D beneficiaries. Additionally, this episode highlights the broader legislative efforts to address drug pricing issues. Tune in to this episode to learn more.
Meet Your...
DEA’s Telehealth Proposed Rules: Expanding Access & Preventing Medication Misuse, or Not?
“The initial reaction to the rules is that they are much more restrictive than necessary and impose concerning limitations and burdens on clinicians and the patients they treat.”
In episode 10 of Complications: Health Policy Unraveled, host Stephanie Kennan discusses the Drug Enforcement Agency’s telehealth proposed rules which could impact how patients gain access to certain medications. The DEA received 38,000 comments on the proposed changes, a record amount of feedback.
It is likely that when finalized, the rule will contain many of the elements of the proposed rule, which will add complexity for patients and provider...
Who Has Access to Our Health Data? Understanding the ADPPA
The concept of a federal consumer privacy framework is something that Congress has worked on for several years in both the House and Senate, but it's never come to fruition.
In episode 9 of Complications: Health Policy Unraveled, host Stephanie Kennan discusses the American Data Privacy and Protection Act (ADPPA), which would, if passed, create a comprehensive federal consumer privacy framework. The goal of the legislation would be to protect consumers from discriminatory use of their data and require entities to use more stringent security measures. Though the House Energy and Commerce Committee is currently revamping legislation, the p...
The “Ghosts’ of Mental Healthcare: Democratic Staff of the Senate Finance Committee Release Report Concerning Medicare Advantage Plans
“More than 80% of the listed in-network mental health providers [that] staff tried to contact were ‘ghosts’ as they were either unreachable, not accepting new patients, or not a network.”
In this episode of Complications: Health Policy Unraveled, host Stephanie Kennan discusses “ghost networks” and Medicare Advantage plans. Based on a recent Senate Finance Committee study, Medicare Advantage provider directories are littered with inaccurate or unreachable listings for mental health services. Stephanie discusses the Committee’s recent recommendations on how to rectify “haunted” provider lists.
Meet Your Host
Name: Stephanie Kennan
Title: Senior Vice Preside...
Unraveling the PBM Puzzle: Navigating Bipartisan Bills and Proposed Reforms
All this activity on PBM legislation ensures that something is likely to happen this year.
In this episode of Complications: Health Policy Unraveled, host Stephanie Kennan walks through legislation pending in both the House and Senate aimed at addressing the practices of Pharmacy Benefit Managers (PBMs), the drug pricing middlemen many blame for high drug costs and drug access issues.
Meet Your Host
Name: Stephanie Kennan
Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consulting
Specialty: Stephanie Kennan helps clients navigate the legislative and executive branches of federal g...
Appropriations: Battle Expected at Year’s End (Again), Despite Promises Otherwise
Here we go again. A year-end appropriations showdown is likely, despite promises earlier this year to have the process work on time for a change.
In ep. 6 of Complications: Health Policy Unraveled, host Stephanie Kennan discusses the current appropriations battles, the timing of appropriations, and the process. You’ll learn about the hurdles in Congress to come to a consensus, and why you shouldn’t expect appropriations to be finished before Congress leaves for August recess.
Meet Your Host
Name: Stephanie Kennan
Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consu...
Nonprofit Hospitals and Tax Exemptions: What's at Stake
In this episode of Complications: Health Policy Unraveled, Stephanie Kennan discusses the tax exemption status of nonprofit hospitals, the legal requirements for tax exemption, and the recommendations made by the General Accounting Office regarding this issue. Despite the lack of clarity from Congress, scrutiny on tax exemption status may increase as the IRS responds to criticisms.
Meet Your Host
Name: 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...
Physician-Owned Hospitals: Politics and Policy
The debate on physician-owned hospitals is beginning again. Or maybe it never really stopped.
In the latest episode of Complications: Health Policy Unraveled, host Stephanie Kennan shares the history behind the creation of physician-owned hospitals, and the current effort to loosen restrictions through legislation while the administration wants to continue restrictions.
Meet Your Host
Name: 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 he...
Closing the Gap: CMS Strengthens Enforcement of Hospital Price Transparency
Healthcare is moving towards a more transparent future.
In this episode of Complications: Health Policy Unraveled, host Stephanie Kennan explores the latest updates in hospital price transparency efforts. Delve into the strengthened enforcement process by CMS, exploring new requirements for corrective action plans, changes in the imposition of civil monetary penalties, and streamlined compliance procedures.
Meet Your Host
Name: 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 i...
The 340B Drug Discount Program: A Healthcare Soap Opera
In this episode of Complications: Health Policy Unraveled, host Stephanie Kennan clarifies the complexities of the 340B Drug Discount Program, discussing its history, ongoing litigation, challenges from drug manufacturers and Congress, and its impact on healthcare providers serving low-income and uninsured patients.
Meet Your Host
Name: Stephanie Kennan
Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consulting
Specialty: Stephanie Kennan helps clients navigate the legislative and executive branches of federal government to solve problems involving a variety of healthcare policy issues. Her work focuses on providers, medical device manufacturers, drug m...
The Debt Ceiling Crisis: Unraveling Its Impact on Healthcare
In this inaugural episode of Complications: Health Policy Unraveled, host Stephanie Kennan discusses the federal debt ceiling and its potential impact on healthcare. As Congress battles over the debt ceiling, healthcare providers and investors hang in the balance, facing delayed payments and potential access issues, in a high-stakes political game with no clear path forward.
In this episode, we'll uncover the political dynamics surrounding the debt ceiling, evaluate competing budget cut proposals, and contemplate the possibility of a government default and its effects on healthcare services. Don't miss out on this crucial information as we navigate the...
Welcome to Complications: Health Policy Unraveled
Tired of being baffled by healthcare policy? McGuireWoods Consulting presents Complications: Health Policy Unraveled, your solution to the policy puzzle. With our host, Stephanie Kennan, discover the ins and outs of healthcare policy and gain insights crucial for providers and investors. Let's simplify the complex together.
Follow us in your favorite 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 mwcllc.com.
And, if you found this podcast valuable, please share it with your colleagues and leave us a revi...
