In addition to receiving several staff briefings on issues covered in its 2023 workplan, the Joint Commission on Health Care began to develop its study plan for 2024 at its October 18 meeting, approving several studies in concept in advance of reviewing formal study resolutions at a future meeting.
Obesity and eating disorders prevention and treatment: Staff briefed the Commission on the results of this study, which was directed by legislation in 2022. Staff was directed to examine the prevalence of obesity and eating disorders; identify evidence-based strategies for prevention, early identification, and treatment; determine the extent to which Medicaid and state-regulated health plans cover these services; and identify barriers for patients and families seeking treatment. Staff found that 34 percent of Virginians were obese in 2021, and that there was a large increase in the number of Medicaid members diagnosed with obesity between 2014 and 2021; however, coverage of treatment services (such as behavioral interventions, weight loss drugs, and bariatric surgery) varies, with Virginia’s Medicaid program generally providing some coverage for these services, while the state’s Essential Health Benefits benchmark plan (a set of benefits that comprehensive individual and small group health insurance coverage must provide) does not specify coverage for behavioral interventions, does not cover weight loss drugs, and does not cover bariatric surgery. Coverage of these services by health insurance plans varies.
Staff’s analysis of eating disorder prevalence and treatment options found that there was an increase in eating disorder cases within the Medicaid-covered population during the COVID-19 pandemic, with the largest increase among adults between 19-29 years of age. Eating disorders are difficult to diagnose, as individuals may also present with other mental health conditions, such as anxiety or depression. While most eating disorders can be treated in outpatient programs, access is limited by low reimbursement rates from commercial insurance and the lack of an established Medicaid rate specific to eating disorder services, as well as requirements for prior authorization by some health insurance carriers. A policy option proposed by staff was a directive to the Department of Medical Assistance Services to conduct a rate study to develop rates for residential, partial hospitalization, and intensive outpatient services for eating disorder treatment; another option was potential legislation to require all Medicaid managed care organizations and state-regulated health insurers to eliminate prior authorization for eating disorder services. Public comments on the study recommendations are due by November 3 and may be provided via email to firstname.lastname@example.org or via U.S. Mail to 411 E. Franklin Street, Suite 505, Richmond, VA 23219.
Prescription drug affordability: Staff provided information on the impact of prescription drug-related provisions in the Inflation Reduction Act (IRA) and the implications of recent federal litigation on state regulation of health plans that are governed by the Employee Retirement Income Security Act (ERISA). The Inflation Reduction Act requires manufacturers that raise drug prices faster than the rate of inflation (based on a reference price calculated by the Centers for Medicare and Medicaid Services) to pay rebates to Medicare; one expected effect of this requirement is that drug rebates for Medicaid will be reduced (because these rebates are based on average manufacturer prices, which are expected to decrease), but the full effect is still unclear. The IRA’s redesign of the Medicare Part D benefit is expected to affect a small number of Medicare beneficiaries who experience high prescription drug costs, but the savings will be significant for affected members. The IRA also allows Medicare to negotiate prices of certain drugs, which is expected to reduce the Medicare price of a limited subset of certain high-cost drugs, with negotiated prices for the first ten drugs selected for negotiations taking effect in 2026.
Planned studies for 2024: Members of the Commission’s Executive Subcommittee discussed a number of potential ideas for studies prior to the full Commission’s meeting. Study topics given preliminary approval by the full Commission for 2024 included a continued focus on the health care workforce; a comprehensive study of community health supports (to include community paramedicine, home visiting, supports for older adults to assist in aging in place, and supports for individuals with intellectual or developmental disabilities); a study of issues related to access to health care and social determinants of health; and a study of services for individuals in long-term care facilities with traumatic brain injuries.
The Commission’s next meeting is scheduled for November 13.
VACo Contact: Katie Boyle