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2021 Biennial Report to Legislature and Governor

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2021 Biennial Report to Legislature and Governor May 2021 Prioritization of Health Services A Report to the Governor and the 81st Oregon Legislature HEALTH EVIDENCE REVIEW COMMISSION Acknowledgments Authors Jason Gingerich Ariel Smits, M.D., M.P.H. Others contributing to the report Liz Walker, Ph.D., M.P.H. Daphne Peck Contact person, information Jason Gingerich at [email protected] or 503-385-3594 421 SW Oak St., Suite 775 Portland, OR 97204 Health Evidence Review Commission Health Policy and Analytics Oregon Health Authority 2021 II Prioritization of Health Services Contents » Acknowledgments ................................................................................... II » Executive summary ................................................................................IV » Charge to the Health Evidence Review Commission ...............................1 » The prioritization methodology ................................................................3 » Biennial review of the Prioritized List ......................................................5 » Other biennial review changes .............................................................6 » Interim modifications to the Prioritized List ............................................7 » Recommendations ...................................................................................8 » Appendix A: Commission and subcommittee membership .....................9 » Health Evidence Review Commission members ....................................9 » Value-based Benefits Subcommittee members .................................. 10 » HERC staff ......................................................................................... 10 » Appendix B: Practice guideline changes ............................................... 11 » Changes related to inguinal hernias .................................................... 11 » Changes related to panniculectomy .................................................... 12 » Appendix C: Prioritized health services ................................................. 13 » Frequently asked questions: A user’s guide to the Prioritized List ........ 13 » Line descriptions for the “2022–23 Prioritized List of Health Services” ..................................... 16 » Statements of intent and guideline note descriptions for the “2022–23 Prioritized List of Health Services” .......................... 41 Appendix D: Evidence-based reports .................................................... 51 » Prioritization of Health Services III Executive summary The Health Evidence Review Commission (HERC) is charged by state statute to maintain the Prioritized List of Health Services. The Legislature uses this list to determine the Oregon Health Plan benefit package. HERC uses clinical effectiveness, cost-effectiveness and public input to rank combinations of conditions and treatments on the list by importance. The 2022–23 Prioritized List of Health Services (aka Prioritized List) in Appendix C shows the final rankings approved by HERC during its March 11, 2021 biennial review. The commission made the following biennial changes: • Developed new coverage indications for inguinal and femoral hernias. Previously, the surgeries for these hernias appeared on line 168 only with severe complications. The commission added coverage for inguinal and femoral hernias causing significant pain or functional limitations to line 168. All ventral hernias remain on line 524. • Combined two lines containing medical and surgical treatments for chronic pancreatitis. Previously, evidence did not support surgery for this condition. Newer evidence finds surgery can be effective in certain situations. These procedures were added to line 250. • Moved treatments for foreign bodies in nose and ear to a higher line. These services were below the 2020–21 funding line. They now appear on line 429. Conditions on this line are easily treated and prevent complications. • Moved Meniere’s disease to a lower priority line (line 527) given the lack of effective therapies. • Created a new line to encompass treatments for uterine polyps (line 421). Uterine polyps and uterine leiomyomas were previously listed together on line 404. However, the combined line contained procedures not appropriate for uterine polyps, such as a total hysterectomy. The creation of the separate line clarifies which procedures pair with which conditions. The commission also considered reprioritizing panniculectomy (a surgery to remove excess skin after significant weight loss) to a higher line. Ultimately, the commission did not make this change. Instead, it developed a new guideline for the existing line specifying coverage indications. This service remains on line 521. HERC appreciates the opportunity to continue its work on health care prioritization to provide the most beneficial, cost-effective services to Oregon’s Medicaid population. IV Prioritization of Health Services Charge to the Health Evidence Review Commission HB 2100 (2011) established the Health Evidence Review Commission (HERC) in part to: “[D]evelop and maintain a list of health services ranked by priority, from the most important to the least important, representing the comparative benefits of each service to the population to be served.” * As it performs this work, HERC must also: “[C]onsider both the clinical effectiveness and cost-effectiveness of health services, including drug therapies, in determining their relative importance using peer- reviewed medical literature…” † HERC is composed of 13 members appointed by the Governor and confirmed by the Senate: • Five physicians (including one doctor of osteopathy and one hospital-based physician) • Two consumer representatives • A public health nurse • A behavioral health representative • A dentist • A complementary and alternative medicine provider • A pharmacy representative, and • A health insurance representative. HERC relies heavily on input from its subcommittees and ad hoc advisory panels. HERC’s Value-based Benefits Subcommittee (VbBS) reviews all potential changes to the Prioritized List. VbBS includes both commission members and other provider and stakeholder representatives.‡ An Oral Health Advisory Panel, Behavioral Health Advisory Panel and Genetics Advisory Panel provide recommendations on the placement of new codes and issues specific to their areas of expertise. * Oregon Revised Statutes (ORS) 414.690(3). † Oregon Revised Statutes 414.690(4)(c). ‡ See Appendix A for a list of the commission and VbBS members Prioritization of Health Services 1 HERC’s Prioritized List consists of lines, each of which contains diagnosis and treatment codes representing the services on that line. The conditions on the list are represented by the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). Medical treatments are listed using codes from the American Medical Association’s Current Procedural Terminology (CPT), the American Dental Association’s Current Dental Terminology (CDT) and the Healthcare Common Procedure Coding System (HCPCS). Appropriate diagnostic services are covered under the Oregon Health Plan (OHP) whether or not the final diagnosis appears in the funded region of the Prioritized List. After a diagnosis is made, the list is used to determine whether further treatments are covered. Therefore, the list does not include diagnosis codes for signs and symptoms or procedure codes for diagnostic procedures. Palliative care is covered regardless of the underlying condition. The first of six statements of intent associated with the Prioritized List defines the palliative care benefit. Appropriate ancillary services are covered if the condition or the treatment is in the funded region. This includes items and services such as prescription drugs, durable medical equipment or removal of sutures. Ancillary service codes do not appear on the list due to the number of codes that would appear on most lines. In some cases, HERC has created guidelines for specific ancillary and diagnostic services to clarify its evidence-informed intent for coverage of these services. Some procedure codes represent services excluded from the list because they are not appropriate for coverage. These include codes for experimental treatments, travel vaccines, cosmetic services and other services not included in the Oregon Health Plan. Diagnosis codes that are non-specific or which do not identify a health condition or disease process are also often not included on the Prioritized List. The Oregon Health Authority’s Health Systems Division maintains electronic files to keep track of codes that are not on the list and to ensure appropriate fee-for-service reimbursement. OHP providers and contracted coordinated care organizations (CCOs) have web-based access to this information through the Medicaid Management Information System (MMIS). This ensures service coverage is as uniform as possible. HERC staff regularly consult with CCO medical directors and staff from the OHA’s Health Systems Division and Office of Actuarial and Financial Analytics to determine what effect prioritization changes might have on program cost and administrative burden. These entities share these findings with HERC during its decision-making process as appropriate. This information can also help plan the implementation of a list change, including any necessary changes to the CCO global budgets. 2 Prioritization of Health Services The prioritization methodology HERC continues to use the prioritization methodology in place since 2008. • Each line item
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