The following is the latest health policy news from the federal government for April 18-24.  Some of the language used below is taken directly from government documents.

Congress

The House and Senate are in recess until April 28.  Upon their return to Washington D.C., committees will begin marking up reconciliation legislation for submission to their respective chambers’ budget committees by May 9.  The Energy and Commerce Committee is expected to mark up its bill, with $880 billion in cuts, the week of May 5.  The committee is expected to seek nearly $550 billion in cuts to Medicaid spending, with the most likely means for achieving those cuts to include:

  • work requirements for Medicaid eligibility
  • increased enforcement of Medicaid eligibility requirements
  • reducing the federal matching rate (FMAP) for the Medicaid expansion population
  • tightened limits on Medicaid provider taxes and state-directed payments
340B Drug Pricing Program

Senator Bill Cassidy, M.D. (R-LA), chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, has released a report presenting the findings from the committee majority staff’s investigation into how covered entities use and generate revenue from the 340B Drug Pricing Program.  The report notes that “… there are concerns about whether the 340B Program truly benefits low-income and uninsured patients, with some studies suggesting that the 340B benefit does not translate into increased care or lower costs for vulnerable populations.”  The report also outlines potential changes for improving the program to better serve patients, including requiring additional reporting on the use of 340B savings, scrutiny of contract pharmacy arrangements, and potential legislative changes to the definition of an eligible patient and the inventory replenishment model used by contract pharmacies.  Learn more from this news release and the full report “Congress Must Act to bring Needed Reforms to the 340B Drug Pricing Program.”

Centers for Medicare & Medicaid Services
  • CMS has filed a Paperwork Reduction Act request to extend without change Form CMS-460, which is the agreement physicians, suppliers, or their authorized officials sign to become participating providers in Medicare Part B.  The physician address information is used for publication in a Medicare participating provider directory, which CMS characterizes as an incentive for physician participation in the Medicare program.  Go here and click the link for two downloadable files.
  • CMS has posted a bulletin clarifying billing practices for patients transferring from a hospital or critical access hospital to the same facility’s psychiatric unit after an emergency department visit.  Find that bulletin here.
  • CMS has fined three PACE (Program of All-Inclusive Care for the Elderly) programs because they “failed substantially” to comply with the conditions of the PACE program or the terms of their PACE program agreement.  To find the notices go here and scroll down.
  • CMS has approved the following state plan amendments for Medicaid and CHIP programs.
    • To Minnesota, establishing the states’ annual inflationary increase to the Adult Crisis Stabilization rate.
    • To Kentucky, updating the Mobile Crisis Intervention reimbursement rate.
    • To Pennsylvania, establishing a new class of disproportionate share hospital (Medicaid DSH) payments to qualifying Medicaid-enrolled acute-care general hospitals to promote access to comprehensive inpatient services for Medicaid-eligible persons.
    • To Pennsylvania, making a technical change to update references to a 60-day postpartum period to a 12-month postpartum period.  This technical change reflects the coverage individuals are currently and have been receiving since April 1, 2022, when Pennsylvania opted to provide coverage for a 12-month postpartum period.
    • To Idaho, updating Core Set Reporting assurance language.
    • To Kansas, updating psychiatric collaborative care services.
    • To Kansas, allowing partial hospitalization programs and intensive outpatient treatment for mental health disorders related to eating disorder care.
    • To Rhode Island, modifying its medically needy income levels and confirming the new income standards for its optional state supplement program, beneficiaries of which are eligible for Medicaid under Rhode Island’s state plan.
    • To Louisiana, extending the temporary rates for intermediate care facilities for individuals with intellectual disabilities.
HHS Newsletters, Reports, and Videos
  • CMS – MLN Connects – April 24
  • AHRQ News Now – April 22
  • HRSA – Office for the Advancement of Telehealth – Announcements – April 22
Food and Drug Administration (FDA)

The FDA has issued alerts urging providers not to use certain catheters made by the companies BD and Conavi.  See the FDA alert about the BD product here and about the Conavi product here.

Congressional Research Service

The Congressional Research Service has published the report “Congressionally Directed Medical Research Programs Funding for Fiscal Year 2025:  Considerations for Congress.”  Find it here.

Stakeholder Events

CMS – CMS Quality Conference – July 1-2

CMS will hold a quality conference on Tuesday, July 1 and Wednesday, July 2.  Further information is not yet available but when it is it will be posted here and elsewhere.