Federal Health Policy Update for March 21

The following is the latest health policy news from the federal government for March 15-21.  Some of the language used below is taken directly from government documents. The White House The White House has announced new actions to advance women’s health research and innovation and issued an executive order in support of that objective.  The order directs executive branch agencies to integrate women’s health across the federal research portfolio; prioritize investments in women’s health research; pursue new research on women’s midlife health; and assess unmet needs to support women’s health research.  Learn more from this White House fact sheet, which [...]

Providers Faring Well in Surprisingly Busy Dispute Resolution Process

Health care providers are winning more than three-quarters of all payment disputes being brought through an unexpectedly active federal Independent Dispute Resolution process. The process, created under the 2020 No Surprises Act to settle payment disagreements between providers and payers and to spare consumers surprise medical bills – especially for receiving emergency care from providers outside of their insurer’s network.  2023 saw 13 times more disputes during the first half of 2023 – nearly 300,000 cases in all – than federal officials anticipated. With more than 20 percent of the disputes submitted for resolution rejected as ineligible for the process, [...]

2024-02-20T21:23:48+00:00February 21, 2024|Uncategorized|

No Surprises Act Implementation Yields Mixed Results

Is the No Surprises Act working?  Is it protecting patients from surprise medical bills?  Are providers and insurers happy? The Washington Post reports mixed results. On one hand, millions of people have been protected from surprise medical bills. But on the other hand… Experts thought that once the terms of the program were understood there would be only about 22,000 cases sent to arbitration – the law’s Independent Dispute Resolution process – in 2022.  Instead, nearly 500,000 cases went that route, with nearly half of the requests for arbitration coming from physician staffing companies owned by private equity firms.  At [...]

2024-02-14T16:33:47+00:00February 14, 2024|Uncategorized|

States Not Depending on Federal Action on Prior Authorization

Unwilling to leave the challenge of addressing the troubling prior authorization practices of many health insurers, officials in some states are trying to take matters into their own hands. Last year, lawmakers in 29 states considered 90 different bills to impose varying prior authorization requirements on health insurers serving their constituents.  Among the changes these proposals seek:  shorter response times for requests for authorization and mandatory public reporting of insurers’ prior authorization activity.  In addition, last year five states required insurers to engage in a practice known as gold carding:  waiving prior authorization for requested items and services for individual [...]

2024-02-13T16:56:53+00:00February 14, 2024|Uncategorized|

Lack of Instructors Impedes Fixing Nurse Shortage

The current shortage of nurses across the U.S. can be traced in part to the lack of training opportunities for aspiring nurses and not to a lack of people seeking to pursue nursing as a career. Last year U.S. nursing programs rejected nearly 80,000 qualified applicants because they did not have the capacity train them. Driving this problem are three major challenges. First is the lack of nursing school faculty:  nearly 2000 full-time faculty positions remain unfilled, and many part-time positions as well, a problem caused by low salaries; working nurses often earn much more than nursing instructors.  Another complication:  [...]

2023-10-11T13:00:09+00:00October 11, 2023|Uncategorized|

CMS Warns States About Medicaid Renewals

Some states are falling short in their efforts to process Medicaid renewal applications and are inappropriately finding too many people ineligible to continue participating in the program, the Centers of Medicare & Medicaid Services has written in a letter it sent to all 50 states. In this letter, CMS wrote that As the Centers for Medicare & Medicaid Services (CMS) has worked with states on the return to regular eligibility operations following the end of the Medicaid continuous enrollment condition, we have identified issues where states are out of compliance with renewal requirements. CMS has worked with those states individually [...]

2023-09-05T06:00:57+00:00September 5, 2023|Uncategorized|

No Surprises Act’s Dispute Resolution Suspended

When a federal court in Texas rejected an increase in the fee for providers to initiate payment challenges under the No Surprises Act’s Independent Dispute Resolution process, the Centers for Medicare & Medicaid Services quickly suspended use of that process while it reviewed the court ruling – suspended both the adjudication of current complaints and the filing of new ones. Almost as quickly, CMS announced that it would reduce the fee required to initiate payment disputes between providers and payers under the 2020 law that sought to prevent surprise medical bills from $350 to $50 – but it did not [...]

2023-08-18T06:00:20+00:00August 18, 2023|Uncategorized|

No Surprises Act Arbitration Decisions Resume

After revising its guidelines on how certain medical fee disputes should be resolved, the Centers for Medicare & Medicaid Services has directed the Independent Dispute Resolution entities responsible for arbitrating fee disputes between payers and providers to resume making and issuing their decisions. After a February ruling in federal court that aspects of CMS’s implementation of the 2020 No Surprises Act contradicted the language of the act itself and unfairly favored payers over providers, CMS ordered a moratorium on new arbitration decisions for disputes filed on or after October 25, 2022 while it reviewed and revised its guidance on how [...]

2023-03-22T13:00:58+00:00March 22, 2023|Uncategorized|

Some Surprise Billing Dispute Decisions to Resume

The Independent Dispute Resolution entities empowered by the No Surprises Act of 2020 to adjudicate disagreements between providers and payers may resume their work – but only some of it. According to the Centers for Medicare & Medicaid Services, On February 24, 2023, certified IDR entities were instructed to resume processing payment determinations on February 27, 2023, for disputes involving items or services furnished before October 25, 2022. But CMS also announced that Certified IDR entities will continue to hold issuance of payment determinations that involve items or services furnished on or after October 25, 2022 until the Departments issue further [...]

2023-02-28T06:00:13+00:00February 28, 2023|Uncategorized|

Surprise Billing Law Stumbles in Court

A federal judge in Texas has vacated part of the arbitration process that is a major aspect of the No Surprises Act, the federal law enacted to reduce surprise medical bills.  In the wake of this ruling, the Department of Health and Human Services has directed the entities charged with mediating payment disagreements to stop making decisions. In the Texas case challenging the fairness of the independent dispute resolution process that is a key component of the surprise billing law’s implementation, the federal judge found that the arbitration process unfairly favored payers over providers, most notably by placing undue emphasis [...]

2023-02-14T06:00:22+00:00February 14, 2023|Uncategorized|
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