The following is the latest health policy news from the federal government for March 31 – April 7. Some of the language used below is taken directly from government documents.
The White House
President Biden has signed an executive order calling for the modernization of the regulatory review process. Among other objectives, the order seeks to improve the effectiveness of the regulatory review process and promote inclusive regulatory policy and public participation. The order gives the Office of Management and Budget, through its Office of Information and Regulatory Affairs and in consultation with the Council of Economic Advisers and representatives of relevant agencies, one year to revise and update the regulatory review process. Find the executive order here.
Medicare Payment Regulations
- CMS has released its proposed Medicare inpatient rehabilitation facility (IRF) prospective payment system rule for FY 2024. The proposed rule calls for increasing IRF rates three percent and adjusting the outlier threshold to maintain outlier payments at three percent of total IRF payments. CMS also proposes permitting hospitals to open new IRF units at any time during the cost reporting period that would be paid under the IRF prospective payment system if the hospital notifies the CMS regional office and its Medicare Administrative Contractor (MAC) in writing at least 30 days before the date of the change and maintains the information needed to determine the costs attributable to the new IRF unit. The proposed rule also calls for changes in the IRF quality reporting program. Learn more about CMS’s proposed IRF payment rule for FY 2024 from this CMS fact sheet and from the proposed rule itself. The deadline for stakeholders to submit comments about the proposed rule is June 2.
- CMS has released its proposed skilled nursing facility (SNF) prospective payment system rule for FY 2024. The proposed rule calls for a 3.7 percent increase in SNF rates and changes in the SNF quality reporting and value-based purchasing programs, including a health equity adjustment in the latter. CMS also explains that it continues to study the question of establishing minimum direct care staffing requirements for SNFs and will address this issue in separate rulemaking in the spring. Learn more from this CMS fact sheet and a pre-publication version of the proposed rule. The deadline for stakeholders to submit comments is June 5.
- CMS has released its proposed Medicare inpatient psychiatric facility (IPF) prospective payment system rule for FY 2024. The proposed rule calls for a three percent rate increase for IPFs; a 1.1 percentage point increase in the labor-related share of payments, from 77.4 percent to 78.5 percent; regulatory changes that would enable hospitals to open and bill Medicare for new inpatient psychiatric distinct part units; changes in the IPF quality reporting program; and more. Learn about these and other changes from this CMS fact sheet and this pre-publication version of the proposed rule itself. Stakeholder comments are due by June 5.
- CMS has published its proposed Medicare hospice payment rates for FY 2024. The proposed rule calls for a 2.8 percent rate increase; changes in Medicare’s Hospice Quality Reporting Program; changes involving telehealth services at the expiration of the COVID-19 public health emergency; and measures to address fraud, waste, and abuse. Learn more from this CMS fact sheet and the proposed FY 2024 hospice payment update regulation. The deadline for stakeholder comments is May 30.
- CMS has released a final Medicare Advantage rule with contract year 2024 policy and technical changes to the Medicare Advantage program, Medicare prescription drug benefit program, Medicare cost plan program, and Program of All-Inclusive Care for the Elderly. Among other changes, the final rule seeks to prevent misleading marketing schemes by Medicare Advantage plans, Part D plans, and their downstream entities; remove barriers to care created by complex coverage criteria, utilization management, and prior authorization practices; expand access to behavioral health care; promote health equity; and implement a provision in the Inflation Reduction Act that seeks to improve access to affordable prescription drug coverage for low-income individuals. Learn more from this CMS news release; a CMS fact sheet; and this pre-publication version of the final rule itself. Most of the final regulation’s provisions take effect on June 5.
- CMS has published its final Medicare Advantage and Part D rates for calendar year 2024. The final rule includes a 3.32 percent rate increase – more than three times the 1.03 percent increase CMS originally proposed. Learn about the new rates and their underlying rationale and find information about other aspects of the final rule from this CMS fact sheet; a CMS news release; and CMS’s 2024 rate announcement.
Centers for Medicare & Medicaid Services
- CMS has posted an FAQ responding to questions about the status of COVID-19-related coverage and benefits established by the Families First Coronavirus Response Act and the CARES Act, such as diagnostic testing, vaccines, and preventive services, upon the anticipated expiration of the COVID-19 public health emergency after May 11. Find the FAQ here.
- CMS has posted a notice explaining a change in its Medicare hospital outpatient prospective payment system regarding average sale price calculations that takes effect on April 1. Find the notice here.
- CMS has issued a notice about new CLIA-waived tests approved by the FDA and the modifiers to be used when billing for these tests beginning in July. Learn more from this CMS notice.
- CMS has published a 2023 eligible measure applicability and denominator user guide for the quality performance category of its traditional merit-based incentive payment system (MIPS). This resource reviews the denominator reduction process available to clinicians, groups, virtual groups, and alternative payment model (APM) entities with fewer than six measures available for reporting traditional MIPS. Find the user guide here.
- Under an extension through calendar years 2025 to 2030, the Medicare Advantage Value-Based Insurance Design (VBID) Model will introduce changes intended to better address the health-related social needs of patients, advance health equity, and improve care coordination for patients with serious illness. Learn more about the changes to the model under this extension from this overview from CMS’s Center for Medicare and Medicaid Innovation.
- CMS has published new editions of MLN Connects, its online newsletter with information about Medicare reimbursement matters. The latest editions include new billing codes for recently authorized COVID-19 boosters for children ages six months to four years; a notice about discontinuing use of the CR modifier and DR condition code after the formal end of the COVID-19 public health emergency on May 11; fourth quarter PEPPERS (Program for Evaluating Payment Patterns Electronic Reports) for long-term-care hospitals, critical access hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, hospices, and skilled nursing facilities; and more. Find the two latest issues of MLN Connects here and here.
- CMS has published its 2024 Quality Rating System Measure Technical Specifications, which includes the measure specifications and guidelines for data collection for the 2024 quality rating system measure set. Qualified health plan issuers will need to reference this document to collect and submit quality rating system measure data to CMS in accordance with 2024 quality rating system requirements. Find the technical specifications document here.
- Various CMS regulations governing certain providers and certified suppliers require compliance with the 2012 edition of the National Fire Protection Association Health Care Facilities Code. A 2021 update permitted emergency power for essential electric systems to be supplied by sources other than a generator or battery system, including a health care microgrid system. Now, CMS has issued a categorical waiver permitting new and existing health care facilities subject to CMS requirements to use alternative sources of power other than a generator set or battery system only if in accordance with the 2021 edition of the code. CMS explains this categorical waiver in this agency memo to state survey agencies.
- CMS has posted a draft of its Quality Improvement Strategy Issuer List for the 2024 plan year. Find a link to it here.
Department of Health and Human Services
- HHS’s Office for Civil Rights has written to state health care officials to remind them of states’ obligations under federal civil rights laws to ensure that individuals and families continue to have access to Medicaid and Children’s Health Insurance Program (CHIP) coverage upon the expiration of the Families First Coronavirus Response Act continuous enrollment requirement. States are required to take reasonable steps to provide meaningful language access for individuals with limited English proficiency and ensure effective communication for individuals with disabilities. This letter explains these civil rights requirements and offers best practices. Find the letter here.
- HHS has released a national cancer plan developed by the NIH’s National Cancer Institute. Learn more about the plan and its objectives from this HHS news release and find the plan itself here.
- HHS and its Health Resources and Services Administration (HRSA) have awarded nearly $23 million to 46 grantees to plan and develop Teaching Health Center residency programs in community-based settings. The Teaching Health Center Planning and Development Program supports the planning and establishment of residency training programs in family medicine, internal medicine, pediatrics, internal medicine-pediatrics, psychiatry, obstetrics and gynecology, general dentistry, pediatric dentistry, and geriatrics. These planning grants will support the work of building a program, developing a training curriculum, recruiting clinical faculty, retooling workflow to integrate residents, and getting accredited. Learn more about the program and find a link to a list of grant recipients from this HHS news release.
- HRSA has published the weekly edition of HRSA eNews, its online newsletter. The latest edition includes information about a funding opportunity from the National Institute of Diabetes and Digestive and Kidney Diseases to support testing interventions that screen for and address social determinants of health during health care visits, other funding opportunities, and more. Find the newsletter here.
- HHS’s Agency for Healthcare Research and Quality has posted the latest edition of AHRQ News Now, its weekly online newsletter. This issue has features on nurse staffing gaps in hospitals, source materials for information on patient safety, and more. Find it here.
- HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) is inviting nominations from qualified organizations to be considered for non-voting liaison representative positions on a subcommittee of the Advisory Committee for Women’s Services focused on maternal mental health. This subcommittee will consist of five non-voting liaison representatives who are nominated by their organizations to serve as representatives of their organizations to advise the agency on appropriate activities to be undertaken to address women’s substance use and mental health services. Learn more about the committee, its scope of endeavor, the types of participants SAMHSA seeks, and how to submit nominations from this agency announcement, which includes a link to a Federal Register notice. The deadline for submitting nominations is April 10.
- HHS is seeking nominations to its Advisory Council on Alzheimer’s Research, Care, and Services. Learn more about the council, its responsibilities, the backgrounds it seeks in nominees, and how to submit nominations from this HHS notice, which includes a link to a Federal Register notice. The deadline for submitting nominations is April 28.
Provider Relief Fund
April 30 is the deadline for Provider Relief Fund participants to return any unused funds from their Phase 4 payments. Go here to learn more about Provider Relief Fund repayment and debt collection.
Federal Emergency Management Agency (FEMA)
While FEMA has been reimbursing some entities for emergency-related expenses associated with the COVID-19 public health emergency, it has announced that it will discontinue reimbursing costs through its public assistance program for work related to COVID-19 following the May 11 end of the formal public health emergency. Recognizing that costs may be incurred for demobilization, disposition, and disposal activities after the emergency work completion deadline, however, FEMA is providing a limited 90-day extension, to August 9, to complete demobilization, disposition, and disposal activities. Learn more from this FEMA memo to its regional administrators.
Food and Drug Administration
- The FDA has announced that it is requiring manufacturers of opioid analgesics dispensed in outpatient settings to make prepaid mail-back envelopes available to outpatient pharmacies and other dispensers as an additional opioid analgesic disposal option for patients. When implemented, outpatient pharmacies and other dispensers will have the option of ordering prepaid mail-back envelopes from opioid analgesic manufacturers, which they may then provide to patients prescribed opioid analgesics. The new policy also requires manufacturers to develop educational materials for patients on safe disposal of opioid analgesics. Learn more from this FDA news release.
- The FDA has announced that it has withdrawn its approval of the prescription drug Makena, which it previously approved to reduce the risk of preterm birth in pregnant women who have a history of spontaneous preterm birth. Learn more from this FDA news release.
CMS – Physicians, Nurses, and Allied Health Professionals Open-Door Forum – April 12
CMS will hold an open-door forum via conference call for physicians, nurses, and allied health professionals on Wednesday, April 12 at 2:00 (eastern). To view the meeting agenda and find information about how to participate in the call, go here.
HHS – Navigating Telehealth Legislative and Policy Changes – April 12
HHS will host a webinar on navigating telehealth legislative and policy changes beyond the public health emergency on Wednesday, April 12 at 3:00 (eastern). Go here to register to participate.
CMS – Comparative Billing Report on Urinalysis Laboratory Testing Webinar – April 12
Comparative Billing Report, a program created by CMS as an educational tool for providers and intended to enhance accurate billing and/or prescribing practices and support providers’ internal compliance activities, will hold a webinar on billing for urinalysis laboratory testing on Wednesday, April 12 at 3:00 (eastern). A Comparative Billing Report reflects a specific provider’s billing and/or prescribing patterns in comparison to peers’ patterns within a service area that may be prone to improper Medicare Part B payments. Each Comparative Billing Report is unique to a single provider, is disseminated only to that individual provider, and is not publicly available. Go here to learn more about Comparative Billing Reports and this webinar, to register to participate, and to obtain webinar handouts.
CMS – Skilled Nursing /Long-Term-Care Facility Open Door Forum – April 13
CMS will hold an open-door forum via conference call for skilled nursing and long-term-care facilities on Thursday, April 13 at 2:00 (eastern). To see the meeting agenda and learn how to participate in the call, go here.
MedPAC – Commissioners’ Meeting – April 13-14
MedPAC’s commissioners will hold their next public meeting on Thursday, April 13 and Friday, April 14. Go here to see the meeting agenda and to register to participate in the individual sessions.
MACPAC – Commissioners’ Meeting – April 13-14
MACPAC’s commissioners will hold their next public meeting on Thursday, April 13 and Friday, April 14. Go here to register to participate virtually in the meeting.
CMS – Medicaid and CHIP Continuous Enrollment Unwinding Webinar – April 26
CMS will hold a webinar on the unwinding of Medicaid and CHIP continuous enrollment and what providers need to know and how to prepare for that unwinding on Wednesday, March 22 at noon (eastern). During the webinar, CMS officials will review recently released CMS unwinding resources to help partners with their outreach efforts and respond to questions about Medicaid renewals and terminations, Medicaid to marketplace transitions, Medicaid to Medicare transitions, communication and outreach strategies, and more. Go here to register to participate. CMS will offer the same webinar on May 24 and June 28. Go here and scroll down for materials from previous webinars on Medicaid unwinding.
CMS Quality Conference – May 1-3
The 2023 CMS Quality Conference, “Building Resilient Communities: Having an Equitable Foundation for Quality Health Care,” will be held virtually on Monday, May 1 through Wednesday, May 3. The conference will feature expert speakers who will address improving quality, equity, and innovation and discuss how advocates, providers, researchers, and champions in health care quality improvement can develop and spread solutions to address America’s most pervasive health system challenges. Go here to learn more about the conference and how to register to participate.