The following is the latest health policy news from the federal government for August 11-24.  Some of the language used below is taken directly from government documents.

Centers for Medicare & Medicaid Services

  • After suspending the No Surprises Act-created Independent Dispute Resolution process in the wake of a court ruling striking down a recent increase in fees for that process, CMS has established a new rate structure for initiating the adjudication of payment disagreements between providers and payers.  It explains the new rate structure in this new FAQ, which nevertheless notes that despite the creation of new rates, the Independent Dispute Resolution process remains suspended until further notice.
  • CMS has updated the ICD-10 MS-DRG grouper version 41 with changes that will take effect on October 1.  Go here for further information, additional resources, and links to downloads.
  • CMS has posted a brief animated explainer video, “Social Determinants of Health Items:  Determining When a Proxy Response is Allowed,” to help home health, hospice, and long-term-care hospitals determine when the use of a proxy response is permitted for the following social determinants of health items:  A1005 – ethnicity; A1010 – race; A1110 – language; A1250 – transportation; B1300 – health literacy; and D0700 – social isolation.  Find the video here.
  • CMS has released a new toolkit for increasing access, quality, and equity in postpartum care in Medicaid and CHIP.  This toolkit provides information to help state Medicaid and CHIP agencies maximize the use of existing authority to increase postpartum care access, quality, and equity for Medicaid and CHIP beneficiaries and includes a strategy checklist and suggestions for partnering with Medicaid and CHIP managed care plans to implement quality improvement strategies.  Find the toolkit here.
  • CMS has published a Request for Applications detailing model payment, care delivery, quality, and other policies for its new Making Care Primary Model.  This model seeks to strengthen coordination between patients’ primary care clinicians, specialists, social service providers, and behavioral health clinicians to drive improved chronic disease prevention, fewer emergency room visits, and better health outcomes.  The model will launch in July of 2024 in Colorado, North Carolina, New Jersey, New Mexico, New York, Minnesota, Massachusetts, and Washington and operate over a ten-year period.  Go here to see the Request for Applications.
  • CMS’s Center for Medicare and Medicaid Innovation has announced changes in its Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model starting in performance year 2024.  Among the changes, the program will require fewer model participants and establish a buffer to accommodate temporary variations in enrollment; expand its definition of what constitutes a high medical needs population; change its risk adjustment methodology; and revise the health equity benchmark payment criteria by introducing a new methodology for identifying underserved beneficiaries living in high cost-of-living areas.  Learn about these and other changes for 2024 from this introduction to the changes and this more detailed description.
  • CMS has released draft guidance for comment on a new Medicare Prescription Drug Payment Plan that would give seniors with Medicare prescription drug coverage (Medicare Part D) the option of paying out-of-pocket costs in monthly payments spread out over the year beginning in 2025.  The draft guidance provides information on identifying Medicare Part D enrollees likely to benefit from the program, the opt-in process for Part D enrollees, program participant protections, and the data collection needed to evaluate the program.  Additional draft guidance will be released for comment in early 2024 and will focus Medicare Part D enrollee outreach and education, Medicare Part D plan bid information, and monitoring and compliance.  Learn more about the proposed Medicare Prescription Drug Payment Plan from this CMS news release; a CMS fact sheet; a timeline of CMS’s plan for developing, introducing, and implementing the plan; and the draft guidance itself.  Stakeholder comments are due by September 20.
  • CMS has issued a memo to state Medicaid programs advising them that the Consolidated Appropriations Act of 2023 requires state Medicaid agencies to apply the spousal impoverishment rules to married applicants and beneficiaries eligible for home- and community-based services (HCBS) through September 30, 2027.  Learn more from this CMS memo.
  • CMS has issued a memo to state Medicaid programs to provide guidance on claiming federal financial participation (FFP) for Medicaid managed care expenditures through capitation payments.  In certain circumstances, the memo explains, a portion of a capitation payment should be matched with FFP at a “differential match rate” that varies from the standard Federal Medical Assistance Percentage (FMAP) for each state.  Learn more about the potential implications for the funding of state Medicaid programs from the CMS memo to state Medicaid programs.
  • HHS’s Office of the Inspector General has issued an unfavorable opinion about a company’s proposal to assist physicians who perform surgeries for which the company’s services are used with the formation and operation of a turnkey physician-owned entity that would perform those same services.  Find the opinion here.
  • HHS’s Office of the Inspector General has updated its work plan of current and upcoming audits and reviews.  Find the recently added items here and learn about the overall work plan here.
  • CMS has released a quarterly update for clinical laboratory fee schedule and laboratory services subject to reasonable charge payment.  Find the update here.  The update takes effect on October 1.
  • New CMS policies and safeguards seek to quickly identify and take action against hospices engaged in fraud, waste, and abuse and to ensure that hospices are providing critical, quality care to their patients.  In response to published reports about troubling practices in some hospice programs, the agency conducted 7000 unannounced visits of such programs and has informed 400 of those its inspectors visited that they face potential action, including possible revocation of their Medicare billing privileges, if they do not correct the problems CMS identified.  CMS outlines its recent efforts and previews upcoming initiatives in the latest entry on the CMS blog.
  • CMS has posted a video that highlights the 2022 targeted review submission process for its Merit-Based Incentive Payment System (MIPS) program.  The video addresses targeted reviews and explains how to request and monitor a targeted review.  Find the video here.
  • CMS has posted a list of the 2023 Qualified Clinical Data Registries for its MIPS program.  Go here and scroll down to “Full Resource Library” and then to “Qualified Clinical Data Registries (QCDRs) Qualified Posting” for this direct download file.
  • CMS has posted a list of the 2022 Qualified Registries for its MIPS program.  Go here and scroll down to “Full Resource Library” and then to “Qualified Registries Qualified Posting” for this direct download file.
  • CMS has posted a document that includes information on the amount of Advanced APM incentive payments that were paid to eligible clinicians this year based on their participation in Qualifying APM Participant Performance Period 2021.  Go here and scroll down to “Full Resource Library” and then to “Advanced Alternative Payment Model (APM) Incentive Payments for 2023” for this direct download file.

Department of Health and Human Services

  • HHS and its Health Resources and Services Administration (HRSA) have awarded more than $100 million in grants to train more nurses and address the increasing demand for registered nurses, nurse practitioners, certified nurse midwives, and nurse faculty.  The grants focus, in particular, on three priorities:  helping licensed practical nurses become registered nurses; training nurses who will deliver primary care, mental health care, and maternal health care; and addressing bottlenecks in nurse training by supporting more nurse faculty.  Learn more about the grant funding and its objectives and find a link to a list of grant recipients from this HHS news release.
  • HHS and its Substance Abuse and Mental Health Services Administration (SAMHSA) have awarded more than $64 million in grants to address the nation’s mental health crisis.  Among the awards are more than $59 million in new funding to states and territories through the Community Mental Health Services Block Grant program and more than $5 million for Mental Health Awareness Training grants to prepare individuals and communities to respond appropriately and safely to persons with mental health challenges and/or disorders.  Learn more about the grants and their intended use and find links to lists of recipients from this HHS news release.
  • HHS and SAMHSA have awarded nearly $89 million in grants to seven different federal programs that seek to address behavioral health and substance use disorders among young people.  Learn more about the grant funding and the individual grant programs and find links to lists of grant recipients from this HHS news release.
  • SAMHSA seeks applications from qualified individuals or organizations to be considered for non-voting representative positions on the Maternal Mental Health Task Force subcommittee of its Advisory Committee for Women’s Services.  Learn more about the committee and its work, the background it seeks in prospective members, and how to apply to participate from this CMS announcement.  The deadline for application is September 22.
  • HHS and its Administration for Strategic Preparedness and Response (ASPR) have awarded more than $1.4 billion for Project NextGen to support the development of a new generation of tools and technologies to protect against COVID-19 in the future.  The $1.4 billion in grants includes $1 billion for four Biomedical Advanced Research and Development Authority (BARDA) clinical trial partners to support vaccine Phase IIb clinical trial studies and more than $300 million for the development of a next-generation monoclonal antibody for COVID-19 prevention.  Learn more about the funding and how it will be used from this HHS news release.

HHS Newsletters

Food and Drug Administration

The FDA has approved the first vaccine for use by pregnant individuals to prevent lower respiratory tract disease and severe respiratory tract disease caused by respiratory syncytial virus (RSV) in infants from birth through six months of age.  Learn more about the approval and the FDA’s reasoning behind it from this FDA news release.

Centers for Disease Control and Prevention

  • The CDC has launched the “Hospital Sepsis Program Core Elements” program to help hospitals ensure that effective teams and resources are in place to be able to quickly identify sepsis and save more lives.  This new resource is intended to help hospitals implement, monitor, and optimize sepsis programs and improve survival rates.  Learn more about the program from this CDC news release and go here for more detailed information about the program.
  • The CDC has updated its guidance for health care professionals who are caring for people in community settings under isolation with COVID-19.  This updated guidance reflects new recommendations for isolation and precautions for people with COVID-19.  Learn more from this updated CDC guidance.
  • Twenty percent of women surveyed reported experiences of mistreatment during pregnancy and delivery care, according to a new CDC report.  Reported mistreatment during maternity care was higher among Black (30 percent), Hispanic (29 percent), and multiracial (27 percent) women while women with no insurance (28 percent) or public insurance (26 percent) at the time of delivery experienced more mistreatment during maternity care than women with private insurance (16 percent).  Learn more from this CDC news release and the full CDC report.

Government Accountability Office

The GAO has published a study on trauma-informed care and the challenges to developing and implementing performance partnership pilots to serve children.  Find the study here.

Stakeholder Events

CMS – SNF QRP Listening Session – August 29

On behalf of CMS, Acumen LLC is hosting a virtual listening session to seek feedback from skilled nursing facility administration and management staff, software vendors, and clinical staff on the expansion of collection and submission of Minimum Data Set assessment data used for the Skilled Nursing Facility Quality Reporting Program to include all residents receiving short-term skilled care in a skilled nursing facility regardless of their payer.  This event will be held on Tuesday, August 29 at noon (eastern).  Go here (and scroll down) for further information about the listening session and to register to participate.

HHS – Health Resources and Services Administration – Advancing Health Equity Among Hispanic/Latino Populations – August 29

HRSA will hold its fourth webinar in its Advancing Health Equity among Hispanic/Latino Populations series on Tuesday, August 29 at 1:00 (eastern).  The webinar will highlight strategies to increase the Hispanic/Latino health workforce, and presenters will discuss HRSA’s programs and resources to support individuals across diverse health workforce settings and disciplines, including physicians, nurses, and community health workers.  For more information about the webinar, including how to register, go here.

CDC – Prevention and Treatment of Flu in Children – August 31

The CDC will hold a webinar for clinicians during which it will present an overview of influenza prevention and treatment recommendations for the 2023–2024 season from the American Academy of Pediatrics on Thursday, August 31 at 2:00 (eastern).  Continuing education credits are available.  Go here for a link to the webinar.

 MedPAC – Commissioners’ Public Meeting – September 7 and 8

Members of the Medicare Payment Advisory Commission will hold their next public meeting on Thursday, September 7 and Friday, September 8.  Meeting times and locations and remote participation information is not yet available, but when it is it will be posted here.

HHS – HRSA – National Telehealth Conference – September 12

HHS’s Health Resources and Services Administration (HRSA) will host a virtual National Telehealth Conference that brings public and private sector leaders together to discuss telehealth best practices, including balancing telehealth solutions and in-person services.  The conference, to be held on Tuesday, September 12, will examine the importance of integrating telehealth into standard care.  Go here to learn more about the conference and to register to participate.

DEA – Listening Session on the Remote Prescribing of Controlled Substances – September 12-13

The Drug Enforcement Administration will conduct public listening sessions to receive input from stakeholders about the practice of telemedicine involving controlled substances and potential safeguards that could effectively prevent and detect diversion of controlled substances prescribed via telemedicine.  The listening sessions will be held on Tuesday, September 12 and Wednesday, September 13 at 9:00 (eastern) at DEA headquarters in Arlington, Virginia and also will stream live online.  Learn more about the sessions and how to participate from this DEA announcement, which includes a link to a Federal Register notice.

Agency for Healthcare Research and Quality – CAHPS Program – September 13

HHS’s Agency for Healthcare Research and Quality (AHRQ) will hold a webinar on about how its Consumer Assessment of Healthcare Providers and Systems (CAHPS) program is addressing stakeholders’ emerging needs for patient experience measurement and improvement.  Speakers will discuss recent survey updates, the development of new surveys to address current information needs and the use of survey results to improve patient experience.  The webinar will be held on Wednesday, September 13 at noon (eastern).  Go here to learn more about the webinar and to register to participate.

MACPAC – Commissioners’ Public Meeting – September 21-22

Members of the Medicaid and CHIP Payment and Access Commission (MACPAC) will hold their next public meeting on Thursday, September 21 and Friday, September 22.  Meeting times and locations and remote participation information is not yet available, but when it is it will be posted here.

CMS – Medicaid and CHIP – September 27 (and future dates)

HHS and CMS host a series of monthly webinars on Medicaid and CHIP renewals to educate partners.  Topic covered vary each month.  Go here to register for upcoming webinars, please click here.

  • September 27 at 12:00 pm (eastern)
  • October 25 at 12:00 pm (eastern)
  • December 6 at 12:00 pm (eastern)

Recordings, transcripts, and slides from past webinars can be found on the CMS National Stakeholder Calls webpage.

CMS – Burden Reduction Conference – November 15

CMS will convene leadership from the federal government, health provider organizations, and the patient advocacy community to focus on opportunities across the health care enterprise to reduce administrative burden, strengthen access to quality care, and make it easier for clinicians to provide that care during a day-long virtual conference it will hold on Wednesday, November 15 beginning at 9:00 (eastern).  Go here to learn more about the conference and find a link for registration.