The following is the latest health policy news from the federal government for July 29-August 3.  Some of the language used below is taken directly from government documents.

Medicare Payment Regulations

  • CMS has issued a final rule updating Medicare payment policies and rates for inpatient and long-term-care hospital services under its inpatient prospective payment system and long-term care prospective payment system for FY 2024.  The final rule increases hospital inpatient rates 3.1 percent and LTCH rates 3.3 percent in FY 2024.  Other highlights include a nearly $1 billion cut in Medicare disproportionate share (Medicare DSH) and Medicare DSH uncompensated care payments; changes in diagnosis codes and health equity hospital categorizations to address health equity and a program that will pay bonuses to hospitals that provide excellent care to especially large numbers of dually eligible (Medicare and Medicaid) patients; continuation of Medicare’s low-wage hospital policy and changes in its rural wage index calculation methodology; and more.  Learn about these and other aspects of the final FY 2024 inpatient prospective payment system and long-term care prospective payment system from this CMS news release; a CMS fact sheet; and a pre-publication version of the final rule.
  • CMS has issued a final rule updating Medicare payment policies and rates for skilled nursing facilities under its skilled nursing facility prospective payment system for FY 2024.  The final rule calls for a four percent increase in skilled nursing facility rates; updates of the skilled nursing facility quality reporting program and value-based purchasing program, including a health equity scoring adjustment and potential payment bonus in the latter; and an adjustment of its PDPM case-mix classification system.  Learn more about these and other changes from this CMS news release and this pre-publication version of the final rule.
  • CMS has issued a final rule updating Medicare hospice payments for FY 2024 and other aspects of how it governs hospice services.  The final rule increases hospice payments 3.1 percent; finalizes a proposal that physicians who certify patient eligibility for hospice services must be enrolled in Medicare or validly opted out as a prerequisite for payment for the hospice period of care in question; offers an update on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey mode experiment; and more.  Learn more from this CMS news release and this CMS announcement about the final rule, which includes a link to a Federal Register notice.


Centers for Medicare & Medicaid Services

  • CMS has issued an advisory to alert certain clinicians who are qualifying Alternative Payment Model (APM) participants and eligible to receive an APM incentive payment that CMS does not have the current billing information needed to disburse their payment.  This advisory provides information to these clinicians on how to update their billing information to receive this payment.  Learn more from this CMS notice.  The deadline for submitting the needed information to receive the payments is September 1.
  • CMS has issued new guidance to state Medicaid programs as they work to return to normal operations after the end of the flexibilities available to support states and beneficiaries during the COVID-19 public health emergency.  Specifically, this guidance announces an update of CMS’s policy regarding the end date for flexibilities approved in states’ section 1915(c) Home and Community-Based Services waiver Appendix K amendments.  Under CMS’s prior policy, these flexibilities were set to expire six months after the expiration of the COVID-19 public health emergency, but in this letter CMS explains that these flexibilities may remain in effect for a longer period of time.  Learn more from this guidance letter from CMS to state Medicaid programs.
  • CMS and its Center for Medicare and Medicaid Innovation will launch a new “Guiding an Improved Dementia Experience (GUIDE) Model” that seeks to improve the quality of life for people living with dementia, reduce strain on unpaid caregivers, and help people remain in their homes and communities through a package of care coordination and management, caregiver education and support, and respite services.  Through the GUIDE Model, CMS will test an alternative payment for participants that deliver key supportive services to people with dementia.  Under the model, people with dementia and their caregivers will have access to a care navigator who will help them obtain services and supports, including clinical services and non-clinical services.  CMS will release an application for GUIDE, which will be a voluntary, nation-wide model, this fall.  Prior to the application release, interested organizations are encouraged to submit letters of intent to CMS by September 15.  The model will run for eight years beginning July 1, 2024.  Learn more from this CMS news release; the agency’s GUIDE Model Fact Sheet; and the GUIDE Model webpage, which includes information about submitting letters of intent.  CMS’s Center for Medicare and Medicaid Innovation also will hold a webinar on the GUIDE Model on Thursday, August 10; go here for further information and to register.
  • CMS has updated the Electronic Clinical Quality Improvement (eCQI) Resource Center Value Set Information.  It also has posted new value set review and maintenance guidance on the Value Set Information page.  The information provides guidance for creating, reviewing, and maintaining value sets on the Value Set Authority Center (VSAC).  This new guidance includes information and recommendations on frequency of value set maintenance review, VSAC’s review and maintenance statuses, determining value set use, and considering transfer of stewardship, value set grouping and member review, and value set expansions in relation to maintenance status.
  • CMS and its eCQI Resource Center team seek to improve their users’ experience by establishing a user group to provide feedback on web site functionality and content improvements and is asking for participants to serve on such a group.  Learn more about what the eCQI Resource Center seeks to do, the commitment it seeks from participants in its new user group, and when the group’s meetings will be held from this web site user group notice.
  • CMS has shared its response a May 2023 data breach in Progress Software’s MOVEit Transfer software on the corporate network of Maximus Federal Services, Inc. (Maximus), a contractor to the Medicare program, that involved Medicare beneficiaries’ personally identifiable information and/or protected health information.  CMS and Maximus are sending letters to individuals who may have been affected, notifying them of the breach and explaining actions being taken in response.  CMS estimates the MOVEit breach affected approximately 612,000 current Medicare beneficiaries.  Learn more about this situation and CMS’s response from this CMS news release.
  • CMS has released calendar year 2024 Medicare Part D premium and bid information.  This annual release provides information to help Part D plan sponsors finalize their offerings and helps individuals understand overall Part D premium trends ahead of Medicare open enrollment. According to CMS, the average total monthly Part D premium is projected to decrease from $56.49 in 2023 to $55.50 in 2024.  Learn more from this CMS fact sheet and from additional supporting data.
  • CMS has posted four new resources for participants in its MIPS Value Pathway (MVP) program:
  • 2023 MVP Registration Form and Fact Sheet. This zip file includes the 2023 MIPS MVP Registration Form and a related fact sheet.  The fact sheet reviews the process for MVP registration, and subgroup registration if applicable, for the 2023 performance year, along with frequently asked questions about registration and next steps.
  • MIPS Reporting Options Comparison Resource.  This document discusses the three MIPS reporting options available to MIPS eligible clinicians to meet MIPS reporting requirements.
  • 2023 CAHPS for MIPS Survey Overview Fact Sheet.  This document is a fact sheet that provides an overview of the 2023 Consumer Assessment of Healthcare Providers and Systems (CAHPS) for the MIPS Survey.
  • MVPs Subgroup Participation Examples.  This resource provides examples of how a practice could choose to report a MIPS MVP for the 2023 performance year, including the new subgroup participation option available for the MVP reporting option.

These documents are all available as direct downloads; find them here.

Department of Health and Human Services

  • HHS has established a new Office of Long COVID Research and Practice, which will be charged with implementation of the National Research Action Plan on Long COVID, promotion of the Services and Supports for Longer-Term Impacts of COVID–19, and coordinating the whole-of-government response to the longer-term effects of COVID–19, including Long COVID and associated conditions.  Learn more from this HHS announcement.
  • Amid growing use of telehealth during the COVID-19 public health emergency, HHS’s Office of the Inspector General conducted an audit to determine, for end-stage renal disease-related telehealth services provided during the pandemic, what information on telehealth services was documented in medical records and whether the claims for such services met certain Medicare requirements.  Learn more about the audit, why it was performed, and what it found in the HHS OIG report “Telehealth During 2020 Helped Ensure End-Stage Renal Disease Patients Received Care, But Limited Information Related to Telehealth Was Documented” or see a summary of that report.
  • HHS’s Administration for Strategic Preparedness and Response has update the document “CMS Emergency Preparedness Rule Integrated Healthcare Systems Implications,” which outlines the information available to health care system emergency planners about the integrated health care system requirements in the final CMS Emergency Preparedness Rule.  It includes excerpts from and links to legal language and input from experts regarding their experience organizing emergency preparedness programs for integrated health care systems.  Find the document here.

HHS Newsletters

National Institutes of Health

  • The NIH has launched and is opening enrollment for phase 2 clinical trials that will evaluate at least four potential treatments for long COVID, with additional clinical trials to test at least seven more treatments expected in the coming months.  Treatments will include drugs, biologics, medical devices and other therapies.  The trials are designed to evaluate multiple treatments simultaneously to identify more swiftly those that are effective.  Learn more from this NIH news release.
  • The NIH’s National Library of Medicine has published “Early Financial Impact of the COVID-19 Pandemic on U.S. Hospitals,” which shares findings from research that sought to analyze how hospital profitability changed during the first year of the pandemic.  It specifically studied the association between COVID-19 infections and hospitalizations and county-level variables with operating margins and total margins.  Find the article here.

Food and Drug Administration

  • The FDA has published an open letter (“Dear Americans”) outlining what it is doing to resolve the shortages of prescription stimulant medications:  drugs that play a role in the treatment of conditions such as attention-deficit/hyperactivity disorder (ADHD), binge eating disorder, and uncontrollable episodes of deep sleep (narcolepsy).  Find that letter here.
  • The FDA has approved RiVive, a naloxone hydrochloride nasal spray, for over-the-counter, non-prescription use for the emergency treatment of known or suspected opioid overdose.  This is the second non-prescription naloxone product the agency has approved.  The timeline for availability and the price of this non-prescription product will be determined by the manufacturer.  Learn more from this FDA news release.


Stakeholder Events

HHS – CMS – Medicaid and CHIP Renewal Webinars for Special Populations – August 8-24

CMS will hold a series of Medicaid and Children’s Health Insurance Program (CHIP) renewals webinars that focus on special populations.  This webinar series will seek to provide partners with strategies to reach out to diverse communities and audiences to share information about Medicaid and CHIP renewals. Each webinar will include a “train-the-trainer” presentation during which CMS will present a set of downloadable slides that partners can use to educate others in their communities about Medicaid and CHIP renewals.  Below is a list of the upcoming webinars, all of which will be held at 3:00 (eastern).  Go here to register for any or all of them:

  • Tuesday, August 8:  Reaching Hispanic and Latino Populations
  • Thursday, August 10:  Reaching Black American Populations
  • Thursday, August 17:  Reaching Aging and Disability Populations
  • Thursday, August 24:  Reaching Rural Populations

CMS – Center for Medicare and Medicaid Innovation – Guiding and Improved Dementia Experience (GUIDE Model) Webinar – August 10

CMS’s Center for Medicare and Medicaid Innovation will host a webinar on Thursday, August 10 at 2:00 (eastern) to provide more information on the Guiding and Improved Dementia Experience (GUIDE Model).  During the webinar, the GUIDE Model team will discuss the goals of the model, participant and beneficiary eligibility criteria, care delivery requirements, and model payment.  Go here to learn more and register.

HHS – Bureau of Primary Care – Contextualizing Our Understanding of Mental Health and Substance Use – August 10

In this webinar, to be held on Thursday, August 10 at 2:00 (eastern), the Health Resources and Services Administration’s Bureau of Primary Care will describe a contextual framework for understanding mental and substance use conditions supporting person-centered/culturally relevant care.  Go here to register to participate.

CMS – Medicare-Medicaid Coordination Office – Promising Practices for Utilizing Motivational Interviewing to Improve Care Coordination and Address Social Determinants of Health – August 17

CMS will hold a webinar on “Promising Practices for Utilizing Motivational Interviewing to Improve Care Coordination and Address Social Determinants of Health” on Thursday, August 17 at 2:00 (eastern).  This webinar will explore how motivational interviewing can improve communication in integrated care settings and improve relationships between health plans, providers, and individuals dually eligible for Medicare and Medicaid.  Speakers will share information about prioritizing person-centered motivational interviewing approaches, with a focus on addressing social determinants of health, to improve member self-efficacy and outcomes for dually eligible individuals.  For more information and to register to participate, go here.

CMS – Advisory Panel on Hospital Outpatient Payment – August 21-22

CMS’s Advisory Panel on Hospital Outpatient Payment will meet virtually on Monday, August 21 and Tuesday, August 22 at 9:30 (eastern) on both days.  The purpose of the panel is to advise CMS on the clinical integrity of the Ambulatory Payment Classification groups and their associated weights, which are major elements of the Medicare hospital outpatient prospective payment system and the ambulatory surgical center payment system.  Interested parties may contact the panel about submitting letters and comments to be added to the meetings’ agenda.  Learn more, including how to participate, from this CMS notice, which also lists the panel’s members, including recent appointees.

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.

HHS – Health Resources and Services Administration – 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.