The following is the latest health policy news from the federal government for August 25-31.  Some of the language used below is taken directly from government documents.

No Surprises Act

For the second time in less than a month a court has rejected how federal agencies are implementing the Independent Dispute Resolution process of the No Surprises Act.  A federal court concluded that the process for establishing the Qualifying Payment Amount, or QPA – the median rate insurers pay for in-network services and a critical factor in settling payment disputes – inappropriately permits insurers to depress that rate and unfairly favors payers over providers.  Learn more about this latest setback to implementation of the No Surprises Act, which was already suspended after another federal court ruling in early August and remains suspended today, from the federal court decision.

Centers for Medicare & Medicaid Services

  • CMS has sent a letter to all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands requiring them to determine whether they have an eligibility systems issue that could cause people, especially children, to be disenrolled from Medicaid or CHIP even if they are still eligible for coverage and requiring them to act immediately to correct the problem and reinstate coverage.  Specifically, CMS is concerned about how some states are performing auto-renewals, also often referred to as ex parte renewals.  If CMS informs a state that it has a problem with this process, the state must immediately take the following steps to avoid CMS taking action to bring it into compliance:  pause procedural disenrollments for those individuals affected; reinstate coverage for all affected individuals; implement one or more CMS-approved mitigation strategies to prevent continued inappropriate disenrollments; and fix systems and processes to ensure that renewals are conducted appropriately and in accordance with federal Medicaid requirements.  Learn more about CMS’s action from this agency news release; the letter it sent to the states; and a mitigation template for ex parte renewal compliance issues.
  • CMS has published a final rule establishing requirements for mandatory annual state reporting of the Core Set of Children’s Health Care Quality Measures for Medicaid and the Children’s Health Insurance Program, the behavioral health measures on the Core Set of Adult Health Care Quality Measures for Medicaid, and the Core Set of Health Home Quality Measures for Medicaid.  Learn more about the core sets and their purpose and the specific data reporting requirements from this CMS announcement, which includes a link to a Federal Register notice.
  • CMS has posted a bulletin summarizing changes it has adopted in the Medicare inpatient psychiatric facilities prospective payment system that will take effect in FY 2024 (beginning on October 1, 2023).  Find the bulletin here.
  • CMS has posted a bulletin describing changes to the laboratory national coverage determination (NCD) edit software that will take effect on January 1, 2024.  Find the bulletin here.

Department of Health and Human Services

  • HHS has announced the first ten drugs covered under Medicare Part D selected for negotiation under a process established in the 2022 Inflation Reduction Act.  The negotiations with participating drug companies will take place in 2023 and 2024, with any negotiated prices to take effect beginning in 2026.  The negotiation process will consider each selected drug’s clinical benefit, the extent to which it fulfills an unmet medical need, and its impact on people who rely on Medicare, among other considerations, such as costs associated with research and development as well as production and distribution for the selected drugs.  The selected drugs are Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and the diabetes products Fiasp; Fiasp FlexTouch; Fiasp PenFill; NovoLog; NovoLog FlexPen; and NovoLog PenFill.  Learn more from the following resources:
  • The White House has announced that as part of Overdose Awareness Week it is awarding $450 million in grants to strengthen prevention, harm reduction, treatment, and recovery support services and crack down on illicit drug trafficking.  The new spending includes:
    • $20.5 million from the White House Office of National Drug Control Policy for 164 new Drug-Free Communities Support Program awards.
    • $1 million, also from the White House Office of National Drug Control Policy, for that office’s Real Deal on Fentanyl campaign with the Ad Council.
    • $18.9 million from the White House Office of National Drug Control Policy in FY 2023 discretionary funding for its High Intensity Drug Trafficking Areas Program, adding to the more than $275 million provided in base funding released earlier this year.
    • $279 million from the CDC in Overdose Data to Action grants to states and localities to expand harm reduction strategies, link people to care, and make the latest data available so authorities can get ahead of the constantly evolving overdose crisis.
    • $80 million from the Health Resources and Services Administration (HRSA) to rural communities in 39 states to support strategies to respond to the overdose risk from illicit fentanyl and other opioids.
    • $57.6 million from the Substance Abuse and Mental Health Services Administration (SAMHSA) to connect Americans to substance use treatment and recovery support services, including $1.7 million to the Comprehensive Opioid Recovery Centers Program; $29.6 million to the Promoting the Integration of Primary and Behavioral Health Care Program; $1.2 million to the Recovery Community Services Program; $735,000 to the Recovery Community Services Program-Statewide Network Program, which strengthens community-based recovery organizations, their statewide networks of recovery stakeholders and specialty and general health care systems as key partners in the delivery of state and local recovery support services through collaboration, systems improvement, public health messaging and training conducted for or with key recovery groups; $6.6 million to the Rural Emergency Medical Services Training Grant Program; $15.8 million to the Treatment for Individuals with Serious Mental Illness, Serious Emotional Disturbance, or Co-Occurring Disorders Experiencing Homelessness Program; and $2 million to the Treatment, Recovery, and Workforce Support Grant Program.

Learn more about this funding, why it is been awarded, and the specific programs it will support from this White House fact sheet.  Learn more about the HRSA funding for rural communities from this HHS news release and about the various SAMHSA grants from this SAMHSA news release.

  • HHS’s Advanced Research Projects Agency for Health (ARPA-H) has launched the Digital Health Security project to protect the U.S. health care system’s electronic infrastructure.  The agency is soliciting proposals for proven technologies developed for national security to apply them to civilian health systems, clinical care facilities, and personal health devices.  Focusing on security protocols, vulnerability detection, and automatic patching, this effort seeks to reduce attacks on digital health software and prevent large-scale cyberattacks.  In addition to addressing cybersecurity vulnerabilities, the project hopes to identify and fix software-related weaknesses that affect patient safety and experience.  Learn more about the project from this ARPA-H announcement and this solicitation of proposals.  Proposal abstracts are due by September 7.
  • HHS’s Office of the Inspector General has updated its resources describing its work overseeing Medicaid and Medicare managed care programs.  Find those resources here.

HHS Newsletters

Centers for Disease Control and Prevention

  • The CDC has issued a health alert in response to a very limited number of locally acquired cases of malaria in Florida, Maryland, and Texas.  The alert describes the cases and the disease itself and offers information and guidance to clinicians, hospitals, laboratories, public health officials, and the general public and provides links to additional resources about malaria.  Find the health alert here.
  • The CDC is soliciting nominations for membership on its Lead Exposure and Prevention Advisory Committee.  The committee consists of 15 members who are federal and non-federal experts in fields associated with lead screening, the prevention of lead exposure, and services for individuals and communities affected by lead exposure.  Nominations for membership are due by September 30.  Go here for further information about the committee and its work and how to submit nominations.

Medicare Payment Advisory Commission (MedPAC)

MedPAC has submitted formal comments to CMS in response to the latter’s publication of proposed regulations governing the Medicare home health prospective payment system for FY 2024; the end-stage renal disease payment system; and transitional coverage for emerging technologies.


Stakeholder Events

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.

AHRQ – Innovative Use of Technology in Primary Care Delivery – September 14

HHS’s Agency for Healthcare Research and Quality will hold a webinar on innovative use of technology in primary care on Thursday, September 13 at 1:30 (eastern).  This webinar will feature AHRQ grantees discussing their research on the use of innovative technology to improve the quality and safety of primary care. The webinar will include a discussion on what the researchers see emerging for future use of new technologies in primary care delivery.  There will be a Q&A session after the presentations.  Go here 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.