Federal Health Policy Update for December 22

The following is the latest health policy news from the federal government for the week of December 19-22.  Some of the language used below is taken directly from government documents.

Congress

As of this writing, Congress continues to work on an FY 2023 omnibus spending bill:  the Senate has passed it but the House has not yet addressed it.  Highlights of what negotiators have agreed to – but that have not yet been adopted – include:

• Preventing the additional four percent Medicare sequester for two years.
• Reducing by more than half the 4.5 percent cut in Medicare payments to physicians that was scheduled to take effect on January 1.  The agreement calls for reducing that 4.5 percent cut to just two percent in 2023 and then imposing a 3.5 percent cut in 2024.
• Extending COVID-19 public health emergency Medicare telehealth policies for two years, through 2024.
• Ending the maintenance-of-effort requirement from the Families First Coronavirus Response Act that prohibited states from removing ineligible individuals from their Medicaid rolls.  Under that law, states were prohibited from reviewing the eligibility of Medicaid beneficiaries for the duration of the COVID-19 public health emergency in exchange for a 6.2 percentage point increase in FMAP.  This agreement, if adopted, would end that requirement as of April 1 regardless of whether the public health emergency is still in effect at that time and introduce new requirements for implementing eligibility redeterminations during an April through December 2023 transition period.  The maintenance of effort requirement will continue for 12 months for children and pregnant and postpartum women.

Regulations

• HHS has proposed a regulation that seeks to adopt a set of standards – a standard format for attachments – for the electronic exchange of clinical and administrative data to support prior authorizations and health care claims adjudication in the hope that it will speed prior authorization decisions and claims processing, reduce burden on providers and plans, and result in more timely delivery of patient health care services.  Learn more this HHS news release; an HHS fact sheet; and this announcement, which also includes a link to a Federal Register notice with the entire proposed rule.  Comments are due by March 21.
• HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) has published a notice of proposed rulemaking to solicit public comment on its proposal to modify its regulations regarding medications for the treatment of opioid use disorder.  In the notice, SAMHSA proposes modifying current regulations to update opioid treatment program accreditation and certification standards; treatment standards for the provision of medications for opioid use disorder as dispensed by opioid treatment programs; and requirements for individual practitioners eligible to dispense and prescribe certain types of medications for opioid use disorder.  Learn more from this notice, which includes a link to a Federal Register notice.  Comments are due by February 14.
• CMS has issued a final rule titled “Basic Health Program; Federal Funding Methodology for Program Year 2023 and Changes to the Basic Health Program Payment Notice Process.”  This rule finalizes the methodology and data sources necessary to determine federal payments to be made for program year 2023 to states that elect to establish a Basic Health Program under the Affordable Care Act to offer health benefits coverage to low-income individuals otherwise eligible to purchase coverage through health insurance exchanges.  This is a final rule that takes effect on January 1.  Learn more from this CMS announcement, which includes a link to a Federal Register notice with the complete regulation.

Department of Health and Human Services

• HHS and its Administration for Strategic Preparedness and Response (ASPR) have announced that they are making additional supply of Tamiflu available to jurisdictions to respond to an increased demand for the antiviral during this flu season, including through the Strategic National Stockpile.  Jurisdictions will work with their ASPR regional teams to evaluate any requests for Tamiflu.  Learn more from this HHS news release.
• Reporting period 4 for the use of Provider Relief Funds opens on January 1.  Go here for more information about reporting.
• HHS’s Health Resources and Services Administration (HRSA) has updated its list of current agency funding opportunities.  Go here and scroll down to see the list.
• HHS’s Office of the Inspector General (OIG) has issued an advisory opinion on a hospital’s use of its employed nurse practitioners to perform services traditionally performed by a patient’s attending physician in certain medical units.
• Providers sought reimbursement for nearly $10 billion of Medicare bad debts on their cost reports for cost reporting periods ending during FY 2016 through 2018.  HHS’s OIG has conducted a review to determine whether providers complied with federal requirements when claiming that reimbursement and whether their policies and procedures for collecting Medicare deductibles and coinsurance classified as Medicare bad debts complied with federal requirements.  Learn what they found in the report “Providers Did Not Always Comply With Federal Requirements When Claiming Medicare Bad Debts.”
• HHS’s OIG has published “OIG’s Top Unimplemented Recommendations:  Solutions To Reduce Fraud, Waste, and Abuse in HHS Programs,” an annual publication in which it focuses on the top 25 unimplemented recommendations that, in its view, would most positively affect HHS programs in terms of cost savings, program effectiveness and efficiency, and public health and safety if implemented.  Find a list of the 25 recommendations here and the complete report here.
• HHS’s Agency for Healthcare Research and Quality (AHRQ) has published a blog post on improving the quality of care in long-term-care settings; one on the challenges of providing high-quality behavioral health care; and a third on improving the delivery of quality home health care.
• AHRQ has published the statistical brief “Comorbidities Associated With Adult Inpatient Stays, 2019.”
• HHS has released its “National Plan to Address Alzheimer’s Disease:  2022 Update.”  Learn more about the plan and its objectives from this HHS news release and from the plan document itself.
• HHS has published the December edition of its Expanded Home Health Value-Based Purchasing (HHVBP) Model newsletter.
• HHS has released detailed ownership data for the more than 7000 hospitals certified to participate in the Medicare program.  The data includes enrollment information, such as organization name, type, practice location addresses, National Provider Identifier, and CMS Certification Number;  detailed information about each owner, such as whether it is an organization or an individual and whether it is a direct owner or an indirect owner; and a numerical associate ID for each owner to enable linkage to the enrollment file.  Learn more from this HHS news release and go here to begin exploring the data itself.

Centers for Medicare & Medicaid Services

• CMS has posted an update on Medicare ambulatory surgical center payments that take effect on January 1.
• CMS has posted a new edition of MLN Connects, its online newsletter with information about Medicare reimbursement matters.  This issue includes features on the clinical laboratory fee schedule for calendar year 2023, updated Medicare outpatient prospective payment system rates for 2023, the extension of changes of the Low-Volume Hospital and Medicare-Dependent Hospital programs, and more.  Find the latest MLN Connects here.
• CMS has released policy and operational guidance to states on changes to the mandatory Medicaid eligibility group serving youth formerly in foster care.  These changes, which were made by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, expand eligibility to individuals who were in foster care from other states and simplify eligibility determinations and enrollment processes for this population.  Find the guidance here.
• CMS’s Center for Medicare and Medicaid Innovation (CMMI) has issued a request for applications for new participants in its Medicare Advantage Value-Based Insurance Design (VBID) Model.  This model is testing a broad array of complementary Medicare Advantage health plan innovations designed to reduce Medicare program expenditures, enhance the quality of care for Medicare beneficiaries, and improve the coordination and efficiency of health care service delivery.  In 2024 the VBID Model program will test a number of new components and CMMI is seeking organizations interested in participating in this undertaking.  For more information about the VBID Model and how to apply to participate in the program in 2024, see CMMI’s Medicare Advantage Value-Based Insurance Design Model web page.  Applications are due by April 14.
• Earlier this year CMS issued a request for information seeking feedback from stakeholders on subjects related to health care access in Medicaid and CHIP, including enrollment in coverage, maintaining coverage, and access to services and supports.  Now, CMS has issued a summary of the comments it received as well as a complete report sharing stakeholder comments.

Centers for Disease Control and Prevention

• The CDC has issued a health alert to emphasize to providers, public health departments, and the public that the majority of omicron sublineages circulating in the U.S. have reduced susceptibility to the monoclonal antibody bebtelovimab and the monoclonal antibody combination of cilgavimab and tixagevimab (Evusheld).  It notes that antiviral therapeutics for the treatment of COVID-19, such as ritonavir-boosted nirmatrelvir (Paxlovid), remdesivir (Veklury), and molnupiravir (Lagevrio), retain activity against currently circulating omicron sublineages.  Find the alert here.

National Institutes of Health

• To address the overdose crisis, the NIH has established a research network that will test harm reduction strategies in different community settings to inform efforts to help save lives.  Learn more from this NIH news release.
• The NIH has published updated significant changes that have already been made to the NIH Grants Policy Statement in FY 2022 that will be reflected in the Grants Policy Statement for FY 2023.  The statement provides up-to-date policy guidance that serves as NIH standard terms and conditions of award for all NIH grants and cooperative agreements and guidance to those interested in pursuing NIH grants.  Learn more from this NIH announcement, which includes a link to a formal Federal Register notice.

Food and Drug Administration

• The FDA is inviting nominations for individuals to serve on its National Mammography Quality Assurance Advisory Committee in the Center for Devices and Radiological Health.  Nominations received on or before February 21 will be given first consideration for membership on the committee and nominations received after February 21 will be considered for nomination to the committee as later vacancies occur.  Learn more from this FDA announcement, which includes a link to a formal Federal Register notice.

Department of Homeland Security

• The Department of Homeland Security’s U.S. Citizenship and Immigration Services has issued policy guidance to address the public charge grounds of inadmissibility to the U.S. under the Immigration and Nationality Act.  Among many other matters, the policy addresses immigrants’ eligibility for Medicare, Medicaid, and other federal aid programs.

Government Accountability Office (GAO)

• The GAO has published the report “Medicare:  CMS Needs to Address Risks Posed by Provider Enrollment Waivers and Flexibilities.”  The report examines 47 waivers and flexibilities that CMS issued in response to COVID-19 and provider performance under these waivers and flexibilities.
• The GAO has published the report “COVID-19 in Nursing Homes:  Outbreak Duration Averaged 4 Weeks and Was Strongly Associated with Community Spread.”
• The GAO has published the report “COVID-19 Relief Funds:  Lessons Learned Could Improve Future Distribution of Federal Emergency Relief to Tribal Recipients.”
• The GAO has published the report “Private Health Insurance: State and Federal Oversight of Provider Networks Varies.”

Congressional Research Service

• The Congressional Research Service has updated its publication “Finding Medicare Fee-For-Service (FFS) Payment System Rules:  Schedules and Resources.”

Stakeholder Events

CMS – National Nursing Home Stakeholder Call – January 5

CMS and the CDC will hold a national nursing home stakeholder call on Thursday, January 5 at 3:00 (eastern).  The agencies encourage long-term-care providers, facility staff, and resident advocates to attend.  Registration is required; go here to register.