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.


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.


  • 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

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

Government Accountability Office (GAO)

Congressional Research Service

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.