The following is the latest health policy news from the federal government for the week of December 4-8. Some of the language used below is taken directly from government documents.
No Surprises Act
- CMS has published an FAQ about implementation of good faith estimates for uninsured and self-pay patients under the No Surprises Act. In the FAQ the agency explains that it will extend enforcement discretion for situations in which good faith estimates do not include expected charges from co-providers or co-facilities. This enforcement discretion was expected to end on January 1 but CMS now writes that it will remain suspended pending future rulemaking. Find the FAQ here.
Centers for Medicare & Medicaid Services
- CMS has published a proposed rule for improving prior authorization processes for Medicare Advantage plans, Medicaid managed care plans, state Medicaid agencies, and other payers by making greater use of advanced interoperability and better data-sharing. Learn more about the proposed rule from this CMS news release; a CMS fact sheet; and a pre-publication version of the proposed rule itself. Stakeholder comments are due by March 13.
- CMS has posted information on changes in the Medicare inpatient and long-term care prospective payment system for FY 2023.
- CMS has posted this week’s edition of MLN Connects, its online newsletter with information about Medicare payment issues. The latest edition includes features on updated rates for rural health clinics for calendar year 2023, a link to the revised “Medicare National Correct Coding Initiative Policy Manual” that takes effect on January 1, and more. Find it here.
- CMS has announced that it will charge a $688 application fee in calendar year 2023 for institutional providers that are initially enrolling in the Medicare, Medicaid, and CHIP programs; revalidating their Medicare, Medicaid, or CHIP enrollment; or adding a new Medicare practice location. This fee is required with any enrollment application submitted on or after January 1, 2023. Learn more from this CMS notice and also find a link to the formal notice published in the Federal Register.
- CMS has released new training materials, including a video, about the Emergency Medical Treatment and Labor Act (EMTALA). Find the materials here.
Department of Health and Human Services
- HHS has published its federal Medical Assistance percentages (FMAP), the rate at which the federal government matches state Medicaid and CHIP expenditures and other selected state health care expenditures, for FY 2024. Learn more from this HHS notice about the FY 2024 rates and also find a link to the formal notice published in the Federal Register.
- After a preliminary analysis of Medicare Part B claims data indicated that some diagnostic testing laboratories billing for COVID-19 tests also billed for other diagnostic tests, HHS’s Office of the Inspector General performed an outlier analysis to identify labs that billed for add-on tests at questionably high levels compared to other labs that billed for COVID-19 tests and found that 378 labs billed Medicare Part B for add-on tests at questionably high levels – in volume, payment amount, or both – compared to the 19,199 other labs. Learn more about the HHS OIG’s findings in its report “Labs With Questionably High Billing for Additional Tests Alongside COVID-19 Tests Warrant Further Scrutiny.”
- The Pandemic Response Accountability Committee, created by the CARES Act to coordinate oversight of the federal government’s pandemic response and consisting of the inspectors general from the departments of Health and Human Services, Justice, Veterans Affairs, and Labor and the Office of Personnel Management, has published a study examining the expansion of telehealth across federal programs during the COVID-19 pandemic and, along with this expansion, the emerging risks from that expansion. Learn about what the committee found from its report “Insights on Telehealth Use and Program Integrity Risks Across Selected Health Care Programs During the Pandemic.”
- HHS’s Office of the Inspector General has submitted its semi-annual report to Congress. The report includes sections on Medicare and Medicaid, human services agencies, public health agencies, and more. Find it here.
- HHS has updated its list of funding opportunities for telehealth and broadband-related endeavors.
Centers for Disease Control and Prevention
- As of December 15, hospitals will no longer submit their COVID-19 data via TeleTracking; they will submit it instead to the CDC’s National Healthcare Safety Network (NHSN). Go here to learn more about the transition, including dates and times for training programs.
- The CDC has updated the terms of its agreement with providers that contract with the agency to administer free mpox vaccines. Go here to learn more about the updated provider contract.
Food and Drug Administration
The FDA has amended the emergency use authorizations for the updated bivalent Moderna and Pfizer COVID-19 vaccines to include use in children down to six months of age. Learn why and what the change of status means from this FDA news release.
Congressional Budget Office
The Congressional Budget Office (CBO) periodically issues a compendium of policy options for changing federal tax and spending policies in particular areas. For each option, CBO presents an estimate of its effects on the budget but makes no recommendations. The latest update of options includes a number with potential implications for health care providers, including:
- changing the cost-sharing rules for Medicare and restricting medigap insurance
- reducing Medicare Advantage benchmarks
- reducing Medicare’s coverage of bad debt
- consolidating and reducing federal payments for graduate medical education at teaching hospitals
- establishing caps on federal spending for Medicaid
- limiting state taxes on health care providers
- reducing federal Medicaid matching rates
CDC – Clinical Guidance and Patient Education for Bivalent COVID-19 Vaccines – December 13
The CDC will hold a webinar for providers on clinical guidance and patient education for bivalent COVID-19 vaccines on Tuesday, December 13 at 2:00 (eastern). During the webinar, CDC staff will discuss updates on bivalent vaccines, including the most recent vaccine effectiveness data, the CDC’s clinical guidance for bivalent vaccines, and strategies for communicating with patients about COVID-19 vaccination. Learn more about the webinar, including how participants may obtain continuing education credits, from this CDC notice.
FDA – Cardiovascular and Renal Drugs Advisory Committee – December 14
The FDA’s Cardiovascular and Renal Drugs Advisory Committee will meet virtually on Wednesday, December 14 at 9:00 (eastern). For information on the meeting’s agenda, the docket the committee has created for the meeting, how to submit comments and papers, and how to join the meeting, see this Federal Register notice.
HHS – New Technology Town Hall – December 14-15
HHS will hold a new technology town hall meeting on Wednesday, December 14 and Thursday, December 15, with both virtual sessions to begin at 9:00 (eastern), to discuss FY 2024 applications for add-on payments for new medical services and technologies under the hospital inpatient prospective payment system. Interested parties may present comments, recommendations, and data regarding whether the FY 2024 new medical services and technologies applications meet the substantial clinical improvement criterion. Learn more about the meeting and its purpose and how to participate from this Federal Register notice.