The following is the latest health policy news from the federal government for April 5-11.  Some of the language used below is taken directly from government documents.

CMS – Proposed FY 2025 Medicare Inpatient Prospective Payment System Regulation

Earlier this week CMS issued its proposed FY 2025 Medicare inpatient prospective payment system regulation – the rule under which it envisions paying acute-care hospitals, critical access hospitals, and long-term care hospitals for inpatient care in the coming fiscal year.  Highlights of the proposed rule include:

  • Rate increases of 2.6 percent for acute-care and critical access hospitals and 2.8 percent for LTCHs.
  • CMS proposes to use data from the 2020 Census Bureau designations for Medicare Area Wage Index purposes, which may result in significant changes for some hospitals.
  • An additional $560 million in Medicare DSH uncompensated care payments.
  • A supplemental payment for hospitals with fewer than 100 beds that maintain a “buffer” supply of prescription drugs on hand as protection from drug shortages.
  • A plan to make at least half of new residency slots for psychiatric or psychiatric subspecialty physicians, especially in health professional shortage areas.
  • A new, mandatory “Transforming Episode Accountability Model” under which participating hospitals would see their payments capped for specific surgical procedures.  (See below for a more detailed description.)
  • Additions, deletions, and changes in the hospital inpatient quality reporting program.
  • A series of requests for information from stakeholders for input on how best to calculate the LTCH outlier threshold; the impact of Medicare rates on inpatient pregnancy and childbirth services; how to improve hospital discharge practices; potential changes in the Promoting Interoperability Program; the development of an LTCH star rating program; the development of new LTCH measurement concepts; future data reporting on respiratory conditions; and the reporting of hospital data to the CDC’s National Syndromic Surveillance Program.

Learn more about the proposed FY 2025 Medicare inpatient prospective payment system regulation from the following resources:

Stakeholder comments are due June 10.

Centers for Medicare & Medicaid Services
  • As part of this year’s proposed FY 2025 inpatient prospective payment system regulation, CMS has proposed a mandatory Transforming Episode Accountability Model (TEAM) to help advance the agency’s prior work on episode-based alternative payment models.  TEAM would be a mandatory episode-based alternative payment model in which selected acute-care hospitals would coordinate care for people with traditional Medicare who undergo one of the surgical procedures included in the model and assume responsibility for the cost and quality of care from surgery through the first 30 days after the Medicare beneficiary leaves the hospital.  As part of taking responsibility for cost and quality during the episode, hospitals would connect patients to primary care services to help establish accountable care relationships and support optimal, long-term health outcomes.  The surgical procedures included in the model would be lower extremity joint replacement, surgical hip femur fracture treatment, spinal fusion, coronary artery bypass graft, and major bowel procedure.  CMS would provide participating hospitals with a target price that would represent most Medicare spending during an episode of care, which would include the surgery (including the hospital inpatient stay or outpatient procedure) and items and services following hospital discharge, such as skilled nursing facility stays or provider follow-up visits.  The proposed model would launch on January 1, 2026, and run for five years, ending on December 31, 2030.  Learn more from the TEAM web page, which includes a description of the program and links to a news release, a CMS fact sheet, an FAQ, and more.
  • CMS has issued a final rule that seeks to strengthen enrollee protections and guardrails to ensure that Medicare Advantage and Medicare Part D prescription drug plans best meet the needs of people with Medicare.  Among other provisions, the rule establishes a set amount that a Medicare Advantage or Part D plan can compensate agents and brokers; requires Medicare Advantage plans to include an expert in health equity on their utilization management committees and for those committees to conduct an annual health equity analysis of the plans’ prior authorization policies and procedures; expands network adequacy evaluation requirements to a new outpatient behavioral health specialty type that includes marriage and family therapists, mental health counselors, addiction medicine clinicians, opioid treatment providers, and other behavioral health practitioners providing psychotherapy or medication for substance use disorder; finalizes new guardrails for certain supplemental benefits available only to chronically ill enrollees; requires Medicare Advantage plans to send a mid-year, personalized communication to their enrollees about pursuing unused supplemental benefits; finalizes greater flexibility for Part D plans to substitute lower cost biosimilar biological products for their reference products; and more.  Learn more from this HHS news release; this CMS fact sheet; and this pre-publication version of the final rule, which is scheduled for official publication on April 23 and will take effect on June 3.
  • CMS has posted a bulletin describing its April 2024 ambulatory surgical center payment update.  Find that bulletin here.  The changes described in the bulletin took effect on April 1.
  • CMS has updated its medical record maintenance and access requirements.  Go here for a fact sheet that describes recent changes.
  • CMS has issued an informational bulletin to the states updating its Home and Community-Based Services (HCBS) Quality Measure Set for 2024.  The agency encourages states to use the measures and plans to incorporate use of the HCBS quality measure set into the reporting requirements for specific Medicaid program authorities that include HCBS.  Find that bulletin here.
  • CMS has issued an informational bulletin to the states describing the HCBS quality measure set reporting requirements for Money Follows the Person grant recipients subject to the updated demonstration program’s terms and conditions and addresses requirements and expectations in the following areas:  populations groups, reporting time frame, required measures, stratification, and sampling.  Find that bulletin here.
Department of Health and Human Services
  • HHS and its Health Resources and Services Administration (HRSA) have announced the availability of $51 million for the first-ever funding opportunity for HRSA-funded health centers to implement innovative approaches to support transitions in care for people leaving incarceration.  Under this program, applicants are asked to propose approaches that focus on reducing drug overdose risk, addressing mental health and substance use disorder treatment needs, managing chronic conditions, and preventing, screening, diagnosing, and treating hepatitis C, HIV, syphilis, and other infectious diseases.  Learn more from this HHS news release, which includes links to further information about the program and the grant funding.
  • HHS’s Health Sector Cybersecurity Coordination Center and its Office of Information Security have issued a report identifying the ten most active ransomware threats against the health care sector.  The report identifies the sources of the threats, describes the nature of the threat they pose, offers steps for defense and mitigation, and directs health sector participants to additional resources.  Find the report here.
HHS Newsletters
  • CMS – MLN Connects – April 11
  • AHRQ News Now – April 9
  • HRSA eNews – April 4 (includes funding opportunities)
Centers for Disease Control and Prevention (CDC)
  • The CDC has issued a health alert to inform clinicians, state health departments, and the public of a recently confirmed human infection with highly pathogenic avian influenza (“bird flu”).  The alert offers recommendations for infection prevention and control and directs readers to additional resources.  Find the alert here and additional CDC guidance here.
  • The CDC has updated its consumer guidance on the use of ivermectin as treatment for COVID-19.  Find that updated guidance here.
  • A new CDC study has found that only about 65 percent of women between the ages of 50 and 74 who have three or more health-related social needs – that is, social determinants of health – are up to date with their mammograms.  Cost and access, the study found, are not the only barriers women face to getting mammograms.  Learn more from this CDC news release and the CDC study “Mammography Use and Association with Social Determinants of Health and Health-Related Social Needs Among Women — United States, 2022.”  In addition, the CDC held a press briefing about the study; go here for a recording and a transcript of that briefing.
Medicaid and CHIP Payment and Access Commission (MACPAC)

In a new issue brief, MACPAC reviews the different types of payments Medicaid makes to hospitals, including supplemental payments such as Medicaid DSH, and describes payment goals, amounts, and their relationships to other types of Medicaid payments.  The paper also illustrates how the use of supplemental payments varies by state and describes how state methods for financing Medicaid payments affect net hospital payments.  Learn more from the MACPAC issue brief “Medicaid Base and Supplemental Payments to Hospitals.”

Stakeholder Events

CMS – Hospital Open Door Forum – April 16

CMS will hold an open-door forum for hospitals on Tuesday, April 16 at 2:00 (eastern).  Go here to register to participate.

CMS – “Understanding Medicare” Webinars – April 16-17

CMS will offer two interactive training webinars covering Medicare basics.  Subjects include Medicare enrollment and eligibility; Social Security Administration and CMS roles and responsibilities; cost and coverage under Medicare Part A (hospital insurance) and Medicare Part B (medical insurance); why enrolling on time is important; an overview of Medicare Supplement Insurance (Medigap) policies; Medicare drug coverage (Part D); Medicare Advantage plans; coordination of benefits; how to detect and report suspected Medicare fraud, waste, and abuse; and different resources to help find answers to Medicare policy and coverage questions.  Go here to register to participate; enrollment for the two days will be limited; the event will  be recorded and posted here.

HHS – Office of Climate Change and Health Equity – Webinars on Taking Advantage of Provisions in the Inflation Reduction Act –April 18

HHS’s Office of Climate Change and Health Equity is holding a series of webinars to help health care providers, and especially safety-net organization, take advantage of the tax credits, grants and other supports made available by the Inflation Reduction Act, which creates opportunities for health sector organizations to invest in clean energy, building efficiency, infrastructure resilience, and more.  The next webinar will be held on Thursday, February 8, with additional events scheduled on February 22, March 7 and 21, and April 4 and 18.  Separate break-out sessions will be held for essential hospitals, community health centers, and rural providers.  Go here to learn more about the webinar series, future events, and the break-out sessions; go here for a recording of a November briefing on Inflation Reduction Act resources available to health care providers; and go here to register to participate.

CMS – Long-Term Care Support and Services Open Door Forum – April 23

CMS will hold an open-door forum for long-term-care support and services providers on Tuesday, April 23 at 2:00 (eastern).  Go here to register to participate.

CMS – Rural Hospitals Open Door Forum – April 25

CMS will hold an open-door forum for rural hospitals on Thursday, April 25 at 2:00 (eastern).  Go here to register to participate.

CMS – Health Equity Conference – May 29-30

CMS will hold its second annual CMS Health Equity Conference on Wednesday, May 29 and Thursday, May 30.  The free, hybrid conference will be held in person in Bethesda, Maryland and available online for virtual participation and involve health equity leaders from federal and local agencies, health provider organizations, academia, community-based organizations, and others. Conference participants will hear from CMS leadership on recent developments and updates to CMS programs; explore the latest health equity research; discuss promising practices and creative solutions; and collaborate on community engagement strategies.  Go here for information about how to register to participate.