The following is the latest health policy news from the federal government for December 20 through January 3.  Some of the language used below is taken directly from government documents.

Congress

The 119th Congress convened today to swear in new members and members of the House of Representatives have re-elected Rep. Mike Johnson (R-LA) as Speaker.

Centers for Medicare & Medicaid Services
  • CMS has published a solicitation for up to 10 additional hospitals from eligible low population density states to participate in its Rural Community Hospital Demonstration program.  The Medicare Prescription Drug, Improvement and Modernization Act of 2003 directed the agency to establish a demonstration program to test the feasibility and advisability of establishing cost-based reimbursement for “rural community hospitals” to furnish covered inpatient hospital services to Medicare beneficiaries.  The demonstration pays rural community hospitals for such services under a cost-based methodology for Medicare payment and is designed to test the feasibility and advisability of reasonable cost reimbursement for inpatient services to small rural hospitals, seeking to increase the capability of the selected rural hospitals to meet the needs of their service areas.  Learn more about the program, eligibility criteria, and how to apply to participate from this CMS announcement.  The deadline for submitting applications is March 1.
  • CMS has published the rates that will be charged in 2025 by the Independent Dispute Resolution (IDR) entities created under the 2020 No Surprises Act.  For these disputes, the administrative fee is $115 per party per dispute and the certified IDR entity fee ranges are $200-$840 for single determinations and $268-$1,173 for batched determinations.  A CMS website now includes information on the fee set by the individual IDR entities within these ranges and took effect on January 1.  Learn more from this CMS announcement and the CMS web page that lists IDR fees.
  • As part of its continued guidance to support states’ efforts to verify Medicaid and CHIP eligibility and conduct Medicaid and CHIP eligibility and renewal in compliance with federal requirements, CMS has sent an informational bulletin to the states to remind them about requirements and expectations for providing renewal forms to Medicaid and CHIP beneficiaries when their eligibility cannot be renewed on an ex parte basis using available, reliable information.  Specifically, the bulletin addresses renewal requirements related to elements of a renewal form; modality and timeline requirements for accepting renewal forms; completing the renewal process; enabling individuals to designate authorized representatives; and enhanced federal matching for eligibility system changes.  Learn more from this CMS informational bulletin to the states.
  • To foster seamless coverage transitions between Medicaid, separate CHIPs, and other insurance affordability programs and the exercise of enforcement discretion to delay implementation of certain coverage transition requirements, CMS has sent an informational bulletin to the states to provide guidance about new federal requirements related to coverage transitions of children between Medicaid and separate CHIPs.  This bulletin also advises states that CMS is exercising temporary enforcement discretion in connection with implementation of certain other new requirements related to the issuance of combined Medicaid and separate CHIP eligibility notices and the transfer of individuals procedurally disenrolled from Medicaid and separate CHIPs to other insurance affordability programs.  Learn more from this CMS informational bulletin to the states.
  • CMS has written to states to provide its 2026 updates to the Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP and the Core Set of Adult Health Care Quality Measures for Medicaid and to share its expectations for 2026 Core Set quality measure reporting, due to CMS by December 31, 2026.  The CMS letter to the states addresses mandatory Child Core Set and behavioral health measures in the Adult Core Set; annual updates of the 2026 Child and Adult Core Sets; adherence to mandatory reporting guidance; populations that states should include in reporting and the population exemption process; and data stratification categories and measures for which stratified reporting is mandatory.  The changes will affect the data states require of providers that serve Medicaid and CHIP patients.  Find the CMS letter here.
  • CMS has sent a memo to state survey agencies outlining revised reporting requirements that took effect on January 1 under which long-term-care facilities are required to electronically report information about COVID-19, influenza, and RSV in a standardized format and frequency.  Find that memo here.
  • CMS has posted new and updated materials about changes in the Home Health Value-Based Purchasing Program for calendar year 2025.  These new materials include Expanded HHVBP Model:  Changes to the Applicable Measure Set Beginning in CY 2025 – Overview; Expanded HHVBP Model Resource Index; Expanded HHVBP Model Frequently Asked Questions (FAQs) – December 2024; Expanded HHVBP Model Guide – December 2024 update; and HHVBP help desk question highlights.
  • CMS has announced that for hospitals and critical access hospitals participating in its Hospital Inpatient Quality Reporting Program and/or the Medicare Promoting Interoperability Program, the deadline for submitting electronic clinical quality measure (eCQM) data for the CY 2024 reporting period has been extended from February 28 to March 14.  Learn more from this CMS announcement.
  • CMS has hired a contractor to collect stakeholder feedback for an assessment of patient autonomy in end-stage renal disease (ESRD) treatment decision-making and is seeking volunteers to serve on a technical experts panel to advise that contractor.  Learn more about the panel’s planned work, the backgrounds CMS seeks among participants, the work commitment involved, and how to participate from this CMS announcement; scroll down to the link for “Assessment of Patient Autonomy in ESRD Treatment Decision-Making.”  The deadline for submitting applications is January 20.
  • CMS has hired a contractor to help it develop and evaluate an inpatient psychiatric facility patient assessment instrument and is seeking volunteers to serve on a technical experts panel to advise that contractor.  Learn more about the panel’s work, the backgrounds CMS seeks among participants, the work commitment involved, and how to apply to participate from this CMS announcement; scroll down to the link for “Development and Evaluation of an Inpatient Psychiatric Facility (IPF) Patient Assessment”).  The deadline for submitting applications is January 24.
  • CMS has announced that some Medicare enrollees will pay less for 64 drugs available through Medicare Part B because those drugs will have a reduced Part B coinsurance rate from January 1, 2025 until March 31, 2025 because the drug companies that manufacture those specific drugs raised prices for each faster than the rate of inflation.  More than 853,000 people with Medicare use these drugs annually to treat conditions such as cancer, osteoporosis, and substance use disorder.  According to CMS, some people with Medicare who use these drugs in the first quarter of 2025 may save between $1 and $10,818 a day.  Learn more from this HHS news release and from an FAQ about the program and a list of the 64 drugs involved.
  • CMS has updated its Electronic Clinical Quality Improvement (eCQI) Resource Center with new webpages dedicated to the Quality Improvement Core standard for expressing clinical quality information.  Learn more from this CMS announcement.
Department of Health and Human Services
  • HHS, in conjunction with the Department of Labor and the Treasury Department, has announced that it has withdrawn its notice of proposed rulemaking governing coverage of certain preventive services under the Affordable Care Act.  The notice, published on February 2, 2023, sought to resolve long-running litigation involving religious objections to providing contraceptive coverage by respecting the objecting entities’ religious objections while also ensuring that women enrolled in plans or coverage sponsored, arranged, or offered by objecting entities could independently obtain contraceptive services at no cost.  The proposed rules would have rescinded the regulation providing for an exemption based on non-religious moral objections and established a new individual contraceptive arrangement that individuals in plans or coverage subject to a religious exemption could use to obtain contraceptive services at no cost directly from a provider or facility that furnishes contraceptive services without any involvement on the part of an objecting entity.  After receiving nearly 45,000 comments, the agencies have decided to withdraw the notice of proposed rulemaking and to reconsider whether and how to move forward.  Learn more from this Federal Register notice.
  • HHS and its Office for Civil Rights have issued a proposed rule to improve cybersecurity and better protect the health care system from the growing number of cyberattacks.  The proposed rule would modify the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule to require health plans, health care clearinghouses, and most health care providers and their business associates to strengthen cybersecurity protections for individuals’ protected health information.  The rule seeks to clarify and provide more specific instruction about what covered entities and their business associates must do to protect the security of electronic protected health information; would require that policies and procedures be in writing and reviewed, tested, and updated regularly; and seeks to align more effectively the HIPAA rule with modern best practices in cybersecurity.  Learn more from this HHS announcement; an HHS fact sheet; and this pre-publication version of the proposed rule.
  • HHS’s Health Resources and Services Administration (HRSA) has formally adopted updates in the women’s preventive services guidelines it proposed in October.  At that time the agency presenting recommendations for screening and counseling for intimate partner and domestic violence, breast cancer screening for women at average risk, and patient navigation services for breast and cervical cancer screening.  Under applicable law, non-grandfathered group health plans and health insurers offering non-grandfathered group and individual health insurance coverage must include coverage, without cost-sharing, for certain preventive services, including those provided for in the HRSA-supported guidelines.  Learn more from this Federal Register notice.
  • HRSA has proposed updating its methodology for calculating the full-time equivalent resident count for the children’s hospitals graduate medical education payment program.  Learn more about the proposed changes from this HRSA announcement.  The deadline for submitting comments is January 29.
  • HHS will award $306 million to continue its bird flu response. Included in the sum will be $183 million in additional funding for regional, state and local preparedness programs; $111 million in funding for additional enhancements to support monitoring bird flu at the local, state and national levels; and $11 million in funding for additional research into potential medical countermeasures for bird flu.  Learn more about how the money will be allocated from this HHS news release.
  • Medicare could save billions of dollars with comparable access to care for enrollees if critical access hospital payments for swing-bed services were similar to those paid under Medicare’s fee-for-service prospective payment system, HHS’s Office of the Inspector General concludes in a new report.  Find that report here.
  • Some selected skilled nursing facilities did not comply with Medicare requirements for reporting related-party costs, HHS’s Office of the Inspector General has concluded based on a recent audit.  Learn more about the OIG’s findings from this report.
  • According to a new report by the OIG, Medicaid gross spending on 10 selected diabetes and two selected weight-loss drugs totaled more than $9 billion in 2023, an increase of 540 percent since 2019.  Find that OIG report here.
  • HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) has awarded $10 million for the Community-Based Maternal Behavioral Health Services Program, a new grant program supporting the behavioral health of pregnant and postpartum women.  Learn more about the program and find a link to a list of the grant recipients from this HHS announcement.
  • HHS’s Office of the Assistant Secretary for Planning and Evaluation (ASPE) has published a report on Medicaid and CHIP telehealth utilization trends based on enrollee and provider rurality from 2019 through 2021.  Find that report here.
  • ASPE has posted a report on the availability of and access to bacterial infection diagnostics in the U.S.  Find that report here.
  • The wages of direct care workers continue to be lower in most states in comparison to other entry-level jobs in those states, ASPE concludes in a new issue brief.  Find that issue brief here.
  • ASPE has published a report presenting an approach for evaluating each Inflation Reduction Act Medicare drug-related provision, including identification of key research questions and outcomes; the potential methods that can be used; and the challenges that may arise.  Find that report here.
  • HHS has extended its declaration of public health emergencies in Georgia, North Carolina, and Tennessee in the aftermath of Hurricane Helene.  Such declarations give the agency additional flexibility to support beneficiaries of HHS programs.  Learn more here.
HHS Newsletters and Reports
  • CMS – Expanded Home Health Value-Based Purchasing (HHVBP) Model Newsletter – December 2024
  • HRSA – Office for the Advancement of Telehealth – Announcements, December 23
  • Center for Medicare and Medicaid Innovation – CMS Innovation Center Highlights – December 2024
National Institutes of Health

The NIH has published its assessment of the risk posed by bird flu (H5N1 avian influenza A virus (HPAI H5N1)).  Learn more from this NIH news release.

Congressional Budget Office (CBO)

The CBO has published its assessment of how increased use of gene therapy treatment for sickle cell disease could affect federal spending in the coming years.  Find that report here.

Stakeholder Events

CMS – Home Health, Hospice, and Durable Medical Equipment Open Door Forum – January 8

CMS will hold an open-door forum for home health, hospice, and durable medical equipment providers on Wednesday, January 8 at 2:00 (eastern).  Go here to register to participate.

CMS – Hospital Open Door Forum – January 14

CMS will hold a hospital open-door forum on Tuesday, January 14 at 2:00 (eastern).  Go here to register to participate.

MedPAC – Commissioners Meeting – January 16-17

MedPAC’s commissioners will hold their next public meeting virtually on Thursday, January 16 and Friday, January 17.  An agenda and information about how to participate are not yet available but when they are they will be posted here.

CMS – Physicians, Nurses, and Allied Health Open Door Forum – January 16

CMS will hold an open-door forum for physicians, nurses, and allied health professionals on Thursday, January 16 at 2:00 (eastern).  Go here to register to participate.

MACPAC – Commissioners Meeting – January 23-24

MACPAC’s commissioners will hold their next public meeting virtually on Thursday, January 23 and Friday, January 24.  An agenda and information about how to participate are not yet available but when they are they will be posted here.

CMS – Rural Health Open Door Forum – January 23

CMS will hold an open-door forum for rural health care providers and organizations on Thursday, January 23 at 2:00 (eastern).  Go here to register to participate.

CMS – Long-Term Services and Support Open Door Forum – January 28

CMS will hold an open-door forum for providers of long-term services and supports on Tuesday, January 28 at 2:00 (eastern).  Go here to register to participate.