The following is the latest health policy news from the federal government for June 29-July 5.  Some of the language used below is taken directly from government documents.

Department of Health and Human Services
  • Because it has found that Medicare Advantage organizations sometimes deny prior authorization requests for post-acute care after a qualifying hospital stay even though the requests met Medicare coverage rules, HHS’s Office of the Inspector General will examine selected Medicare Advantage plans’ processes for reviewing prior authorization requests for post-acute care in long-term acute-care hospitals, inpatient rehabilitation facilities, and skilled nursing facilities. It also will review the extent to which the selected Medicare Advantage plans denied requests for post-acute care and examine the care settings to which patients were discharged from the hospital.  Learn more here.
  • Following the Supreme Court’s decision in Moyle v. United States, HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure sent a letter to hospital and provider associations reminding them that it is a hospital’s legal duty, under the Emergency Medical Treatment and Labor Act (EMTALA), to offer necessary stabilizing medical treatment (or transfer, if appropriate) to all patients in Medicare-participating hospitals who are found to have an emergency medical condition. Learn more from this HHS news release, which includes the letter.
  • HHS and its Health Resources and Services Administration (HRSA) have published a notice informing the public of the availability of the complete lists of all geographic areas, population groups, and facilities designated as primary medical care, dental health, and mental health professional shortage areas (HPSAs) as of April 15, 2024. The lists are available on the shortage area topic page on HRSA’s website.  All currently designated HPSAs remain designated until final lists are published later this fall.  Learn more from this HHS notice.
  • HRSA has published a notice of funding opportunity to evaluate, develop, and expand the use of technology-enabled collaborative learning and capacity-building models for health care providers and other professionals to improve retention of health care providers and increase access to health care services. HRSA will award approximately $3.8 million to up to eight new cooperative groups over a period of five years.  Learn more about the funding, what it covers, and eligibility criteria from this notice of funding opportunity.  The deadline for submitting applications is August 2.  HRSA will hold a technical assistance webinar on the program and the application process on Monday, July 8 at 4:00 (eastern); join that webinar here.
  • HRSA provided more than $200 million to support 42 programs across the country aimed at improving care for older Americans, including those experiencing Alzheimer’s disease and related dementias. HRSA’s Geriatrics Workforce Enhancement Program will train primary care physicians, nurse practitioners, and other health care clinicians to provide age-friendly and dementia-friendly care for older adults.  The program also focuses on providing families and other caregivers of older adults with the knowledge and skills to help them best support their loved ones.  Learn more from this HHS news release, which includes a link to a list of the funding recipients.
  • HHS, through its Biomedical Advanced Research and Development Authority (BARDA), will provide $176 million to Moderna to develop an mRNA-based pandemic influenza vaccine for public health emergencies such as avian influenza A (H5N1). Learn more about this contract and why it was awarded from this HHS news release.
Centers for Medicare & Medicaid Services
  • CMS has issued a proposed rule, “Medicare Program: Mitigating the Impact of Significant, Anomalous, and Highly Suspect Billing Activity on Medicare Shared Savings Program Financial Calculations in Calendar Year 2023,” that is part of its effort to address “significant, anomalous, and highly suspect billing within ACO reconciliation.”  Recently, CMS reports observing an increase in durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) billing to Medicare for selected intermittent urinary catheter supplies in 2023 that could adversely affect the accuracy, fairness, and integrity of Shared Savings Program financial calculations.  In this proposed rule, CMS calls for excluding payments for the two HCPCS codes on DMEPOS claims submitted by any supplier from expenditure and revenue calculations used for assessing performance year 2023 financial performance of Shared Savings Program ACOs; establishing benchmarks for ACO starting agreement periods in 2024, 2025, and 2026; and calculating factors used to determine revenue status and repayment mechanism amounts in the application and change request cycles for ACOs applying to enter a new agreement period beginning on January 1, 2025 or to continue their participation in the program in performance year 2025.  The purpose of this rule is to protect providers from financial penalties caused by fraudulently submitting claims for the catheters in question.  CMS notes that the modifications of the Shared Savings Program financial methodology in this proposed rule would delay by up to six weeks issuance of initial determinations and disbursements of earned performance payments for performance year 2023.  Learn more from this CMS fact sheet and the proposed rule.  The deadline for stakeholders to submit comments is July 29.  Additional information will be forthcoming in the agency’s proposed 2025 physician fee schedule.
  • CMS has posted a bulletin describing changes to the laboratory national coverage determination edit software that will take effect in October of this year. The bulletin includes newly available codes, recent code changes, and information about how to find NCD coding information.  Find the bulletin here.
  • CMS has posted a bulletin with the expanded diabetes screening and diabetes definitions policy update for the calendar year 2024 physician fee schedule final rule. The update includes the revised definition of diabetes, revised diabetes screening frequency limitations, and information about coverage of the hemoglobin A1c (HbA1c) test for diabetes screening.  Find the bulletin here.
  • CMS has updated its fact sheet for providers on Medicare Part D-covered vaccines. Find the updated fact sheet here.
  • CMS has issued a request for applications from the states for a voluntary model – the Cell and Gene Therapy Access Model – to test whether a CMS-led approach to developing and administering outcomes-based agreements for cell and gene therapies would improve Medicaid beneficiary access to innovative treatment, improve health outcomes for Medicaid beneficiaries, and reduce health care expenditures. The focus of the model is on the treatment of sickle cell disease.  Learn more about the model, including the role CMS envisions for providers in states’ proposals, from this CMS request for applications.  The deadline for states to submit applications to participate in the model is February 28, 2025.
  • Most of CMS’s new price transparency requirements for hospitals took effect on Monday, July 1. Those requirements are summarized in this CMS FAQ.
  • CMS has issued a reminder to hospitals participating in the Medicare Promoting Interoperability Program that they are required to report on six electronic clinical quality measures (eCQMs) for the calendar year 2024 reporting period. This includes three self-selected eCQMs plus the Safe Use of Opioids – Concurrent Prescribing measure, Severe Obstetric Complications measure, and the Cesarean Birth measure.  Learn more about the required reporting from this CMS notice.
  • CMS has updated its Electronic Clinical Quality Measure (eCQM) Data Element Repository to provide information on eCQMs used in CMS quality reporting and incentive programs for the calendar year 2025 reporting and performance periods. Learn more here.
  • Connecticut, Maryland, and Vermont will be the first states to participate in the Center for Medicare and Medicaid Innovation’s (CMMI) States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. CMMI’s goal in the AHEAD Model is to collaborate with states to curb health care cost growth, improve population health, and advance health equity by reducing disparities in health outcomes.  CMMI will support participating states through various AHEAD Model components that seek to increase investment in primary care, provide financial stability for hospitals, and support beneficiary connection to community resources.  Learn more about the first participants and the program from this CMS announcement and the AHEAD web page.
  • CMS is asking the Office of Management and Budget (OMB) for permission to revise the CMS-855A Medicare enrollment application, the purpose of which is to gather information from certified providers or certified suppliers that tells the agency who the providers are, whether they meet certain qualifications to be a health care provider, where they practice or render services, the identity of their owners, and other information necessary to establish correct claims payments. Learn more about the data CMS currently collects, its intended use, and the administrative burden CMS anticipates from this CMS announcement.  The deadline for stakeholders to submit comments is August 2.
  • CMS is asking the OMB for permission to continue, without change, certain data collection requirements for graduate medical education affiliated groups – hospitals that share medical residents – through form CMS-10326. Learn more about the data CMS currently collects, its intended use, and the administrative burden CMS anticipates from this CMS announcement.  The deadline for stakeholders to submit comments is September 3.
HHS Newsletters
  • CMS – MLN Connects – July 3
  • AHRQ News Now – July 2
  • HRSA eNews – July 5  (includes funding opportunities)
Congressional Budget Office (CBO)
  • The CBO has a panel of health advisors with a variety of backgrounds, areas of expertise, and experience that it consults on issues throughout the year. The agency has just announced its 2024 appointees to the panel.  Learn more about the panel and its work and the 2024 appointees from this CBO notice.
  • The CBO has prepared a presentation that describes some of the factors it considers when assessing the budgetary effects of policies that would change Medicare’s coverage of telehealth. It also discusses areas of research that would help inform CBO’s analyses.  Find the CBO presentation here.
Stakeholder Events

CMS – Physicians, Nurses, and Allied Health Professionals Open Door Forum – July 11

CMS will hold an open-door forum for physicians, nurses, and allied health professionals on Thursday, July 11 at 2:00 (eastern).  Go here to register to participate.

HHS/Health Resources and Services Administration – National Telehealth Conference – July 16

HHS’s Health Resources and Services Administration (HRSA) will hold a virtual national telehealth conference on Tuesday, July 16 from 9:30-5:00 (eastern).  Conference topics will include licensing across state lines to increase access to behavioral health care; implications of health policy to inform telehealth’s future; expanding access to services for underserved and low-income communities; exploring health care innovations and future telehealth technologies; and improving health equity through expansion of broadband connectivity and adoption of telehealth.  Go here to learn more about the conference and to register to participate.

CDC – Update for Clinicians on Highly Pathogenic Avian Influenza A – July 16

The CDC will present an update for clinicians and health centers on the highly pathogenic avian influenza A (H5N1) virus on Tuesday, July 16 at 2:00 (eastern).  The session will offer an update on the current outbreak in the U.S. and CDC surveillance and monitoring efforts and provide information for clinicians and others on testing, using antivirals, and infection prevention and control recommendations.  Learn more about the session, how to participate, and continuing education credits available for physicians, nurses, pharmacists, and others from this CDC notice.

CMS – Rural Health Open Door Forum – July 18

CMS will hold an open-door forum for rural health care providers on Thursday, July 18 at 2:00 (eastern).  Go here to register to participate.

CMS – Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests – July 25-26

CMS’s Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests will hold public meetings on Thursday, July 25 and Friday, July 26.  The panel advises the Secretary of the Department of Health and Human Services and the CMS Administrator on issues involving clinical diagnostic laboratory tests.  Learn more about the meetings and how to participate from this CMS notice.

CMS – Skilled Nursing Facility/Long-Term Care Open Door Forum – July 25

CMS will hold an open-door forum for skilled nursing facility and long-term care facility operators on Thursday, July 25 at 2:00 (eastern).  Go here to register to participate.

CMS – Long-Term Services and Supports Open Door Forum – July 30

CMS will hold an open-door forum for long-term services and supports providers on Tuesday, July 30 at 2:00 (eastern).  Go here to register to participate.

CMS – Post-Acute Care Health Equity Confidential Feedback Report Listening Session – July 31

CMS will hold a listening session on Wednesday July 31 at 2:00 (eastern) to discuss the 2023 Health Equity Confidential Feedback Reports, which were released to post-acute-care providers in home health, inpatient rehabilitation facility, long-term-care hospital, and skilled nursing facility settings.  The goal of the listening session is to gather feedback from providers and stakeholders on the post-acute care health equity confidential feedback to guide the development of this report in the future.  Go here to learn more about the listening session and to register to participate.

CMS – 2024 “Rural Health Hackathon” – August 14, 22, and 29

In August CMS and its Center for Medicare and Medicaid Innovation will hold a series of collaborative sessions, to be held in person, designed to generate and develop creative and actionable ideas to address rural health challenges.  The event seeks to build on CMS’s outreach to rural communities through site visits and listening sessions to better understand rural health care issues.  At these sessions CMS will bring together rural health community care providers, community organizations, industry and tech entrepreneurs, funders, policy experts, and beneficiaries to attempt to take advantage of the collective experience and expertise of participants to generate new ideas to address some of the top challenges affecting health care in rural health settings and drive action to improve clinical outcomes, increase access, and foster a better care experience for patients and providers in rural communities.  Hackathon events will be held in person on August 14 in Bozeman, Montana; on August 22 in Dallas; and on August 29 in Wilson, North Carolina.  Learn more about the event, including how to participate in person or submit ideas virtually, from this CMS announcement.

CMS – National Provider Compliance Conference – August 7-8

CMS will hold its National Provider Compliance Conference on Wednesday, August 7 and Thursday, August 8.  The conference will bring together Medicare Administrative Contractors (MACs) and program integrity experts to provide compliance professionals with the information and tools they need to efficiently and effectively submit Medicare Part A, Part B, home health, hospice, and durable medical equipment claims.  The target audience is anyone who processes Medicare Part A and Part B, home health, hospice, or DME claims, including physicians, non-physician practitioners, billing specialists, suppliers, associations, coders, and medical review contractors.  Go here to learn more about the conference and to register to participate in the virtual event.  The deadline for registering is July 31.