The following is the latest health policy news from the federal government for June 7-13.  Some of the language used below is taken directly from government document.

Supreme Court

The Supreme Court has agreed to hear a challenge to how the Department of Health and Human Services calculates hospitals’ Medicare disproportionate share (Medicare DSH) payments.  The case was added to the court’s 2024-2025 schedule.

Congress

Individual members and key committees in Congress continue to introduce and mark up health care-related legislation with an eye toward including these initiatives in an end-of-year package.  This work is expected to continue through the end of July, when Congress breaks for a six-week recess.

  • Members of Congress have re-introduced updated legislation to improve Medicare Advantage plans’ handling of prior authorization requests.  This bill is based on legislation first introduced in 2019 and again in 2022.  This bill, like its predecessors, has wide bipartisan support in the House and Senate.  According to the Regulatory Relief Coalition, the Improving Seniors’ Timely Access to Care Act of 2024 would:
    • Establish an electronic prior authorization process for Medicare Advantage plans, including standardization for transactions and clinical attachments.
    • Increase transparency around Medicare Advantage prior authorization requirements and their use.
    • Provide a pathway for CMS to institute real-time decisions for routinely approved items and services in the future and clarify CMS’s authority to establish time frames for e-prior authorization requests, including expedited determinations and real-time decisions for routinely approved items and services and other prior authorization requests.
    • Expand beneficiary protections to improve enrollee experiences and outcomes.
    • Require HHS and other agencies to report to Congress on program integrity efforts and other ways to improve the e-prior authorization process.

Find the bill text here.

  • Yesterday the House Energy and Commerce Committee unanimously passed 13 health bills that may now be considered by the full House – again, likely at the end of the year.  Those bills include legislation to create a billing code for mental health services provided by telehealth; to provide funding for autism research and care; to improve maternal and fetal health; and more.  Read more about the markup and the bills considered here.
Centers for Medicare & Medicaid Services
  • CMS has sent a memo to state governments providing them with additional tools to improve their monitoring and oversight of managed care in Medicaid and CHIP.  This guidance also reminds states of Medicaid managed care and separate CHIP mental health and substance use disorder parity requirements.  Find that memo here.
  • CMS has posted 2025 ICD-10 Procedure Coding System (ICD-10-PCS) files with information on ICD-10-PCS updates for FY 2025.  These 2025 ICD-10-PCS codes are for discharges occurring from October 1, 2024 through September 30, 2025.  Find the FY 2025 downloadable files here.
  • CMS has posted a bulletin presenting its quarterly update of the Healthcare Common Procedure Coding System (HCPCS) codes used for skilled nursing facility consolidated billing enforcement.  Find the bulletin here.  The changes it describes take effect on October 1.
  • CMS and its eCQI Resource Center have posted updated value set guidance regarding the Concepts with Logical Observation Identifiers, Names and Codes (LOINC) status “discouraged” on the Value Set Information page.  The guidance includes an overview of LOINC concepts with the status of “discouraged” and information for value set authors on mapping these concepts and finding remapped code.  Learn more from the Value Set Information page and learn more about value sets from the Value Set Authority Center.
  • CMS invites public comment on the use and burden associated with the collection of generic data it requires of health care entities encompassing 50 distinct areas for which the agency currently collects data.  CMS is already authorized to collect this data and is now seeking authority to continue doing so.  Learn more about the data CMS collects under these categories and the collection authority it seeks to retain from this CMS notice.  Stakeholder comments are due by August 12.
  • CMS invites public comment on the use and burden associated with the collection of data used to ascertain whether Medicare Advantage plans have established adequate provider networks and that the participants in those networks have appropriate access to care and to the benefits to which they are entitled.  Learn more from this CMS notice.  The deadline for submitting comments is July 10.
  • CMS invites public comment on the use and burden associated with the data it collects on the home office of Medicare providers – offices that typically furnish central management and administrative services such as centralized accounting, purchasing, personnel services, management direction and control, and other services.  Learn more from this CMS notice.  The deadline for submitting stakeholder comments is August 12.
  • CMS invites public comment on the use and burden associated with the following information collection:  CMS-10003 – Notice of Denial of Medical Coverage (or Payment); CMS-10146 – Notice of Denial of Medicare Prescription Drug Coverage; and CMS-R-240 – Prospective Payments for Hospital Outpatient Services and Supporting Regulations.  Learn more from this CMS notice.  The deadline for submitting comments is August 9.
Department of Health and Human Services
  • HHS and its Health Resources and Services Administration (HRSA) have awarded more than $11 million to 15 organizations to establish new residency programs in rural communities.  Award recipients will each receive up to $750,000 over three years to establish new rural residency programs and will use this funding to support accreditation costs, curriculum development, faculty recruitment and retention, resident recruitment activities, and consultation services for program development.  Learn more about the funding and how it will be used and find a list of the recipients in this HHS news release.
  • HHS has issued five reports showing gains in health care coverage and highlighting increases in coverage among minority communities since the implementation of the Affordable Care Act’s coverage provisions.  In support of increasing those gains, HHS is making available $500 million in grants over the next five years for “navigators”:  individuals and entities that help people across the country, especially in underserved areas, find and enroll in health insurance.  Learn more about the coverage gains and find links to the five reports in this HHS news release.  For information about the first round of navigator grants see this CMS grant opportunity notice; the agency will award $100 million in grants for the first year, with individual first-year grants of up to $16 million.  The deadline for submitting grant applications is July 8.
  • HHS’s Office of Assistant Secretary for Planning and Evaluation (ASPE) has published a report on changes in ownership of skilled nursing facilities from 2016 through 2021.  The report describes variations by size, occupancy rate, penalty amount, and type of ownership.  Learn more about the report here.
  • HHS’s Agency for Healthcare Research and Quality (AHRQ) intends to publish a notice of funding opportunity to create “state-based healthcare extension cooperatives” that can accelerate the dissemination and implementation of patient-centered outcome research evidence into practice.  In addition, AHRQ intends to publish two related notices of funding opportunities, for a National Coordinating Center and a National Evaluation Center, to support AHRQ initiatives that seek to accelerate the dissemination and implementation of patient-centered outcome research evidence through improvements in health care policy, payment, and practice and to reduce health care disparities, especially among people who receive Medicaid, are uninsured, and are medically underserved.  Learn more about what AHRQ seeks and eligibility to participate from this explanation of the agency’s intention to post a notice of funding opportunity in the near future.
  • HHS’s Health Sector Cybersecurity Coordination Center and its Office of Information Security have issued a sector alert addressing prevention of unauthorized access for Snowflake, which is a managed software service that provides a single platform for data warehousing, data lakes, data engineering, data science, data application development, and secure sharing and consumption of real-time/shared data.   In early June, Snowflake observed an increase in cyber threats targeting accounts on its cloud data platform.  The sector alert describes the nature of the threat and lists several hundred IP addresses from which suspicious activity is originating.  Learn more from this sector alert.
  • HHS’s Office of the National Coordinator for Health Information Technology (ONC) has opened its annual comment period for its Interoperability Standards Advisory.  This year the agency is launching a new interoperability standards platform to house its Interoperability Standards Advisory and all its other important standards initiatives, including the United States Core Data for Interoperability (USCDI), USCDI+, Standards Version Advancement Process, and others.  Learn more about the annual comment period and the subjects on which ONC invites comment from this ONC announcement.  The deadline for submitting stakeholder comments is August 12.
HHS Newsletters
Centers for Disease Control and Prevention
  • High-risk patients with COVID-19 symptoms should use PCR rather than rapid tests, the CDC advises in a “Morbidity and Mortality Weekly Report.”  Find that report here.
National Institutes of Health

The NIH will spend approximately $30 million during fiscal years 2024 and 2025 to pilot a national primary care research network that integrates clinical research with community-based primary care.  The new initiative, called “Communities Advancing Research Equity for Health,” or “CARE for Health,” seeks to improve access to clinical research to inform medical care, especially for those in communities historically underrepresented in clinical research or underserved in health care.  CARE for Health will seek to grow an evidence base that contributes to improved patient outcomes, community access to the best available scientific research, and expanded opportunities to participate in clinical trials and studies.  Learn more from this NIH news release and the program’s web page.

Medicare Payment Advisory Commission (MedPAC)

MedPAC has submitted its mandated annual report to Congress in which it recommends improvements to Medicare payment systems and addresses issues affecting the Medicare program, including changes to health care delivery and the market for health care services.  The six chapters of the June 2024 report cover the following topics:

  • Approaches for updating clinician payments and creating incentives for participation in alternative payment models.  MedPAC considers two approaches for updating fee-for-service Medicare’s physician fee schedule payment rates and contemplates temporarily extending the bonus for participation in advanced alternative payment models.
  • Provider networks and prior authorization in Medicare Advantage.MedPAC discusses the use of provider networks and prior authorization in Medicare Advantage plans, CMS’s regulation of these tools, and the data Medicare Advantage plans currently report in these areas.
  • Assessing data sources for measuring health care utilization by Medicare Advantage enrollees.  Using data from 2020 and 2021, MedPAC assesses the relative completeness of Medicare Advantage encounter data and other data sources that contain information about Medicare Advantage enrollees’ use of services.
  • Paying for software technologies in Medicare.  MedPAC reviews the FDA’s process for clearing software as a medical device, examines Medicare’s current coverage process and payments for medical device software under the payment systems for Part A and Part B services, and discusses issues that policymakers should keep in mind when considering paying for medical software in fee-for-service Medicare.
  • Considering ways to lower Medicare payments for selected conditions in inpatient rehabilitation facilities.  MedPAC considers alternative approaches to lower fee-for-service Medicare’s payment rates to inpatient rehabilitation facilities for beneficiaries with selected conditions.
  • Medicare’s Acute Hospital Care at Home.  MedPAC assesses the experience to date of hospitals and beneficiaries in the fee-for-service Medicare Acute Hospital Care at Home program and reviews considerations for Medicare policy.

Learn more from MedPAC’s June 2024 Report to the Congress:  Medicare and the Health Care Delivery System.

Medicaid and CHIP Payment and Access Commission (MACPAC)

MACPAC has issued its mandated June 2024 report to Congress on Medicaid.  The report consists of four chapters that include:

  • Recommendations to require states to collect and publicly report information on the sources of non-federal share of Medicaid spending, including financing methods, state-level financing amounts, and provider-level financing amounts.
  • Steps toward better coordination of care for people who are dually eligible for Medicaid and Medicare and recommendations for how states can optimize and oversee state Medicaid agency contracts with Medicare Advantage Dual Eligible Special Needs Plans (D–SNPs).
  • Information about Medicare savings programs, MACPAC’s prior work analyzing participation rates in such programs, and previous MACPAC recommendations that seek to improve participation in the Medicare savings programs.
  • A review of demographic data collection in Medicaid, key considerations for collecting such data, and factors affecting data quality.

Learn more from MACPAC’s June 2024 “Report to Congress on Medicaid and CHIP.”

Stakeholder Events

NIH – Addressing the Influence of Interpersonal Biases on Health Outcomes and Disparities – June 16-17

The NIH and the National Institute on Minority Health and Health Disparities will hold a two-day event addressing the influence of interpersonal biases on health outcomes and disparities on Monday, June 17 and Tuesday, June 18 from 12:30 to 5:30 (eastern) both days.  The workshop brings together subject matter experts for presentations and discussions about the impact of exposure to interpersonal biases on health.  The workshop’s objectives are to enhance the understanding of mechanisms and pathways linking interpersonal bias exposure to adverse health outcomes and to inform participants about the current state of the science and identify research gaps and opportunities.  It also will explore strategies for future research toward mitigating the influence of bias exposure on health outcomes and downstream disparities.  Go here to learn more about the event and register to participate.

CMS – Annual Public Meeting About New and Reconsidered Clinical Diagnostic Laboratory Test Codes for 2025 – June 25

CMS will hold a public meeting on Tuesday, June 25 at 9:00 (eastern) to receive comments and recommendations on the appropriate basis for establishing payment amounts for new or substantially revised Healthcare Common Procedure Coding System codes being considered for Medicare payment under the Clinical Laboratory Fee Schedule for calendar year 2025.  This meeting also will provide a forum for those who submitted certain reconsideration requests regarding final determinations made last year on new test codes and for the public to provide comment on the requests.  Go here to learn more about the meeting, including how to submit information and questions and register to participate.

CMS – Home Health, Hospice, and DME Open Door Forum – June 26

CMS will hold an open-door forum for home health, hospice, and durable medical equipment operators on Wednesday, June 26 at 2:00 (eastern).  Go here to register to participate.

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

The Department of Health and Human Services’ 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.

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.