The following is the latest health policy news from the federal government for June 13-19.  Some of the language used below is taken directly from government documents.

Congress

The Senate Finance Committee

The Senate Finance Committee has released its portion of the FY 2025 budget reconciliation bill.  Major proposals include:

  • A freeze on the size of Medicaid provider taxes, phased down reductions of current taxes toward a new, lower limit for many states, and new terms under which provider taxes can be approved.
  • New limits on the use of Medicaid state directed payments so they eventually will not exceed 100 percent of Medicare payments in Medicaid expansion states and 110 percent of Medicare payments in non-expansion states.
  • A “community engagement” requirement, typically work but with some alternatives, for most Medicaid participants but with some exceptions to the requirement.
  • More frequent eligibility redetermination for Medicaid participants in Medicaid expansion states.
  • Medicaid cost-sharing for Medicaid expansion participants whose income exceeds 100 percent of the federal poverty level.
  • A limit of 30 days of retroactive eligibility for newly approved Medicaid and CHIP participants.
  • Limits on eligibility for marketplace premium tax credits Medicare and Medicaid for some non-legal residents and reduced federal Medicaid matching funds for states that enroll such individuals in their Medicaid programs.
  • Reduced federal Medicaid matching funds for Medicaid-covered emergency services for non-legal residents.
  • More frequent income verification for those seeking marketplace premium tax credits.

In addition, the Senate Finance Committee’s proposal does not call for extending the current delay of reduced Medicaid disproportionate share (Medicaid DSH) allotments to the states and does not call for increasing Medicare payments to physicians.

Learn more about the Senate Finance Committee’s proposed portion of the Senate’s reconciliation bill from this Senate Finance Committee’s bill overview; its section-by-section summary; and the text of the bill.

FY 2025 Budget Reconciliation

Republican members will determine the ultimate content of the Senate’s reconciliation bill.  While many of those Republican senators protested that the House bill went too far in cutting Medicaid, in some respects the Senate Finance Committee calls for even more stringent cuts.  While Senate majority leader Thune’s goal is for the Senate to pass its reconciliation bill before its July 4 recess, it is unclear whether that timeline will hold in light of some of the remaining sticking points that need to be addressed if the bill is to be passed by a Senate majority party that can afford to lose only three of its members in the final vote.  Ultimately, the House and Senate will need to work out the differences between their respective proposals – another challenging undertaking.

Centers for Medicare & Medicaid Services
  • CMS has announced the expansion of access to care for American Indian and Alaska Native communities through its approval of Medicaid state plan amendments in several states.  Indian Health Service and Tribal clinics in these states are now authorized to provide Medicaid clinic services beyond the physical clinic site, including in homes, schools, and other appropriate community locations as a result of “four wall exceptions.”  Learn more from this CMS news release and from the state plan amendments approved for the states of Minnesota, New Mexico, Oregon, South Dakota, Washington, and Wyoming.
  • CMS has published a bulletin presenting its updated policies for Medicare-covered colorectal cancer screening and hepatitis B vaccines.  Find the bulletin here.  The revised policies’ implementation date is October 6.
  • In a brief essay published on LinkedIn, Center for Medicare and Medicaid Innovation director Abe Sutton has outlined the strategy he and the agency intend to pursue in the immediate future.  Find the commentary here.
  • CMS has requested permission from the Office of Management and Budget (OMB) to revise the Medicare cost report CMS-2552-10 to add two worksheets:  one addressing a payment adjustment for hospitals for establishing and maintaining access to a buffer stock of essential medicines and another for a payment adjustment for maintaining a stock of domestic NIOSH-approved surgical N-95 respirators.  Go here to learn more about the proposed request, which has not yet passed OMB review.
  • CMS has announced updates of its Nursing Home Compare program.  Go here for an overview of the changes and a link to CMS’s letter to state survey agencies presenting those changes.
  • CMS has updated its information about available waivers to help health care providers in specific counties in Georgia affected by Hurricane Helene.  Find that information here.
  • CMS has added the following items to its Quality Payment Program resource library.  All of these links are direct downloads of zip files.
Approved Medicaid State Plan Amendments and State-Directed Medicaid Payments

CMS has approved the following state plan amendments for Medicaid and CHIP programs.

  • To Pennsylvania, establishing a new class of supplemental payments to qualifying Medicaid-enrolled freestanding children’s hospitals located in a city of the first class.
  • To Kansas, updating Early and Periodic Screening, Diagnosis and Treatment (EPSDT) rates for selected audiology services.
  • To Illinois, transitioning the safety-net hospital obstetrical program from a state plan authority to a directed payments authority.
  • To Illinois, authorizing licensed certified professional midwives who provide maternal health services to be eligible to receive quality incentive add-on payments for postpartum care visits.
  • To Illinois, authorizing licensed certified professional midwives who provide maternal health services to be eligible to receive quality incentive add-on payments for postpartum care visits.
  • To Oklahoma, reducing the SoonerSelect choice period from 60 days to 30 days and clarifying that members covered under the SoonerPlan program for family planning visits are excluded from the ABP and SoonerSelect.
HHS Newsletters, Reports, and Videos
  • CMS – MLN Connects – June 18
  • AHRQ News Now – June 17
  • CMS’s Electronic Quality Improvement (eCQI )Resource Center has posted two videos:  one highlighting the eCQM standards involved in the eCQM cycle, discussing emerging eCQM standards, and exploring their challenges and opportunities; and a second video describing the resources available through the resource center.  Learn more about the videos and find links to them here.
  •  CMS has posted the video “CMS MTF DM DE Enrollment Guide” that explains the Medicare Transaction Facilitator Data Module enrollment process for dispensing entities.  The Medicare Transaction Facilitator will be the mechanism through which pharmacies and dispensing entities will connect with pharmaceutical companies to receive rebates on prescription drugs they sell for which Medicare has negotiated lower prices under the Inflation Reduction Act of 2022.  Find that video here.
  • CDC – Morbidity and Mortality Weekly Report – “Clade II Mpox Infections Among Cruise Ship Passengers and Crew Members — United States, 2024” – June 19
Centers for Disease Control and Prevention (CDC)

The CDC has added new resources to its “Be Ready for Measles” toolkit.  Intended primarily for state and local health agencies, the toolkit includes fact sheets, social media graphics, and videos for the public and outbreak-related response tools for clinicians and other public health professionals.  Find the updated toolkit here.

Congressional Research Service

The Congressional Research Service has published a brief paper describing the potential implications of a provision in the House’s reconciliation bill that would provide indefinite appropriations for reimbursement to private health plans that provide cost-sharing reductions to their members.  Find that paper here.

Stakeholder Events

CMS – CMS Quality Conference – July 1-2

CMS will hold a quality conference on Tuesday, July 1 and Wednesday, July 2.  Go here for the conference agenda, an FAQ, and to register to participate; participation in the conference in person, in Baltimore, is now closed but individuals may still participate virtually.