The following is the latest health policy news from the federal government for June 14-20.  Some of the language used below is taken directly from government documents.

No Surprises Act

HHS and the departments of Labor and the Treasury have announced a policy that offers extra time to health care providers whose desire to engage in No Surprises Act adjudication of payment disagreements with payers was affected by the Change Healthcare cybersecurity attack.  Under this temporary policy,  providers, facilities, and providers of air ambulance services whose ability to initiate timely No Surprises Act open negotiation for any item or service furnished on or after January 1, 2024 was affected by the Change Healthcare cybersecurity incident may choose to initiate No Surprises Act-related open negotiation for such items or services at any point during the 120-calendar-day period beginning on June 14 and ending on October 12 regardless of when the payment or notice of denial of payment and disclosures were transmitted.  Parties may take advantage of this exception period by attesting that their ability to initiate timely open negotiation for an item or service was affected by the cybersecurity incident.  Learn more from this HHS announcement.

Change Healthcare Cyberattack

CMS has announced that payments under the Accelerated and Advance Payment Program for the Change Healthcare/Optum payment disruption will end on July 12.  Launched in early March, the payments were designed to ease cash flow disruptions experienced by some Medicare providers and suppliers due to the unprecedented cyberattack that took health care electronic data interchange Change Healthcare offline in February.  While CMS will continue to monitor the situation for additional aftereffects of the cyberattack, providers that continue to have related problems should contact either Change Healthcare or their Medicare Administrative Contractor (MAC).  Learn more about the termination of the program and how to contact Change Healthcare or MACs from this CMS news release.

Department of Health and Human Services
  • CMS should strengthen program safeguards to prevent and detect improper Medicare payments for short inpatient stays, HHS’s Office of the Inspector General concludes in a new report.  According to the report, hospitals continue to bill as inpatient stays short-term admissions that do not qualify as inpatient stays under Medicare’s two-midnight rule.  Find the OIG report here.
  • HHS and its Substance Abuse and Mental Health Services Administration (SAMHSA) have published notices of $31 million in funding opportunities aimed at improving behavioral health for racial and ethnic minorities, and other underserved populations, providing training and technical assistance to programs serving these populations, and integrating primary and behavioral health care.  The programs support SAMHSA’s priorities of preventing substance use and overdoses; enhancing access to suicide prevention and mental health services; promoting resilience and emotional health for children, youth, and families; integrating behavioral and physical health care; and strengthening the behavioral health workforce.  Learn more about the five notices of funding opportunities and find links to those opportunities with information about eligibility criteria and how to apply from this HHS news release.  Each of the funding programs has its own deadline for submitting applications; those deadlines range from July 8 to July 22.
  • A study by researchers from HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA), CMS, and the NIH examines care following non-fatal overdoses among Medicare beneficiaries, with the study identifying effective interventions and gaps in care.  Learn more about the study from this HHS news release, which includes a link to the complete report, which was published in JAMA Internal Medicine.
  • HHS’s Office of the Assistant Secretary for Planning and Evaluation (ASPE) has published an issue brief on state agency, provider, and consumer experiences amid Medicaid home- and community-based services section 1915 (c) waiver policy flexibilities during the COVID-19 public health emergency.  Find the issue brief here.
  • HHS’s Office of the Inspector General (OIG) has issued a favorable opinion regarding assistance, including travel, lodging, meals, and associated expenses, provided by a pharmaceutical manufacturer to qualifying patients receiving its gene therapy product and their caregivers.  Find that opinion here.
  • HHS’s OIG has updated its audit workplan for the month of June.  Go here to learn about the newly scheduled audits.
  • The Biomedical Advanced Research and Development Authority (BARDA), part of the Administration for Strategic Preparedness and Response (ASPR) within HHS, has awarded $500 million in Project NextGen funding to plan and execute multiple Phase 2b clinical trials evaluating novel vaccines administered as a nasal spray or as a pill to protect against symptomatic COVID-19.  Learn more about the grant recipients and what they are expected to do with these federal funds from this HHS announcement.
Centers for Medicare & Medicaid Services
  • CMS has posted a bulletin presenting a July 2024 update of Medicare’s ambulatory surgical center payment system.  Find the bulletin here.  The updated fee schedule takes effect on July 1.
  • CMS has posted a bulletin presenting the July 2024 quarterly update of Medicare’s durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule.  Find the bulletin here.  The updated fee schedule takes effect on July 1.
  • CMS has contracted with a vendor to develop, reevaluate, and support the implementation of several maternal health measures and the expansion of CMS’s birthing-friendly hospital designation.  To support this effort, the vendor will convene stakeholders and experts on a technical expert panel to contribute direction and input on its work and analysis.  This panel will be engaged to inform two maternal health projects:  the expansion of CMS’s maternal morbidity structural measure and the expansion of CMS’s birthing-friendly hospital designation.  To this end, CMS is seeking individuals with differing perspectives and areas of expertise, such as clinical experts in maternal care, chairs of obstetrical/gynecologic departments, hospital administrators (including chief quality officers or other hospital quality administrators), perinatal quality improvement experts, health equity and birth justice experts, statistical and performance measurement experts, and consumer/patient/family (caregiver) experts.  Learn more about this technical expert panel, the time commitment involved in participation, and how to submit nominations from this CMS notice.  The deadline for submitting applications is July 12.
  • CMS has issued a bulletin to state Medicaid programs providing examples of state Medicaid information technology expenditures to improve access to and coordination of treatment and support services for Medicaid beneficiaries with mental health conditions and/or substance use disorders that may qualify for enhanced federal matching rates.  The bulletin also reminds state Medicaid agencies how to apply for enhanced Medicaid matching rates for these types of expenditures.  Find the bulletin here.
  • CMS has published a notice of funding opportunity for states to participate in its Innovation in Behavioral Health (IBH) Model.  This model is an eight-year, voluntary program focused on improving behavioral and physical health outcomes and quality of care for people with Medicaid and Medicare who experience moderate to severe behavioral health conditions.  The model seeks to bridge the gap between behavioral and physical health by enabling specialty behavioral health practices to integrate behavioral health with physical health care and health-related social needs.  The IBH Model is a state-based model, to be led by state Medicaid agencies, with a goal of aligning payment between Medicaid and Medicare for integrated care.  Learn more from this CMS announcement and this notice of the funding opportunity.  The deadline for states to submit applications for funding is September 9.
HHS Newsletters
  • CMS – MLN Connects – June 20
  • AHRQ News Now – June 18
  • HRSA eNews – June 7 (includes funding opportunities)
  • HHS Health Sector Cybersecurity Coordination Center and its Office of Information Security – May Vulnerability Bulletin
Centers for Disease Control and Prevention

The CDC has issued a health alert informing public health officials, clinicians, and affected patients, their families, and caregivers about potential disrupted access to care among individuals taking prescription stimulant medications and possible increased risks for injury and overdose.  On June 13, 2024, the U.S. Department of Justice announced a federal health care fraud indictment against a large subscription-based telehealth company that provides ADHD treatment to patients ages 18 years and older.  Patients who rely on prescription stimulant medications to treat their ADHD and have been using this or other similar subscription-based telehealth platforms could experience a disruption of their treatment and disrupted access to care.  A disruption involving this large telehealth company could affect as many as 30,000 to 50,000 patients ages 18 years and older across all 50 states.  This potential disruption coincides with an ongoing prescription drug shortage involving several stimulant medications commonly prescribed to treat ADHD.  Learn more about this situation and its implications from this CDC health alert.

Medicare Payment Advisory Commission (MedPAC)
  • MedPAC has written to the Senate Finance Committee in response to that committee’s white paper titled “Bolstering Chronic Care Through Physician Payment:  Current Challenges and Policy Options in Medicare Part B.”  Go here to see MedPAC’s letter, which includes a link to a chapter in MedPAC’s June 2024 report to Congress that addresses this issue.
  • MedPAC has posted a report it commissioned with an updated analysis, using population-based outcome measures, to assess the impact of telehealth expansion on Medicare beneficiaries’ access to care and quality of care.  Find that report here.
  • The GAO has appointed two new members to MedPAC and reappointed four others.  Learn more from this GAO announcement.
Congressional Budget Office (CBO)
  • At a recent conference of the American Society of Health Economists, the CBO offered a presentation on spending for the 340B program.  The presentation was based on data from the Health Resources and Service Administration (HRSA) and measured 340B spending from 2010 to 2021 and examined factors associated with changes in spending over time.  The data on which the presentation is based measures 340B spending by National Drug Code, by the type of facility where drugs were prescribed, and by whether drugs were distributed through a contract pharmacy.  It also considers factors underlying the increase in 340B spending.  Find the CBO presentation here.
  • The CBO has published updated baseline projections of the uninsured rates, Medicare and Medicaid enrollment, enrollment in employer-based and marketplace insurance, and federal subsidies for health insurance coverage from 2024 through 2034.  Learn more from this CBO summary of its analysis and this CBO presentation delivered at a press briefing about the agency’s projections.
  • The CBO has published an initial analysis of the potential federal budgetary effects of policies that would increase treatment of hepatitis C.  The analysis focuses on two sample national policies that would increase treatment rates among Medicaid enrollees.  Find the CBO report here.  At the same time, the CBO also called for research on the effectiveness of outreach and other efforts to increase hepatitis C testing, treatment initiation, and adherence among targeted populations; the costs of treating hepatitis C with direct-acting antiviral medications; and the costs of treating complications from hepatitis C if the disease is untreated.  Find the CBO’s call for this research here.
Stakeholder Events

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.

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.

CMS – Hospital Open Door Forum – July 16

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

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.