The following is the latest health policy news from the federal government for November 17-30. Some of the language used below is taken directly from government documents.
No Surprises Act
CMS has released two new FAQs to provide guidance in advance of the Independent Dispute Resolution portal reopening for batched disputes and air ambulance disputes; that service remains temporarily suspended. These FAQs together explain how certified IDR entities may determine whether a dispute is appropriately batched in light of recent court rulings; provide information about policy for extending existing IDR deadlines once the federal IDR portal reopens to all batched disputes and single disputes involving air ambulance services; will enable disputing parties to submit new batched disputes and new single disputes involving air ambulance services; and will enable certified IDR entities to resume rendering eligibility and payment determinations on batched disputes and single disputes involving air ambulance services initiated on or before August 3, 2023. Learn more from this CMS announcement, which includes links to the new FAQs.
Centers for Medicare & Medicaid Services
- CMS finalized new hospital price transparency requirements in its calendar year 2024 hospital outpatient prospective payment system and ambulatory surgical center payment system final rule. Beginning on July 1, 2024, hospitals will be required to adopt a CMS template layout for the machine-readable file (MRF) and encode their standard charge information using the CMS technical specifications and data dictionary. To help hospitals meet these new requirements, the agency has launched a new resource where users can find the CMS MRF templates and technical instructions and get technical support. Find that new CMS resource here.
- Clinical Laboratory Improvement Amendments (CLIA) regulations require a facility to be certified for each test it performs. CMS edits laboratory claims at the CLIA certificate level to ensure that Medicare and Medicaid only pay for laboratory tests in a facility with a valid, current CLIA certificate. Now, CMS has published a notice listing the latest tests approved by the FDA as waived tests under CLIA. The notice includes HCPCS codes for the new tests with the modifier needed so they will be recognized as waived tests. Find the CMS bulletin here. The changes take effect on January 1.
- CMS has awarded 200 new graduate medical education (GME) residency slots to 99 qualifying hospitals to enhance the health care workforce and fund additional positions in hospitals serving underserved communities. This is the second round of the 1000 new Medicare-funded medical residency positions authorized under section 126 of the Consolidated Appropriations Act of 2021. Learn more about the new slots from this CMS announcement.
- CMS has published a bulletin with a diagnosis code update for add-on payments for blood-clotting factor administered to hemophilia patients. Find the bulletin here. The changes will take effect on April 1, 2024.
- CMS has published a bulletin describing edits to prevent payment of GG2211 with office/outpatient evaluation and management visits coded with modifier 25. Under complexity add-on code GG2211, Medicare will pay separately starting on January 1 and will not pay when providers report an associated office/outpatient evaluation and management visit with modifier 25. Find the bulletin here.
- CMS has announced changes in its intravenous immune globulin demonstration program, which was launched in 2014. The demonstration will end after December 31 and CMS will change how Medicare pays for the service. Learn more from this CMS bulletin.
- CMS has announced changes in its repetitive, scheduled non-emergent ambulance transport prior authorization model. Among the changes, the agency has clarified program criteria and addressed HCPCS codes subject to prior authorization. Learn more from this CMS bulletin.
- CMS is adding 41 new procedure codes to the ICD-10-PCS effective April 01, 2024. Find the new codes here.
- CMS has released guidance documents and tools to help states prepare for the end of the Medicaid continuous enrollment. These resources include two state health official letters: “Promoting Continuity of Coverage and Distributing Eligibility and Enrollment Workload in Medicaid, the Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) Upon Conclusion of the COVID19 Public Health Emergency” (SHO #22-001, dated March 3, 2022) and “Medicaid Continuous Enrollment Condition Changes, Conditions for Receiving the FFCRA Temporary FMAP Increase, Reporting Requirements, and Enforcement Provisions in the Consolidated Appropriations Act, 2023 (SHO #23-002, dated January 27, 2023). Now, CMS has published FAQs on these letters and related CMS guidance. Find the FAQs here.
- CMS has published a summary of the Medicare physician fee schedule final rule for calendar year 2024. Find it here. The changes take effect on January 1.
- CMS has published a summary of changes in its end-stage renal disease (ESRD) prospective payment system and payments for dialysis furnished for acute kidney injury in ESRD facilities for calendar year 2024. Find the summary here. The changes take effect on January 1.
- CMS has published a summary of changes in the clinical laboratory fee schedule for 2024. The bulletin describes changes in the data reporting period, mapping for new test codes, updates for costs subject to the reasonable charge payment, and fee schedule updates. Find the summary here. The changes take effect on January 1.
- CMS released a new toolkit to help providers share information about Medicaid and Children’s Health Insurance Program (CHIP) renewals with patients. The toolkit includes information on how to help patients transition to other health coverage options if they are no longer eligible for Medicaid or CHIP. Find the toolkit here.
Department of Health and Human Services
- HHS has published the Federal Medical Assistance Percentages (FMAP), the rate at which it will match state expenditures from October 1, 2024, through September 30, 2025 for Medicaid, the Children’s Health Insurance Program (CHIP), and other selected health- and child welfare-related programs. Find the FY 2025 rates in this HHS notice.
- The COVID-19 Provider Relief Fund reporting portal is now open for providers that have been approved to submit a late report for reporting period 5. Those providers must return unused funds to HHS’s Health Resources and Services Administration (HRSA) within 30 days of submitting their report. The deadline for late reporting for reporting period 5 is December 2. Learn more here.
- As part of an executive order to strengthen the country’s supply chains, lower selected costs, and secure sectors of the economy, a new executive order signed by President Biden will broaden HHS’s authority under the Defense Production Act to enable investment in domestic manufacturing of essential medicines, medical countermeasures, and other critical inputs, including $35 million for investment in domestic production of key starting materials for sterile injectable medicines. Learn more from this HHS news release.
- A new report by HHS’s Office of the Inspector General (OIG) has concluded that the risk of misuse and diversion of buprenorphine for opioid use disorder in Medicare Part D continued to appear low in 2022, as it had in 2021. Learn more from this report.
- Another audit by HHS’s OIG has found that multiple states made Medicaid capitation payments to managed care organizations after enrollees’ death. Learn more from this summary of the OIG audit, which includes a link to the complete report.
- HHS and its Health Services Administration (SAMHSA) have issued notices of funding opportunities for more than $74 million in grants to address behavioral health challenges in local communities by preventing substance use initiation, reducing the progression of substance use, and addressing other related concerns. The money will be distributed through four grant programs: Grants for Expansion and Sustainability of the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances ($30.4 million); Tribal Behavioral Health ($13.1 million); Strategic Prevention Framework – Partnerships for Success for States ($15.5 million); and Strategic Prevention Framework – Partnerships for Success for Communities, Local Governments, Universities, Colleges, and Tribes/Tribal Organizations ($15.5 million). Private sector organizations are eligible only for the latter; the application deadline for those grants is February 21. Learn more about the grants and find links to the individual grant programs and their notices of opportunity announcements in this HHS news release.
- HHS’s Office of Information Security and its Health Sector Cybersecurity Coordination Center have published alerts on three cyberthreats that target health care organizations: Emotet Malware, NetScaler ADC (formerly Citrix ADC) and NetScaler Gateway (formerly Citrix Gateway), and FortiSIEM.
- CMS – MLN Connects – November 22 and November 30
- AHRQ News Now – November 28
- HRSA eNews – November 16
Centers for Disease Control and Prevention
In the wake of a shortage of RSV vaccine for infants, the CDC has released more than 77,000 additional doses of the vaccine. Learn more about the vaccine and how the new doses will be distributed from this CDC news release.
Cybersecurity & Infrastructure Security Agency
The Cybersecurity and Infrastructure Security Agency, the FBI, and the Multi-State Information Sharing and Analysis Center have released a joint cybersecurity alert about known Rhysida ransomware IOCs and TTPs identified through investigations as recently as September of 2023. Rhysida, an emerging ransomware variant, has primarily been deployed against the education, health care, manufacturing, information technology, and government sectors since May 2023. Learn more from this introduction to the Rhysida alert, which includes a link to a more detailed report.
CMS – Medicaid and CHIP Renewals –December 6
HHS and CMS have been holding a series of monthly webinars on Medicaid and CHIP renewals to educate partners. Topic covered vary each month. The final webinar will be held on Wednesday, December 6 at noon (eastern) Go here to register to participate and go here for recordings, transcripts, and slides from past webinars.
HHS – Agency for Healthcare Research and Quality – Webinar on Child HCAHPS Survey – December 6
HHS’s Agency for Healthcare Research and Quality will hold a webinar on its consumer assessment of healthcare providers and systems child hospital survey database and narrative items on Wednesday, December 6 at 1:00 (eastern). Speakers will provide an overview of the Consumer Assessment of Healthcare Providers and Systems Child Hospital Survey (Child HCAHPS Survey), including highlights from current data, steps for and benefits of future participation, and details about the new narrative item set. Go here to learn more about the webinar and to register to participate.
MedPAC – December 7-8
The Medicare Payment Advisory Commission will hold its next public meeting on Thursday, December 7 and Friday, December 8. The meeting’s agenda and information about how to participate virtually have not yet been released but when they are they will be posted here.
CMS – Town Hall Meeting on FY 2025 Applications for New Medical Services and Technologies Add-On Payments – December 13-14
CMS will hold a virtual town hall meeting on Wednesday, December 13 and Thursday, December 14 during which organizations representing hospitals, physicians, manufacturers, and other interested parties may present comments, recommendations, and data to CMS’s clinical staff about whether individual services or technologies represents a substantial clinical improvement. The meeting will include a discussion of the substantial clinical improvement criteria for the FY 2025 applications for new technology add-on payments. Learn more about the meeting, why it is being held, what it will address, and how to participate from this CMS notice.
MACPAC – December 14-15
The Medicaid and CHIP Payment and Access Commission will hold its next public meeting on Thursday, December 14 and Friday, December 15. The meeting’s agenda and information about how to participate virtually have not yet been released but when they are they will be posted here.
CMS – Hospital Price Transparency Webinar – January 17
To help hospitals prepare for meeting new requirements for price transparency, CMS will hold a webinar on Wednesday, January 17 at 2:00 (eastern) to review the new requirements; to present examples of how to encode machine-readable file standard charge information in the template layout CMS will require hospitals to use; and to demonstrate its “GitHub” repository. Go here to register to participate.