The following is the latest health policy news from the federal government as of 2:30 p.m. on Friday, February 25.  Some of the language used below is taken directly from government documents.

Provider Relief Fund

  • HHS made more than $560 million in Provider Relief Fund (PRF) Phase 4 General Distribution payments to more than 4100 providers across the country this week.  According to HHS, approximately 86 percent of all Phase 4 applications have now been processed and the remaining applications will continue to be processed throughout early 2022.  To date, HHS has distributed $11.5 billion of the $17 billion allocated for Provider Relief Fund Phase 4 payments.  Learn more about this distribution and find links to state-by-state breakdowns of Provider Relief Fund and American Rescue Plan rural hospital distributions from this HHS news release.

The Courts

  • A federal court in Texas has rejected a major aspect of HHS’s implementation of the No Surprises Act, the 2020 law intended to protect consumers from surprise medical bills for out-of-network services.  In the independent dispute resolution process established by the act and implemented in the regulation, HHS calls for arbiters in dispute resolution proceedings to weigh a defined “qualifying payment amount” more heavily in their deliberations.  The court, however, concluded that “Nothing in the Act… instructs arbitrators to weigh any one factor or circumstance more heavily than the others.”   The court wrote that “It is a ‘core administrative-law principle that an agency may not rewrite clear statutory terms to suit its own sense of how the statute should operate.’”  The court therefore vacated the portion of the regulation that requires arbiters to weigh the qualifying amount more heavily when adjudicating payment disputes between payers and providers.  Learn more from the court’s opinion in this case.

White House

  • President Biden has signed a continuation of the National Emergency for COVID-19.  This declaration remains in effect for one year or until revoked.  This is separate from an extension of the public health emergency,
  • The White House has announced a series of measures to ensure that people with disabilities and older adults have equitable access to COVID-19 testing, masks, and other critical mitigation strategies.  Those measures are:
  • equipping schools with guidance and support to keep vulnerable students safe and learning in-person
  • expanding HHS’s Administration for Community Living’s Disability Information and Access Line to support people with disabilities who face difficulty using or cannot use a self-test
  • launching new COVID-19 testing guidance in American Sign Language and reviewing all existing COVID-19 guidance to confirm accessibility for all disabled individuals
  • executing a new effort to develop at-home COVID-19 tests that are accessible to all
  • creating incentives for at-home test manufacturers to prioritize accessibility of those tests
  • requesting accessible instructions from manufacturers that have received FDA emergency use authorizations
  • distributing masks to disabled individuals through community-based organizations and jurisdictions
  • calling on states to directly distribute high-quality masks through community-based organizations serving individuals with disabilities.

Centers for Medicare & Medicaid Services

Health Policy Update

  • CMS and its Center for Medicare and Medicaid Innovation (CMMI) have announced the creation the ACO Realizing Equity, Access, and Community Health (REACH) Model, which they describe as a redesign of their Global and Professional Direct Contracting (GPDC) Model.  The new ACO REACH Model will adhere to the following priorities:  a greater focus on health equity and closing disparities in care; an emphasis on provider-led organizations and strengthening beneficiary voices to guide the work of model participants; stronger beneficiary protections through ensuring compliance with model requirements; increased screening of model applicants and increased monitoring of model participants; greater transparency and data-sharing on care quality and financial performance of model participants; and stronger protections against inappropriate coding and risk score growth.  At the same time CMS announced the creation of this new model it also posted a request for applications to solicit participants for the ACO REACH Model.  Learn more about this development from the following resources:

Applications are due by April 22.

  • At the same time CMS introduced this new model it also announced that it is canceling its Geographic Direct Contracting Model, also known as the “Geo Model,” effective immediately.  The Geo Model was announced in December of 2020 but paused in March of 2021.
  • In March of 2021, CMMI announced a one-year delay in releasing a request for applications for the Accountable Care Organization Transformation Track of its Community Health Access and Rural Transformation (CHART) Model.  Now, CMS reports that it is developing an agency-wide vision and strategy for accountable care, including opportunities to increase ACO adoption in rural areas. In light of these broader efforts, CMMI has removed the ACO Transformation Track from the CHART Model as of February 2022.  Learn more here.
  • CMS has posted updated Supplemental Security Income data used in the calculation of the Medicare disproportionate share (Medicare DSH) adjustments for inpatient prospective payment system hospitals (short-term and long-term acute-care hospitals (LTCHs)) and the low-income patient adjustment for inpatient rehabilitation facilities.  Find the additional information and links to the updated data in the notice here.
  • CMS has posted the latest edition of MLN Connects, its online newsletter with information about Medicare reimbursement matters.  The new edition includes information about ICD-10 code changes, revisions of a national coverage determination for home use of oxygen, skilled nursing center and ESRD web pricers, and more.  Go here to see the February 24 installment of MLN Connects.
  • CMS has hired a contractor to develop a Skilled Nursing Facility Value-Based Purchasing Program scoring methodology that ties SNF payments to the quality of care provided across several domains of care.  This contractor engages groups of stakeholders and experts who contribute direction and input on the scoring methodology for the expansion of the program.  To this end, CMS is seeking individuals to serve on its technical expert panel for the scoring methodology for the expansion of the skilled nursing facility value-based purchasing program who can bring to the undertaking some combination of clinical expertise on SNF quality/safety improvement, statistical/methodological expertise, SNF quality measure expertise, health care disparities expertise, a SNF stakeholder perspective, and SNF patient or family (caregivers) perspective.  Nominations will be accepted until March 16.  Go here to learn more about the technical expert panel and its objectives.

Department of Health and Human Services

Health Policy Update

  • HHS’s Agency for Healthcare Research and Quality is soliciting public input on a draft strategic framework for its future investments in patient-centered outcomes research dissemination and implementation projects.  Find the draft framework and more in this Federal Register notice.  Comments are due April 19.

Centers for Disease Control and Prevention

National Institutes of Health

  • People from all major racial and ethnic minority population groups in the U.S. report experiencing more COVID-19-related discrimination than white adults, a new study shows.  COVID-19-related discrimination includes experiences of being threatened or harassed based on someone’s perception of another having COVID-19.  Learn more from this NIH news release.

Stakeholder Events

CMS – RFI on Medicaid and CHIP – March 1

On February 17, CMS published a request for information on access to care and coverage for people enrolled in Medicaid and CHIP.  On Tuesday, March 1 at 3:30 p.m. (eastern), the agency will hold a webinar discuss with stakeholders its objectives in issuing the RFI and the process for submitting responses.  Go here to register to participate.

MedPAC – commissioners meeting – March 3 and 4

MedPAC will hold four virtual sessions on Thursday, March 3 and Friday, March 4.  Participation will be limited.  Go here to see the agendas for each session and to find instructions on how to join those sessions.

HHS/CMMI – Updates to the Innovation Center Kidney Models – March 3

CMMI will host a webinar on Wednesday, March 2, 2022 at 3:00 p.m. (eastern) to share updates on several of its kidney care models.  This webinar is available to the first 1,000 registrants.  Go here to learn more and find out how to register.

CMS – Emerging Technologies – March 31

CMS will hold public listening sessions on transitional coverage for emerging technologies on Thursday, March 31, also at 3:00 (eastern).  The purpose of these sessions is to obtain feedback to help inform CMS’s development of an alternative coverage pathway to provide transitional coverage for emerging technologies following the repeal of the January 2021 Medicare Coverage of Innovative Technology and Definition of “Reasonable and Necessary” final rule.  For additional information about the listening sessions and to register to participate, go here.