The following is the latest health policy news from the federal government for December 23 through January 5. Some of the language used below is taken directly from government documents.
No Surprises Act
- HHS, the Department of Labor, and the Department of the Treasury have announced increases in the administrative fee for initiating the No Surprises Act’s Independent Dispute Resolution (IDR) process and for certified IDR entities. Learn more about the administrative fee change here and about the certified IDR entity fee change here. Both changes took effect on January 1.
- HHS, the Department of Labor, and the Department of the Treasury have released their initial report on the No Surprises Act’s IDR process. This report includes information on the number of disputes initiated; the number of disputes closed; the types of parties engaged in disputes; the types of services under dispute; and the states in which disputed items and services were provided. The report notes that the process is being used far more often than federal officials anticipated and documents the backlog of disputes that still await resolution. Go here to find the report, which the agencies note is incomplete and will be updated at a later date.
Centers for Medicare & Medicaid Services
- CMS has issued guidance on a way for states to address unmet health-related social needs for Medicaid beneficiaries. This option will help states offer alternative benefits, such as housing and nutrition assistance, through the use of a service or setting that is provided to an enrollee in lieu of a service or setting covered under their state’s Medicaid plan to address a range of unmet health-related social needs to help enrollees maintain their coverage and improve their health outcomes. Learn more from this CMS news release and this letter from CMS to state Medicaid directors.
- CMS has issued guidance that creates an easier path to specialty care for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. For the first time ever, state Medicaid and CHIP programs will be able to pay specialists directly when a beneficiary’s primary health care provider asks for advice. For example, if a pediatrician consults with a specialty behavioral health provider about a specific patient’s needs, both providers may be reimbursed for their care – even if the patient is not present. This move to pay for interprofessional consultations seeks to link routine care with specialty care, enabling more people to benefit from practitioners with specialized knowledge. Learn more from this CMS news release and the guidance letter CMS sent to state Medicaid directors about this subject.
- CMS has published information about changes in coinsurance for physicians, hospitals, and other providers billing Medicare for additional procedures related to colorectal screening of Medicare patients. Find it here.
- CMS has updated its Medicare provider reimbursement manual. Find the updated manual here, with changes indicated in red.
- CMS has published updated information for providers submitting Medicare claims for end-stage renal disease and acute kidney injury services they provide in calendar year 2023. Find the update here, with changes marked in red.
- The deadline for Medicare-eligible hospitals and critical access hospitals to register and submit their calendar year 2022 electronic health record data for the CMS Medicare Promoting Interoperability Program is February 28. Learn more about the program and how to submit data and find links to additional resources from this CMS notice.
- CMS has published the latest edition of MLN Connects, its online newsletter about Medicare reimbursement matters. The latest edition includes information about new codes for ambulatory surgical center billing, updated skilled nursing facility codes, the extension of the rural add-on payment for home health visits, new claims modifiers for home oxygen treatment, and more. Find it here.
- CMS has sent a memo to state Medicaid directors giving them additional guidance on a provision in the American Rescue Plan Act of 2021 that makes a 100 percent federal medical assistance percentage (FMAP) match temporarily available for Medicaid services received through certain urban Indian organizations and certain native Hawaiian health care providers. Find the memo here.
Department of Health and Human Services
- HHS’s Office for Civil Rights has proposed restoring a previous process for handling conscience complaints in the delivery of health care and providing additional safeguards to protect against conscience and religious discrimination. In 2019, the Office of Civil Rights issued a regulation that provided broad definitions, created new compliance regulations, and created a new enforcement mechanism for a number of statutes related to the conscience rights of certain federally funded health care entities and providers but that rule was held unlawful by three federal district courts. This proposed rule seeks to rescind partially the 2019 rule while reinforcing other processes previously in place for handling conscience and religious freedom complaints. Learn more about the proposed rule from this HHS news release and this detailed HHS notice of proposed rulemaking, which also links to the Federal Register notice. The deadline for submitting comments is March 6.
- HHS’s Health Resources and Services Administration (HRSA) has begun issuing final repayment notices to recipients of Provider Relief Fund payments that are required to repay funds. Providers that would like to dispute HRSA’s request for repayment may request a decision review. Learn more from the Provider Relief Fund’s Repayment and Debt Collection web page.
- HRSA is seeking input from the public on the design, implementation, and evaluation of its Healthy Start program. Learn more about the specific aspects of the program for which HRSA seeks comment from this notice, which also includes a link to a formal Federal Register announcement. The deadline for submitting comments is February 3.
- Last November, HRSA sought public comment on recommendations under development by the Bright Futures Pediatric Implementation Program regarding updates to HRSA-supported preventive services guidelines for infants, children, and adolescents in the Bright Futures Periodicity Schedule. The proposed updates addressed increasing the upper age limit for HIV screening. After receiving public comment, HRSA has now updated that schedule. Learn more about the program and the recently adopted changes from this HRSA announcement, which also links to a Federal Register notice.
- Last November, HRSA detailed and sought public comment on recommendations under development by the Women’s Preventive Services Initiative regarding updates to the HRSA-supported Women’s Preventive Services Guidelines. The proposed updates addressed screening for diabetes in pregnancy and screening for diabetes after pregnancy. After receiving public comment HRSA has now updated these guidelines. Learn more about the program and the recently adopted changes from this HRSA announcement, which also links to a Federal Register notice.
- HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) seeks public comment on its initial revised draft of an update of the Certification Criteria for Certified Community Behavioral Health Clinics (CCBHCs). CCBHCs are required to provide a comprehensive array of coordinated services to anyone who requests care for mental health or substance use, regardless of ability to pay, place of residence, or age. In light of significant developments in the CCBHC program and in the broader mental health and substance use disorder field since the development of the current criteria, SAMHSA now seeks to make minor revisions to the criteria. To learn more about SAMHSA’s effort and find links to the current criteria, proposed updates, and a Federal Register notice of this effort, go here. The deadline for submitting comments is January 20.
- SAMHSA has released the results of its annual National Survey on Drug Use and Health, which shows how people living in America reported their experience with mental health conditions, substance use, and pursuit of treatment in 2021. The report includes selected estimates by race, ethnicity, and age group. Learn more from this SAMHSA news release, including a summary of key findings, and find the report and accompanying resources here.
- HHS’s Agency for Healthcare Research and Quality (AHRQ) and the Patient-Centered Outcomes Research Institute (PCORI), which was created by the Affordable Care Act, are inviting applications from qualified institutions to create Learning Health System Embedded Scientist Training and Research Centers to support the professional development of scientists to conduct research that accelerates progress towards an integrated learning health system. Learn more about the program from this funding opportunity notice. Grants will range up to $1 million a year for up to five years. Letters of intent are due by February 10 and applications are due by March 24.
- AHRQ has published a comparative effectiveness review of the use of telehealth during the COVID-19 era. Go here for an overview of the report and links to the entire analysis.
- AHRQ has published the comparative effectiveness review report “Improving Rural Health Through Telehealth-Guided Provider-to-Provider Communication.” Go here for links to the report and other report-related resources.
- AHRQ seeks nominations of individuals to serve as members of the U.S. Preventive Services Task Force. The task force is an independent body of experts in prevention and evidence-based medicine and works to improve the health of Americans by making evidence-based recommendations about the effectiveness of clinical preventive services and health promotion. Learn more about the task force and the background it seeks from prospective members from this notice, which also includes a link to a formal Federal Register announcement. The deadline for nomination is March 15.
- HHS has amended the Public Readiness and Emergency Preparedness Act (PREP Act), which authorizes the Secretary of Health and Human Services to issue a declaration to provide liability immunity to certain individuals and entities against any claim of loss caused by, arising out of, relating to, or resulting from the administration or use of medical countermeasures, except for claims that meet the PREP Act’s definition of willful misconduct. Specifically, it has extended current liability immunity in three areas of endeavor: botulinum toxin, countermeasures against pandemic influenza, and zika virus.
Centers for Disease Control and Prevention
- The CDC has issued a health advisory to notify clinicians and public health authorities of a recent increase in pediatric invasive group A streptococcal (iGAS) infections. These increases are occurring in the setting of increased circulation of respiratory syncytial virus (RSV), influenza viruses, COVID-19, and other respiratory viruses. The advisory includes background information about iGAS and offers recommendations for providers (about diagnosis, treatment, and when and how to address cases with public health laboratories and state governments), laboratories, state health departments, and the public and directs stakeholders to additional resources for further information. Learn more from this CDC health alert.
Medicaid and CHIP Payment and Access Commission
- The U.S. Government Accountability Office (GAO) is inviting nominations for individuals to become MACPAC commissioners later this year. MACPAC reviews Medicaid and CHIP access and payment policies and advises Congress on issues affecting Medicaid and CHIP. The deadline for submitting nominations is January 26. Learn more from this announcement, which includes a link to the Federal Register notice.
- MACPAC has published an issue brief in which it presents estimates of 2019 Medicaid base payments and supplemental payments to skilled nursing facilities across states compared to facility costs. Find the issue brief here.
MedPAC – January 12-13
The Medicare Payment Advisory Commission will meet virtually on Thursday, January 12 and Friday, January 13. The meeting will be divided into three sessions for which stakeholders must register separately. Go here to see the meeting agenda, learn what issues will be addressed during each session, and find links to register to participate.
MACPAC – January 26-27
The Medicaid and CHIP Payment and Access Commission will hold a public meeting on Thursday, January 26 and Friday, January 27. An agenda for the meeting and information about joining it are not yet available but when they are they will be posted here.