The following is the latest health policy news from the federal government for March 13-16. Some of the language used below is taken directly from government documents.
Medicare Payment Advisory Commission (MedPAC)
MedPAC has published its “March 2023 Report to the Congress: Medicare Payment Policy.” In this year’s report MedPAC considers the context of the Medicare program, including the near-term consequences of COVID-19 and the longer-term effects of program spending on the federal budget and the program’s financial sustainability. It evaluates payment adequacy and make recommendations concerning Medicare payment policy in 2024 for selected fee-for-service payment systems but explains that it has discontinued its practice of offering rate recommendations for long-term-care hospitals (LTCHs) and ambulatory surgical centers, citing inadequate data on which to base recommendations. It offers recommendations to redistribute current Medicare disproportionate share hospital (Medicare DSH) and uncompensated care payments and to provide additional resources to Medicare safety-net hospitals and clinicians who furnish care to Medicare beneficiaries with low incomes. Finally, MedPAC reviews the current state of the Medicare Advantage program (Part C) and its prescription drug program (Part D).
MedPAC’s rate recommendations to Congress and the administration, which it approved at its January 2023 meeting and which are not binding, are:
- Outpatient and inpatient prospective payment systems – under current law, the estimated increase would be about 2.9 percent; MedPAC proposes 2.9 percent plus one percent.
- MedPAC has discontinued its practice of offering rate recommendations for long-term-care hospitals (LTCHs) and ambulatory surgical centers, citing inadequate data on which to base recommendations.
- Physician services – increase fees 50 percent of the projected increase in the medical economic index (MEI).
- Skilled nursing facilities – reduce the current base rate three percent.
- Home health services – reduce the current base rate seven percent.
- Hospice services – a complex proposal to increase some payments 2.9 percent but to reduce payments “for providers with very long lengths of stay and lost costs relative to payments.”
- Outpatient dialysis – MedPAC endorses the current law’s call for a 1.8 percent increase.
Medicaid and CHIP Payment and Access Commission (MACPAC)
- MACPAC has published its March 2023 “Report to Congress on Medicaid and CHIP.” The report focuses on four subjects: Medicaid race and ethnicity data collection and reporting; principles for assessing Medicaid nursing facility payment programs; strengthening evidence under Medicaid drug coverage; and MACPAC’s statutorily required review of hospital payment policy for the nation’s safety-net hospitals – specifically, to report on Medicaid disproportionate share hospital (Medicaid DSH) allotments to states. The report states that “As in prior years, the Commission continues to find little meaningful relationship between state DSH allotments and the number of uninsured individuals; the amounts and sources of hospitals’ uncompensated care costs; and the number of hospitals with high levels of uncompensated care that also provide essential community services for low-income and uninsured populations.” Find the report here.
- MACPAC has updated its issue brief “Medicaid Base and Supplemental Payments to Hospitals.” Find it here.
Centers for Medicare & Medicaid Services
- As authorized by last year’s Inflation Reduction Act, CMS has issued initial guidance detailing the requirements and parameters of key elements of the new Medicare Drug Price Negotiation Program for 2026, the first year negotiated prices will apply. This initial guidance addresses how Medicare intends to use its new authority to negotiate with drug companies for lower prices on selected high-cost drugs. Learn more from the following resources:
- A CMS news release.
- The formal CMS guidance memo.
- The CMS document “Drug Price Negotiation Timeline for 2026,” which describes the timeline for drug price negotiations.
- CMS’s “Fact Sheet: Medicare Drug Price Negotiation Program Initial Guidance.”
- The pre-publication version of a Federal Register notice to be published on March 17.
The deadline for stakeholders to submit comments on the approach CMS proposes is April 14.
- The Inflation Reduction Act also requires drug companies to pay rebates to Medicare when prescription drug prices increase faster than the rate of inflation for certain drugs furnished to people with Medicare. This new inflation rebate applies to Medicare Part B rebatable drugs, which are single-source drugs and biological products, including certain biosimilar biological products, beginning on January 1, 2023. CMS has posted an explanation of how this will work and a list of the drugs to which this will apply and their reduced, inflation-adjusted coinsurance percentages. Learn more from the following resources:
- A CMS news release.
- CMS’s “Fact Sheet: Medicare Prescription Drug Inflation Rebate Program Initial Guidance.”
- The CMS document “Reduced Coinsurance for Certain Part B Rebatable Drugs under the Medicare Prescription Drug Inflation Rebate Program,” which includes a list of drugs to which this program will apply this year.
- CMS’s “Fact Sheet: Medicare Prescription Drug Inflation Rebate Program Part B Rebatable Drug Coinsurance Reduction.”
- CMS’s “Inflation Rebates in Medicare” web page, which offers a series of documents about the program.
- CMS has provided state governments with updated interpretive guidance to give state surveyors a
consistent approach for assessing hospitals’ quality performance, patient safety, and overall quality of care. The purpose of such assessments is for surveyors to determine whether hospitals have effective, ongoing systems in place for identifying problem events, policies, or practices and are acting to remedy the problems they identify. Find the CMS memo here.
- CMS has published the latest issue of MLN Connects, its online newsletter with information about Medicare reimbursement matters. The new edition includes features on changes in the use of the DR and CR coding modifiers after the public health emergency ends; information about billing for split and shared critical care visits; coding changes for behavioral health integration services and selected Medicare preventive health services; and more. Find it here.
- In anticipation of the March 31 deadline for providers to submit their Merit-based Incentive Payment System (MIPS) data for the 2022 performance year, CMS has published a data submission user guide. Find it here.
- HHS’s Agency for Healthcare Research and Quality (AHRQ) has published a special edition of AHRQ News Now, its weekly online newsletter, that focuses on patient safety. Find it here.
- AHRQ also has published its regular weekly edition of AHRQ News Now, with articles on health care disparities in insurance coverage among mothers at the time of birth, precision medicine, and its plan to fund substance abuse research. Find it here.
Department of Health and Human Services
- In connection with the COVID-19 public health emergency, HHS’s Office of the Inspector General has issued policy statements and answered questions from stakeholders as part of a broader effort to provide flexibility and minimize burdens for the health care industry as it faced the pandemic’s challenges. With the public health emergency now expected to end on May 11, the Office of the Inspector General intends for its COVID-19-related policy statements to expire at that time. Learn more about the subjects the policy statements addressed and what they did from this Office of the Inspector General notice.
- HHS and its Health Resources and Services Administration (HRSA) have announced the availability of approximately $25 million to expand primary health care, including mental health services, in schools. Applicants will be required to add or expand mental health services to receive school-based funding. HRSA-funded health centers currently operate more than 3,400 school-based service sites in schools across the country. Learn more from this HHS announcement and this HRSA notice about the funding opportunity. The deadline for submitting applications is March 31.
- HHS and its Substance Abuse and Mental Health Services Administration (SAMHSA) have awarded $1 million each to 15 states as one-year Certified Community Behavioral Health Clinic (CCBHC) planning grants. Beginning next year, up to 10 of these states will participate in the CCBHC Medicaid demonstration program and receive enhanced Medicaid reimbursement. CCBHCs were created to transform mental health and substance use treatment and provide sustainable funding for robust community outpatient mental health treatment that includes seeing people in crisis immediately; providing routine outpatient care within 10 business days after initial contact; ensuring access to a comprehensive range of services; providing care coordination when needed and incorporating evidence-based practices; and providing other supports based on a community needs assessment. CCBHCs are required to serve anyone who requests care for mental health or substance use regardless of their ability to pay, place of residence, or age, including developmentally appropriate care for children and youth. See which states were awarded planning grants and learn more about the CCBHC program from this HHS news release.
Provider Relief Fund
The Provider Relief Fund reporting portal is now open for reporting period 4. Providers that received a Provider Relief Fund general or targeted and/or American Rescue Plan Rural payment(s) exceeding $10,000 in the aggregate between July 1, 2021 and December 31, 2021 are required to report on their use of those funds during reporting period 4. The deadline to submit a report is March 31. Go here to learn more.
Food and Drug Administration
- The FDA has published detailed information about the continuation of policies and actions it implemented in response to the COVID-19 public health emergency (PHE) and the status of these policies and actions when that PHE ends, which is currently expected to be on May 11. This information identifies policies that will no longer remain in effect once the PHE officially ends; those that will remain in effect for 180 days after the end of the PHE; those that will remain in effect for 180 days after the PHE ends while the FDA works to revise them; and those that are not tied to the PHE and will remain effect. Learn more from this FDA announcement, which includes a list of individual policies and their status and a link to a formal Federal Register notice.
- The FDA has amended its emergency use authorization of the Pfizer COVID-19 bivalent vaccine to provide for a single booster dose of the vaccine in children six months through four years of age at least two months after completion of primary vaccination with three doses of the monovalent (single strain) Pfizer COVID-19 vaccine. Learn more about this policy and additional information about this vaccine from this FDA announcement.
- The FDA has revised its Janssen COVID-19 vaccine fact sheet for health care providers to include a warning that reports of adverse events following use of the vaccine suggest increased risks of myocarditis and pericarditis; that facial paralysis, including Bell’s Palsy, has been reported; and that the scope of authorization for a booster dose of the Janssen COVID-19 vaccine has been revised to reflect that the vaccine may be administered as a first booster dose at least two months after completion of primary vaccination with an authorized or approved COVID-19 vaccine. Learn more from this FDA news release.
- The FDA has revoked its emergency use authorization for three COVID-19 tests. Learn more from this announcement, which includes a link to a formal Federal Register notice.
Centers for Disease Control and Prevention
- The CDC is seeking nominations for membership on its Board of Scientific Counselors. This board consists of 17 experts knowledgeable in fields relevant to the issues addressed by CDC’s infectious disease national centers, laboratory practice, research, diagnostics, microbiology, immunology, molecular biology, bioinformatics, infectious disease modeling and outbreak analytics, health policy/communications, and industry. Learn more about the board and how to submit nominations from this CDC notice, which includes a link to a formal Federal Register announcement. The deadline for submitting nominations is April 14.
CMS will hold a webinar on the unwinding of Medicaid and CHIP continuous enrollment and what providers need to know and how to prepare for that unwinding on Wednesday, March 22 at noon (eastern). During the webinar, CMS officials will review recently released CMS unwinding resources to help partners with their outreach efforts and respond to questions about Medicaid renewals and terminations, Medicaid to marketplace transitions, Medicaid to Medicare transitions, communication and outreach strategies, and more. Go here to register to participate. CMS will offer the same webinar on April 26, May 24, and June 28. Go here and scroll down for materials from previous webinars on Medicaid unwinding.
CMS – Medicare Home Health Prospective Payment System CY 2023 Webinar – March 29
CMS will hold a webinar on Medicare’s calendar year 2023 home health prospective payment system on Wednesday, March 29 at 1:30 (eastern). During this webinar CMS will provide an overview of several provisions from the CY 2023 home health prospective payment system final rule related to behavior changes, the construction of 60-day episodes, and payment rate development. Learn more about the webinar here and go here to register to participate.
CMS – Medicare Cost Report e-Filing Webinar – March 30
CMS will hold a webinar for Medicare Part A providers to learn about new and upcoming functionality in the Medicare cost report e-filing system on Thursday, March 30 at 1:00 (eastern). Go here to register to participate.
CMS Quality Conference – May 1-3
The 2023 CMS Quality Conference, “Building Resilient Communities: Having an Equitable Foundation for Quality Health Care,” will be held virtually on Monday, May 1 through Wednesday, May 3. The conference will feature expert speakers who will address improving quality, equity, and innovation and discuss how advocates, providers, researchers, and champions in health care quality improvement can develop and spread solutions to address America’s most pervasive health system challenges. Go here to learn more about the conference and how to register to participate.