The following is the latest health policy news from the federal government for February 27 to March 3. Some of the language used below is taken directly from government documents.
No Surprises Act
- The Independent Dispute Resolution (IDR) entities empowered by the No Surprises Act to adjudicate disagreements between providers and payers may resume their work – but only some of it. CMS has directed IDRs entities to resume processing payment determinations on February 27 for disputes involving items or services furnished before October 25, 2022 but not to issue decisions involving items or services furnished on or after October 25, 2022 until federal agencies can provide additional direction. The work of IDRs was brought to a halt by a federal court ruling last month that found that the process created by federal agencies to implement the No Surprises Act violated the terms of that law by unduly favoring health care payers over providers. Learn more about where the dispute resolution process stands and what providers and payers can expect from the federal agencies charged with responsibility for implementing the No Surprises Act from this CMS notice.
- The Congressional Research Service has published a brief overview of the No Surprises Act’s patient-provider dispute resolution process. Find it here.
Centers for Medicare & Medicaid Services
- CMS has issued a fact sheet on waivers, flexibilities, and the transition from the COVID-19 public health emergency. The fact sheet covers COVID-19 vaccines, testing, and treatments under Medicare, Medicaid, CHIP, and private insurance; telehealth services under Medicare, Medicaid, CHIP, and private insurance; health care access, including continuing flexibilities for health care professionals; inpatient hospital care at home; and scope of practice, virtual supervision, nurse aide training for nursing homes, and Medicaid continuous enrollment. Go here for the fact sheet, which includes links to additional resources.
- CMS also has updated its documents that describe the current and future status of waivers and flexibilities that were extended to different types of providers in response to the COVID-19 public health emergency. Find those documents here.
- CMS has issued a proposed rule that would revise its regulations governing the inclusion of days associated with individuals eligible for certain benefits provided by section 1115 demonstrations in the Medicaid fraction of a hospital’s disproportionate patient percentage. This is essentially the same change CMS included in its proposed FY 2022 and FY 2023 inpatient prospective payment system rules and then did not adopt in those final rules. In proposing this change again CMS suggests that this has always been its policy and it therefore needs to update its regulations to reflect that since courts are finding that the existing regulations are contrary to this policy. Learn more from CMS’s announcement of the proposed rule, which includes a link to a formal Federal Register notice. Stakeholder comments are due by May 1.
- CMS has proposed a rule to reflect recent changes of the Social Security Act by the Consolidated Appropriations Act of 2021 that address the hospital-specific limit on Medicaid disproportionate share hospital (Medicaid DSH) payments. The proposed rule seeks to implement the DSH-related provisions of the 2021 act concerning the treatment of third-party payments for purposes of calculating Medicaid hospital-specific DSH limits and to clarify regulatory payment and financing definitions and other regulatory language that could be subject to misinterpretation. Learn more from this CMS announcement, which includes a link to a formal Federal Register notice. The deadline for submitting comments is April 25.
- In December, CMS proposed a regulation governing the adoption of standards for health care attachments, transactions, and electronic signatures and modification of referral certification and authorization transaction standards and last month held a listening session about this proposal. Materials from that session – slides and a transcript – can be found here, along with links to the proposed rule and a fact sheet. The deadline for submitting comments is March 21.
- CMS has published a new edition of MLN Connects, its online newsletter with information about Medicare reimbursement matters. The latest issue includes features on a new PECOS consolidated application coming this summer, upcoming webinars on the Medicare cost report e-filing system and home health prospective payment system, and more. Find the latest MLN Connects here.
- CMS’s Center for Medicare and Medicaid Innovation has published the February 2023 edition of its CMS Innovation Center Evaluation Digest. This issue includes evaluation reports on the Primary Care First Model, white papers on dementia care and palliative care projects, and more. Find the digest here.
- CMS has released the annual update of its drug spending dashboards with data for 2021. These dashboards are interactive, online tools that enable consumers, researchers, policymakers, and other stakeholders to understand changes in spending on prescription drugs in the Medicare Part B, Medicare Part D, and Medicaid programs. Learn more about the dashboards and find links to the individual dashboards in this CMS news release.
Department of Health and Human Services
- HHS’s Health Resources and Services Administration (HRSA) has published HRSA eNews, its weekly newsletter. This week’s edition includes information about loan repayment programs for health care professionals, an updated list of HRSA funding opportunities, and more. Find it here.
- HHS’s Health Sector Cybersecurity Coordination Center (HC3) has issued an alert on MedusaLocker Ransomware, which was first detected in September of 2019 and since then has infected and encrypted systems across multiple sectors but primarily targeting the health care sector. Learn more about this ransomware and how to detect and defend against it from this HC3 alert.
- HHS’s Office of the Inspector General has published a report in which it maintains that Medicare could have saved up to $216 million over five years if program safeguards had prevented at-risk payments for definitive drug testing services. Learn more from this summary of the OIG report, which includes a link to the complete report.
- Another OIG report characterizes the inability to identify claims denied by Medicare Advantage plans as a hindrance to fraud oversight. Find that report here.
- HHS’s Agency for Healthcare Research and Quality has posted the latest edition of AHRQ News Now, its weekly online newsletter. The latest edition has information about AHRQ’s intention to fund clinics to improve care for people with Long COVID; fall prevention; best practices in the use of patient-centered medical homes; and more. Find it here.
Drug Enforcement Administration
- The Justice Department’s Drug Enforcement Administration has issued a notice of proposed rulemaking in which it proposes permanent rules for prescribing certain controlled medications via telemedicine, thereby expanding patient access to selected therapies beyond the scheduled end of the COVID-19 public health emergency. One of its proposed rules call for extending certain flexibilities adopted during the public health emergency with what the DEA considers “appropriate safeguards.” Learn more about what the DEA has proposed from this announcement of the rule, which includes a link to a formal Federal Register notice, and from this DEA news release. The deadline for submitting comments is March 31.
- Another aspect of this DEA effort is a second proposed rule expanding induction of buprenorphine via telemedicine. Learn more about this proposal from this DEA regulatory announcement, which includes a link to a formal Federal Register notice. The deadline for submitting comments is March 31.
Centers for Disease Control and Prevention
- The CDC has updated its guidance for managing health care workers who have been infected by or exposed to COVID-19.
- The CDC has published new information on clinical treatment considerations for patients with severe cases of mpox. The update reviews data on the efficacy of various drugs in treating the disease.
Food and Drug Administration
The FDA has issued emergency use authorization for the first over-the-counter at-home diagnostic test that can differentiate and detect both the flu and COVID-19. Learn more from this FDA announcement.
Medicare Payment Advisory Commission (MedPAC)
MedPAC has submitted comments to CMS on the latter’s advance notice of methodological changes for calendar year 2024 Medicare Advantage capitation rates and Part C and Part D payment policies. The MedPAC letter addresses the technical update to medical education payments in the non-end-stage renal disease per capita cost baseline; Medicare Advantage end-stage renal disease rates; CMS’s hierarchical condition category risk adjustment model for calendar year 2024; the Medicare Advantage coding pattern difference adjustment; and updates for Part C and Part D star ratings. Find the MedPAC letter here.
Government Accountability Office (GAO)
The GAO has published a report evaluating federal funding and subsequent spending in response to the COVID-19 public health emergency. The agency found that six COVID-19 relief laws enacted in 2020 and 2021 provided about $4.6 trillion of funding for pandemic response and recovery and that as of January 31, 2023 the federal government had obligated $4.5 trillion and expended $4.2 trillion, or 98 percent and 90 percent, respectively, of these relief funds. Another $90.5 billion, or two percent of the total amount of funding provided for COVID-19 relief, remained available for obligation and another $23.7 billion has expired and is no longer available for incurring new obligations. Learn more from the GAO report “COVID-19 Relief: Funding and Spending as of Jan. 31, 2023.”
CMS – Office of Minority Health – Improving Data to Advance Health Equity Solutions Webinar – March 7
CMS’s Office of Minority Health will hold a webinar to discuss its recently released white paper, “The Path Forward: Improving Data to Advance Health Equity Solutions,” on Tuesday, March 7 at noon (eastern). Go here to register to participate.
CDC – ICD-10 Coordination and Maintenance Committee – March 7-8
The CDC’s ICD-10 Coordination and Maintenance Committee will meet virtually on Tuesday, March 7 and Wednesday, March 8 at 9:00 (eastern) on both days. The tentative agenda includes discussions about a variety of ICD-10-CM and ICD-10-PCS topics. For further information about the specific topics currently on the agenda and how to participate in the meeting, see this agency notice.
FDA – Workshop on Fatal Overdoses, Product Development, and Public Health Interventions – March 8-9
The FDA, in partnership with the Reagan-Udall Foundation for the FDA, will hold a two-day virtual public meeting entitled “Understanding Fatal Overdoses to Inform Product Development and Public Health Interventions to Manage Overdose.” The event, to be held on Wednesday, March 8 and Thursday, March 9 at 1:00 (eastern) both days, is for stakeholders, including people who use drugs, their families, harm reduction programs, clinicians, academic researchers, and federal partners. Go here to learn more about the event and how to register to participate.
HHS – Agency for Healthcare Research and Quality – March 9
AHRQ, in support of its request for applications for research projects that will help build a new equity-focused evidence base to address disparities in the health care delivery system, will hold a webinar on Thursday, March 9 at 2:00 (eastern) to provide technical assistance to potential applicants. Go here to register to participate – advance registration is required – and go here to learn more about the grant program.
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 – Value-Based Insurance Design (VBID) Model and its Hospice Benefit Component – April 11
CMS will host an office hours session on Tuesday, April 11 at 3:00 (eastern) to discuss the Value-Based Insurance Design (VBID) Model and its hospice benefit component. Participants will receive an overview of the model and the CY 2024 application process and have an opportunity to ask questions of CMS officials about the model. Go here to register to participate.