The following is the latest health policy news from the federal government as of 2:15 p.m. on Monday, June 27. Some of the language used below is taken directly from government documents.
The White House COVID-19 response team has briefed the press about the administration’s latest efforts in the response to COVID-19. Find a transcript of that briefing here and find the slides presented during that briefing here.
In a case that challenged a 2005 change in how CMS calculates Medicare disproportionate share (Medicare DSH) payments, the Supreme Court has, in a 5-4 decision, reversed a lower court ruling and upheld CMS’s policy to count days of care for which Medicare does not pay in the Medicare fraction of the Medicare DSH percentage – a policy change widely viewed as disadvantageous to hospitals that care for larger numbers of low-income patients. This means that Medicare exhausted days and days of care provided to Medicare enrollees with another source of third-party coverage count in the numerator and denominator of the Medicare fraction. In most cases this results in a lower percentage of a hospital’s Medicare patients also being eligible for SSI and the lowering of that ratio, thereby reducing the amount of Medicare DSH payments a hospital receives. For most hospitals, this ruling is more a closing of the door on a potential payment increase than a reduction of expected payments. Learn more from the Supreme Court’s majority decision.
Centers for Medicare & Medicaid Services
- CMS has posted an FAQ on the regulations implementing the No Surprises Act, which seeks to protect patients from surprise medical bills. The FAQ addresses provisions applicable to providers, balance billing and cost-sharing, notice and consent, and more. Find the new FAQ here.
- CMS has announced a new model that seeks to improve cancer care for Medicare patients and lower health care costs. CMS’s Center for Medicare and Medicaid Innovation designed its Enhancing Oncology Model to test how to improve providers’ ability to deliver care centered around patients, consider patients’ unique needs, and deliver cancer care in a way that will generate the best possible patient outcomes. The model will focus on supporting and learning from cancer patients, caregivers, and cancer survivors while addressing inequities and providing patients with treatments that address their unique needs. Learn more about the model from the following resources:
The application submission period opens on June 27 and closes on September 30.
- Following the extension of authorization to administer COVID-19 vaccines to children six months of age and older, CMS has announced that children aged six months to five years with Medicaid and CHIP coverage are eligible for COVID-19 vaccinations without cost-sharing. Learn more about these free vaccines, and others who are eligible for free vaccines, from this CMS news release.
- CMS has issued a proposed rule that would update payment rates and policies under the end-stage renal disease (ESRD) prospective payment system for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2023. This rule also proposes an update to the acute kidney injury dialysis payment rate for renal dialysis services furnished by ESRD facilities for calendar year 2023. In addition, the rule proposes to update requirements for the ESRD Quality Incentive Program and includes requests for information on several topics. CMS also proposes refinements of the ESRD Treatment Choices Model. Learn more about what CMS has proposed in this CMS fact sheet and from the proposed rule itself. Stakeholder comments are due by August 22.
- CMS has posted the latest edition of MLN Connects, its online newsletter that covers Medicare payment matters. The new issue includes features on inpatient rehabilitation facility and long-term-care hospital provider report previews, the next quarterly update of the durable medical equipment, prosthetics, orthotics, and supplies fee schedule, the upcoming expansion of the Ambulatory Prior Authorization Model, and more. Find it all in this week’s MLN Connects.
- To help Medicaid and CHIP agencies prepare for and respond to public health emergencies, disasters, and other emergencies, CMS has developed a toolkit on the strategies available to support Medicaid and CHIP operations and beneficiaries. See what CMS has in mind for state responses to such challenges in the document “Preparedness and Response Toolkit for State Medicaid and CHIP Agencies in the Event of a Public Health Emergency or Disaster.”
- As a companion piece, CMS’s Center for Medicaid and CHIP Services’ Medicaid and CHIP Coverage Learning Collaborative has published “Inventory of Medicaid and CHIP Flexibilities and Authorities in the Event of a Public Health Emergency or Disaster.”
- CMS has published a bulletin to inform providers’ billing staffs about the latest update of the Remittance Advice Remark Code (RARC) and Claims Adjustment Reason Code (CARC) code sets, what they must do if they use Medicare Remit Easy Print (MREP) or PC Print, and where they can find the official code lists. Find CMS’s bulletin here.
- CMS has posted the June edition of its Expanded Home Health Value-Based Purchasing Model Newsletter, with model highlights, a preview of upcoming reports, information about upcoming resources and learning events, and links to additional resources and literature.
Department of Health and Human Services
- HHS has issued a request for information in which it seeks input from people, communities, health care providers, purchasers and payers, educators, researchers, and other members of the public about what the federal government could do to strengthen primary health care in the U.S. For more specific information about the kinds of information HHS seeks and how to submit it, see this HHS news release and this Federal Register notice. Comments are due by August 1.
- HHS has approved Colorado’s Section 1332 State Innovation Waiver amendment request to create the “Colorado Option,” a state-specific health coverage plan that increases health coverage enrollment and lowers health care costs, making insurance more affordable and accessible for nearly 10,000 Coloradans starting in 2023. It is designed to reduce racial and ethnic health disparities by providing new coverage options for Coloradans. It is the first program of its kind in the country. Learn more about the Colorado program, what it aspires to do, and how it will work from this HHS news release.
- In the face of the significant loss of life to COVID-19 among nursing home patients during the pandemic, HHS’s Office of the Inspector General has audited nursing homes to determine the rate at which their employees are vaccinated against the virus and have received booster shots. Find its report here.
- HHS’s Agency for Healthcare Research and Quality (AHRQ) has published the new statistical brief “Geographic Variation in Inpatient Stays for Five Leading Mental Disorders, 2016–2018.”
- AHRQ also has published a new comparative effectiveness review titled “Effectiveness of Telehealth for Women’s Preventive Services.” Learn more from an executive summary of the analysis and go here for the full report.
Medicaid and CHIP Payment and Access Commission (MACPAC)
In 2016, CMS updated the regulations for Medicaid managed care and created a new option for states, permitting them to direct managed care organizations to pay providers according to specific rates or methods. Typically, these directed payment arrangements are used to establish minimum payment rates for certain types of providers or to require participation in value-based payment arrangements. A few states, however, use the directed payment option to require Medicaid managed care organizations to make large additional payments to providers similar to supplemental payments in fee for service. In a new issue brief, MACPAC discusses the history of directed payment policy and examines the use of directed payments based on the commission’s review of directed payments approved as of December 31, 2020. Learn more from the MACPAC issue brief “Directed Payments in Medicaid Managed Care.”
Centers for Disease Control and Prevention
- The CDC has begun began shipping orthopoxvirus tests to five commercial laboratory companies, including the nation’s largest laboratories, to increase quickly monkeypox testing capacity and access during the current monkeypox outbreak. The companies include Aegis Science, LabCorp, Mayo Clinic Laboratories, Quest Diagnostics, and Sonic Healthcare. This will dramatically expand testing capacity nationwide and make testing more convenient and accessible for patients and providers. Providers will be able to use these laboratories by early July and testing capacity through these companies will be ramped up throughout the month. Learn more about this initiative from this HHS news release.
- Between October 1, 2021 and June 15, 2022, nearly 300 American children were diagnosed with a hepatitis of unknown cause, with adenovirus detected among 45 percent of them. Preliminary analyses have not identified common exposures. The CDC has published a report summarizing its interim findings about this problem.
- The CDC, the Transportation, Labor, and Defense departments, HHS, and the EPA have updated the federal government’s planning guidance for handling category A solid waste, which addresses the transportation and disposal of material suspected to contain monkeypox virus. Find an explanation of the updated guidance here and go here to find the guidance itself.
- The CDC has posted an updated map showing the distribution of the 156 confirmed cases of monkeypox in the U.S.
Government Accountability Office (GAO)
Since 2006, multiple federal laws have mandated that HHS take steps to improve the nation’s situational awareness of threats related to public health emergencies, such as the COVID-19 pandemic, including developing a near real-time electronic nationwide public health situational awareness capability through an interoperable network of systems. More than 15 years after the law initially mandated it, the federal government does not yet have this needed situational awareness network capability. In a new report, the GAO looks into the status of HHS’s efforts to comply with these laws, summarizes the laws, and – noting that such a network could have been used to provide vital information to better manage a timely COVID-19 response – summarizes key requirements and the extent to which HHS has implemented them. Learn more from the GAO report “COVID-19: Pandemic Lessons Highlight Need for Public Health Situational Awareness Network.”
GAO has reviewed covered entities’ required reporting to HHS on data breaches. In a new report, the agency examines the number of breaches and affected individuals reported to HHS since 2015, the extent to which HHS has established a review process to assess whether covered entities implemented recognized security practices, and the extent to which improvements can be made related to HHS’s breach reporting requirements. Learn more from the new GAO report “Electronic Health Information: HHS Needs to Improve Communications for Breach Reporting.”
CDC – Update for Clinicians on Monkeypox – June 29
The CDC will hold a webinar on Wednesday, June 29 at 2:00 (eastern) during which it will present what clinicians need to know about monkeypox, including guidance about the typical clinical presentation, treatment options, pre- and post-exposure prophylaxis, and reporting to public health authorities. To learn more about the event, including its objectives, the presenters, supporting materials, and how to log into the webinar, see this announcement.
CMS – Center for Medicare and Medicaid Innovation – Value-Based Insurance Design Model – June 30
The Center for Medicare and Medicaid Innovation will hold a webinar on Thursday, June 30 at 3:00 (eastern) during which national leaders will discuss how value-based insurance design flexibilities are being leveraged to improve care and outcomes for enrollees with diabetes. Learn more about the webinar, including how to register to participate, from this CMS notice.
National Advisory Council for Healthcare Research and Quality – July 21
The National Advisory Council for Healthcare Research and Quality, which advises the Secretary of the Department of Health and Human Services and the Director of Agency for Healthcare Research and Quality (AHRQ) on matters involving to AHRQ’s mission, will meet on Thursday, July 21 at 12:30 p.m. (eastern). Council members will meet in person but the public is invited only virtually. Learn more about the council, the agenda for the meeting, and how to participate in the meeting from this Federal Register notice.