The following is the latest health policy news from the federal government for the week of October 31 to November 3. Some of the language used below is taken directly from government documents.
Medicare Payment Regulations
In the past week CMS has published four regulations presenting how it will pay providers in the coming year.
- Outpatient prospective payment system – CMS announced a 3.8 percent increase for Medicare outpatient and ambulatory surgical payments. It also adopted its proposal to establish rural emergency hospitals as a new kind of hospital provider; removed 11 surgical procedures from its inpatient-only list and authorized four new procedures to be performed in outpatient settings; extended the use of telehealth in the provision of Medicare-covered behavioral health services; authorized outpatient prospective payment system-level payments for outpatient services provided at rural sole community hospitals’ off-campus provider-based departments; and more. This rule also includes changes to the 340B program, see below for more details. Learn more about these and other changes from:
- Physician fee schedule – CMS reduced its conversion factor for physician payments, which will reduce doctors’ payments approximately 4.5 percent. The new regulation also outlines how Medicare will pay for split visits; extends for another year the use of selected telehealth policies that were introduced in response to the COVID-19 public health emergency; adopts a number of changes designed to facilitate access to behavioral health services; and introduces a number of changes in the agency’s Medicare Shared Savings Program. Learn more about these and other changes from:
- Home health prospective payment system – CMS introduced routine updates to the Medicare home health prospective payment system and home infusion therapy services rates for calendar 2023, including an aggregate 0.7 percent increase in home health payments. Learn more about these and other changes from:
- End-stage renal disease (ESRD) prospective payment system – CMS announced increases in ESRD base rates that should increase its total payments to hospital-based ESRD facilities by 3.1 percent and its payments to freestanding facilities by 3.0 percent. Learn more about these and other changes from:
- CMS’s outpatient prospective payment system regulation for 2023 also addresses the 340B prescription drug discount program in light of a recent Supreme Court decision rejecting past cuts in Medicare payments for 340B-covered drugs. The agency announced a general rate of average selling price (ASP) plus six percent for drugs and biologicals acquired through the 340B program and a 3.09 percentage point reduction of payments for non-drug services to achieve budget neutrality for the 340B drug payment rate change for 2023. CMS also announced that it will share its remedy for 340B drug payments from 2018-2022 in future rulemaking and that claims for 340B-acquired drugs paid after a district court’s September 28, 2022 ruling are paid at the default rate, which generally is ASP plus six percent. Find additional information about CMS’s plans for 340B from:
Provider Relief Fund
- HHS’s Health Resources and Services Administration (HRSA) has made 33 additions and changes in its Provider Relief Fund FAQ. Most of the changes address reporting and auditing requirements. They can be found on pages 7, 8, 10, 15, 20, 24 (two changes), 25 (three changes), 26 (3), 27 (2), 28 (4), 29 (4), 30, 32 (2), 33 (3), 38, 41, and 42 (2).
- HRSA has published the new document “Provider Relief Fund Distributions and American Rescue Plan Rural Distribution: Post-Payment Notice of Reporting Requirements” to inform Provider Relief Fund and American Rescue Plan rural recipients of the data elements they are required to report as part of the post-payment reporting process.
Centers for Medicare & Medicaid Services
- CMS has updated its guidance on COVID-19 vaccine requirements for health care workers. Learn more from this CMS memo to state survey agencies.
- CMS has issued a regulation that updates Medicare enrollment and eligibility rules to expand coverage for people with Medicare and advance health equity. The final rule, which implements changes made by the Consolidated Appropriations Act, 2021, makes it easier for people to enroll in Medicare and eliminates delays in coverage. Learn more from this CMS news release; this CMS fact sheet; and the regulation itself.
- CMS has posted the latest edition of MLN Connects, its online newsletter with information about Medicare payment issues. Among the subjects in this week’s edition are the new Medicare Part B immunosuppressive drug benefit, private payer rate data reporting requirements for some clinical laboratories, new home health consolidated billing codes that will take effect next year, and more. Find the new MLN Connects here.
- CMS has approved an amendment to Arkansas’ Medicaid section 1115 demonstration that will test innovative interventions to address housing and food insecurity and other health-related social needs. Learn more about the Arkansas waiver and the specific components of its demonstration project from this CMS news release and this CMS letter to Arkansas state officials.
Department of Health and Human Services
- HHS’s Health Resources and Services Administration (HRSA) is making $2 million in grant money available on a competitive basis under its Rural Health Network Development Planning Program. The purpose of this program is to promote the planning and the development of integrated health care networks. Grants will range up to $100,000. For additional information about the funding opportunity, including eligibility, see this HRSA notice. Applications are due by January 6.
- HRSA is currently offering a number of funding opportunities, with deadlines ranging from this month through January 2023 Find a list of those opportunities here.
Medicaid and CHIP Payment and Access Commission (MACPAC)
- MACPAC members met publicly on October 28 and 29. Go here for the meeting agenda and a summary of the meeting and for links to the presentations made during the meeting.
HHS – Listening Session on Protecting the Safety of Patients and Healthcare Workers – November 14
Representatives of HHS, including Secretary Becerra, and leaders of the Agency for Healthcare Research and Quality (AHRQ), the CDC, CMS, and the FDA will hold a livestreamed listening session that will include chief executive officers of the country’s largest health care systems, board members, organizational patient safety leaders, and patient and family safety advocates to discuss protecting the safety of patients and health care workers. The event, to be held on Monday, November 14 at 1:00 (eastern), will be part of HHS’s plan to co-create a National Healthcare System Action Alliance to Advance Patient Safety. Learn more about the Action Alliance here and go here to register to participate in the November 14 event.
CDC – Flu Testing and Treatment During the COVID-19 Pandemic – November 15
The CDC will hold a webinar for clinics on flu testing and treatment during the COVID-19 pandemic on Tuesday, November 15 at 2:00 (eastern). For further information about the call and how to participate, see this CDC notice. Participants will qualify for continuing education credits.
HHS/Agency for Healthcare Research and Quality – Online Tools for Consumer Assessment of Healthcare Providers and Systems Survey Users – November 16
AHRQ will hold a webinar on Wednesday, November 16 at 3:00 (eastern) to present three online tools that support the work of AHRQ’s Consumer Assessment of Healthcare Providers and Systems (CAHPS). These tools enable survey users to conduct analyses needed to produce valid comparisons of performance across similar health care organizations and to assemble a customized survey instrument to meet their needs. Go here to learn more about the webinar and to register to participate.
CMS – Healthcare Common Procedure Coding System – November 29-December 1
CMS will hold Healthcare Common Procedure Coding System (HCPCS) public meetings on Tuesday, November 29 through Thursday, December 1 to discuss its preliminary coding, Medicare benefit category, and payment determinations for new revisions to the HCPCS Level II code set. Learn more about when these virtual meetings will be held, how to join them, and how to register to speak from this CMS notice.
HHS – Advisory Commission on Childhood Vaccines – December 2
HHS’s Advisory Commission on Childhood Vaccines will meet virtually on Friday, December 2 at 1:00 (eastern). For more information about the commission and the agenda for the meeting, see this Federal Register notice.
FDA – Cardiovascular and Renal Drugs Advisory Committee – December 14
The FDA’s Cardiovascular and Renal Drugs Advisory Committee will meet virtually on Wednesday, December 14 at 9:00 (eastern). For information on the meeting’s agenda, the docket the committee has created for the meeting, how to submit comments and papers, and how to join the meeting, see this Federal Register notice.
HHS – New Technology Town Hall – December 14-15
HHS will hold a new technology town hall meeting on Wednesday, December 14 and Thursday, December 15, with both virtual sessions to begin at 9:00 (eastern), to discuss FY 2024 applications for add-on payments for new medical services and technologies under the hospital inpatient prospective payment system. Interested parties may present comments, recommendations, and data regarding whether the FY 2024 new medical services and technologies applications meet the substantial clinical improvement criterion. Learn more about the meeting and its purpose and how to participate from this Federal Register notice.