The following is the latest health policy news from the federal government for the week of October  21 to October 27.  Some of the language used below is taken directly from government documents.


  • Responding to a federal court ruling that the federal government has shortchanged hospitals in its payments for 340B-covered prescription drugs, CMS has announced how it will compensate hospitals for its underpayments – at least for the 2023 fiscal year.  According to CMS, it “…will apply the default rate (generally ASP plus 6%) to 340B-acquired drugs for the rest of the year.  CMS also will reprocess claims our contractors paid on or after September 28, 2022, using the default rate (generally ASP plus 6%).”  Learn more here.

Centers for Medicare & Medicaid Services

  • CMS has published a guide for states on how they can maximize the use of automation when they review current Medicaid participants’ eligibility when the COVID-19 public health emergency ends, doing so by using reliable information that is already available to state Medicaid agencies and without seeking information directly from the individuals whose Medicaid eligibility is under review.  Learn more from the CMS document “Ex Parte Renewal:  Strategies to Maximize Automation, Increase Renewal Rates, and Support Unwinding Efforts.”
  • CMS has announced that it has approved applications from Georgia and Pennsylvania to extend access to 12 months of Medicaid and Children’s Health Insurance Program (CHIP) coverage after pregnancy, making them the 25th and 26th states to take advantage of this option created under the American Rescue Plan.  Learn more about this latest action and what it means from this CMS news release.
  • CMS is increasing scrutiny and oversight over the country’s poorest-performing nursing facilities in an effort to improve the care they deliver.  In a series of revisions to its Special Focus Facility Program, CMS will toughen requirements for completion of the program and increase enforcement actions for facilities that fail to demonstrate improvement.  CMS also is calling on states to consider a facility’s staffing level in determining which facilities enter the Special Focus Facility Program.  Among the changes CMS has announced are making requirements tougher, terminating federal funding for facilities that do not improve, increasing enforcement actions, and creating incentives for sustainable improvements.  Learn more about the changes from the following resources:
  • CMS has posted the latest edition of MLN Connects, its online newsletter covering Medicare reimbursement matters.  The new edition includes features about new codes for billing for COVID-19 booster vaccines, information about the extension of changes to the low-volume hospital payment adjustment and the Medicare-dependent hospital program, and more.  Find it here.
  • CMS’s Center for Medicare and Medicaid Innovation is realigning internally, with some functions moving from one office within the organization to another.  Read about these changes in this Federal Register notice.
  • CMS is creating a technical expert panel to advise a project to refine nursing home anti-psychotic medication measures in the wake of an HHS Office of the Inspector General report showing abnormally high rates of schizophrenia diagnosis and potential under-reporting of antipsychotics use in nursing homes.  Learn more about the project, the expertise and experience CMS seeks from panel members, the time commitment involved, and how to apply to serve on the panel from this CMS announcement.  Nominations are due by November 11.

Department of Health and Human Services

  • HHS’s Health Resources and Services Administration (HRSA) has proposed changes in how hospitals report graduate medical education data and FTE residents they train through the Children’s Hospitals Graduate Medical Education Payment Program and the Teaching Health Center Graduate Medical Education Programs.  Learn more from this Federal Register notice.  Stakeholder comments are due by November 21.
  • HHS is seeking written comments on an additional objective proposed for addition to its “Healthy People 2030” initiative and written comments from the public proposing additional new core, developmental, or research objectives to be included in Healthy People 2030.  Learn more about Healthy People 2030 and what HHS seeks from this Federal Register notice.  Written comments are due by December 2.
  • Payments made to providers under the COVID-19 accelerated and advance payments program generally complied with the CARES Act and other federal requirements, HHS’s Office of the Inspector General has concluded in a new report.  Find that report here and a summary of the report here.

Government Accountability Office (GAO)

Medicare Payment Advisory Commission (MedPAC)

  • MedPAC has published its updated 2022 “Medicare Payment Basics” series.  Payment Basics documents explain how Medicare’s major payment systems work and are updated annually.  You can find the updated payment basics series here.

Stakeholder Events

CMS – National Stakeholder Call – November 1

CMS administrator Chiquita Brooks-LaSure and her leadership team will provide an update on CMS’s recent accomplishments and how they believe their initiatives are advancing the agency’s strategic plan during a national stakeholder call on Tuesday, November 1 at 3:00 (eastern).  Go here to register to participate.

Center for Medicare and Medicaid Innovation – Safety-Net Provider Roundtable – November 2

On Wednesday, November 2 at 12:30 (eastern) CMS’s Center for Medicare and Medicaid Innovation (CMMI) will hold a safety-net provider roundtable to discuss increasing safety-net participation in CMMI models.  This event will be a follow-up to the March 2022 “Equity Roundtable with Safety Net Providers” and will offer updates on CMMI’s approach to increasing safety-net participation in CMMI models; share findings and discuss recommendations from model application analysis and stakeholder interviews; and solicit input from stakeholders to enhance CMMI’s proposed definition for safety net providers.  Go here to register to participate.

HHS – Agency for Healthcare Research and Quality/Healthcare Cost and Utilization Project – November 2-3

HHS’s Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project will offer a virtual two-day workshop on “Planning Your HCUP Analysis” on Wednesday, November 2 and Thursday, November 3 at noon (eastern).  Go here to find the agenda and information about how to participate.

MedPAC – Commissioners Meeting – November 3-4

The next public meetings of the Medicare Payment Advisory Commission will be held on Thursday, November 3 and Friday, November 4.  An agenda and information about how to participate are not available at this time.  When they are, they will be posted here.

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.

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.

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.

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.