Federal Health Policy Update for Thursday, April 7

The following is the latest health policy news from the federal government as of 2:30 p.m. on Thursday, April 7.  Some of the language used below is taken directly from government documents.

White House

• The administration is proposing to address a flaw in the Affordable Care Act often referred to as the “family glitch.”  Under the ACA, people who do not have access to “affordable” health insurance through their jobs may qualify for a premium tax credit to purchase coverage on the ACA’s health insurance marketplaces.

Current regulations define employer-based health insurance as “affordable” if the coverage for the employee alone is considered affordable; if the coverage for the employee is considered affordable but if it is not considered affordable for the employee’s family, those family members are not eligible for a premium tax credit.  This “family glitch” affects about five million people.

The Treasury Department and the Internal Revenue Service are proposing to eliminate the family glitch so that family members of workers who are offered affordable coverage only for themselves but not for their family may qualify for premium tax credits to buy ACA coverage.  Should this change be made, an estimated 200,000 uninsured people would gain coverage and nearly one million Americans would see their coverage become more affordable.

Learn more about the administration’s proposal to address the family glitch in this White House fact sheet; from this transcript of a background call the administration held with the White House press corps to explain the proposal in greater detail; and from the proposed rule itself, as published in the Federal Register.  Comments are due by June 6.  In addition, a public hearing has been scheduled for Monday, June 27, 2022, at 10:00 a.m. (eastern); see the Federal Register notice for further information.

• President Biden has issued a presidential memorandum directing the Secretary of HHS to coordinate a new effort across the federal government to develop and issue an interagency national research action plan on Long COVID.  The effort will seek to advance progress in prevention, diagnosis, treatment, and provision of services, supports, and interventions for individuals experiencing Long COVID and associated conditions.  The memorandum directs HHS to issue a report outlining services and supports across federal agencies to assist people experiencing Long COVID, individuals who are dealing with a COVID-related loss, and people who are experiencing mental health and substance use issues related to the pandemic.  This report will specifically address the long-term effects of COVID-19 on high-risk communities and efforts to address disparities in access to services and supports.  Learn more from this White House announcement.
• The White House has posted a transcript of the April 5 press briefing given by its COVID-19 response team and public officials.  Go here for the slides presented during that briefing.

Provider Relief Fund

• Providers that failed to submit the required report on their use of Provider Relief Fund round 1 grants by the September 30, 2021 deadline (with two extensions that pushed the deadline back to early December) now may submit to HHS’s Health Resources and Services Administration (HRSA), which administers the Provider Relief Fund, a request to submit their report late for round 1 due to extenuating circumstances.  Requests for extensions may be submitted from Monday, April 11 to Friday, April 22, 2022.  Learn more about requests for extensions, including where and how to file such requests and how HRSA defines “extenuating circumstances,” from this Provider Relief Fund notice.  Separately, HRSA addresses opportunities for providers that failed to meet the deadline for reporting period 2 to request extensions for extenuating circumstances.
• HRSA has updated its list of key deadlines for various Provider Relief Fund-related deadlines.  Find that list here (in the box titled “Key Dates”).

No Surprises Act FAQs

• CMS has issued two FAQs on implementation of the No Surprises Act, the surprise billing law passed in late 2020.  They come in anticipation of the opening next week of the patient dispute portal, a major part of the new law’s Independent Dispute Resolution process.  They are:
  • Frequently Asked Questions for Providers about the No Surprises Rules
  • FAQs About Consolidated Appropriations Act, 2021 Implementation – Good Faith Estimates (GFE) for Uninsured (or Self-Pay) Individuals – Part 2.

Department of Health and Human Services

Health Policy News

• HHS and HRSA will award $4.5 million for hiring, training, certifying, and compensating community-based doulas in areas with high rates of adverse maternal and infant health outcomes.  Learn more about this new funding from this HHS news release and for information about pursuing this grant funding go here.  Applications are due May 31; the maximum grant will be $180,000.
• For an updated list of HRSA funding opportunities, go here.
• HHS’s Office for Civil Rights has published a request for information (RFI) seeking input from the public on two requirements of the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act), as amended in 2021.  This RFI seeks to help HHS consider ways to support the health care industry’s implementation of recognized security practices to protect health information privacy and consider ways to share funds collected through enforcement with individuals who are harmed by violations of HIPAA rules.  Learn more about what HHS seeks from this news release and from this Federal Register notice.  Comments are due by June 6.

COVID-19

• HHS has announced that more than 59 million Americans with Medicare Part B, including those enrolled in a Medicare Advantage plan, may now obtain free over-the-counter COVID-19 tests.  People with Medicare can get up to eight tests a month from participating pharmacies and health care providers for the duration of the COVID-19 public health emergency.
• Learn more from this HHS news release and an accompanying fact sheet.
• A list of eligible pharmacies and other health care providers that have committed publicly to participate in this initiative can be found here.  Because additional eligible pharmacies and health care providers also may participate, people with Medicare should check with their pharmacy or health care provider to find out whether they are participating.
• Providers not on the list that are interested in participating can go here for further information.
• HHS has launched a “test-to-treat” program to help people find places where they can be tested for COVID-19 and, if they test positive, to gain prompt access to treatment.  Find the agency’s announcement about the program here.  Other resources include:
  • a test-to-treat program fact sheet
  • a more detailed description of the program with links to additional resources
  • a separate site to help individuals find treatment if they test positive
• HHS’s Agency for Healthcare Research and Quality (AHRQ) has released three COVID-19-related reports:
  • “Changes in Pediatric Hospitalizations and In-Hospital Deaths in the Initial Period of the COVID-19 Pandemic (April–December 2020), 29 States”
  • “Changes in Hospitalizations and In-Hospital Deaths in the Initial Period of the COVID-19 Pandemic (April-December 2020), 29 States”
  • “Changes in Hospitalizations and In-Hospital Deaths for Adults Aged 65 Years and Older in the Initial Period of the COVID-19 Pandemic (April–December 2020), 29 States”

Centers for Medicare & Medicaid Services

Health Policy News

• CMS proposes delaying the start of its Radiation Oncology Model to an as-yet determined date.  It also proposes redefining the model performance period and possibly the model design.  Learn more from this pre-publication version of the Federal Register notice.  The deadline for comments is June 7.
• Beginning on April 1 state Medicaid programs have the option of extending from 60 days to one year Medicaid post-partum coverage for individuals enrolled in their Medicaid and CHIP programs.  States choosing to extend postpartum coverage must elect this option for both their Medicaid and separate CHIP programs, if applicable, and submit state plan amendments to CMS.  This option is currently limited to a five-year period that ends on March 31, 2027.  Learn more from this HHS news release.
• CMS has posted a new edition of MLN Connects, its online newsletter addressing Medicare reimbursement issues.  This issue includes items about the April 2022 update of the hospital outpatient prospective payment system, claims processing instructions for pneumonia vaccines, regulatory changes and billing information for rural health centers and FQHCs providing mental health visits via telecommunication, and more.  Learn about these issues and more in the latest edition of MLN Connects.
• CMS has released its final calendar year 2023 Medicare Advantage capitation rates and Part C and Part D payment policies.  The agency will increase federal payments to Medicare Advantage plans by an average of 8.5 percent.  The 2023 plan also addresses other aspects of Medicare Advantage reimbursement.  Learn more from this CMS fact sheet and this CMS explanation of its plan for 2023 Medicare Advantage rates.
• CMS has released its 2022-2023 Medicaid managed care rate development guide.  This is a resource for states to use when setting capitation rates for Medicaid managed care plans.  The guide provides details about information that must be included in states’ actuarial rate certifications for CMS to review and approve for rating periods between July 1, 2022 and June 30, 2023.  Find the guide here.

COVID-19

• CMS has announced that it will begin phasing out some (but not all) of the flexibilities it authorized for the delivery of care in skilled nursing facilities and other nursing facilities in response to the COVID-19 public health emergency, explaining that

…steadily increasing vaccination rates for nursing home residents and staff, and with overall improvements seen in nursing homes’ abilities to respond to COVID-19 outbreaks, CMS is taking steps to phase out certain flexibilities that are generally no longer needed to re-establish certain minimum standards while continuing to protect the health and safety of those residing in skilled nursing facilities/nursing facilities (SNFs/NFs). Similarly, some of the same waivers are also being terminated for inpatient hospices, intermediate care facilities for individuals with intellectual disabilities (ICF/IIDs), and end-stage renal disease (ESRD) facilities.

Learn more from this CMS news release explaining this latest action and from a memo CMS has sent today to state survey agencies explaining its actions and detailing which waivers and flexibilities will end in 30 days and which will end in 60 days.

• CMS has revised its guidance to state survey agencies on COVID-19 vaccine immunization requirements among staff of Medicare- and Medicaid-certified providers and suppliers.  A separate document has been released as an addendum to this guidance and is specific to long-term care and skilled nursing facilities.
• CMS has released two documents intended to provide guidance to state Medicaid programs as they transition to normal enrollment and eligibility activities in a post-pandemic world.
  • “Strategic Approaches to Support State Fair Hearings as States Resume Normal Eligibility and Enrollment Operations After the COVID-19 PHE”
    
  • “Medicaid and CHIP Unwinding Planning Efforts Summary of Best & Promising State Practices from CMS/State Discussions”

Centers for Disease Control and Prevention

COVID-19

• Effective April 4, the CDC has revised its COVID-19 laboratory reporting guidance.  Reporting of negative results for rapid or antigen test results is no longer required but testing sites still must report data for all positive diagnostic and screening testing completed for each individual test.  Learn more from this CDC announcement and the revised CDC guidance.
• The CDC has updated its information about the Johnson & Johnson COVID-19 vaccine, recommending that people ages 18 years and older who are moderately or severely immunocompromised and who received Johnson & Johnson’s COVID-19 vaccine get a second dose of an mRNA COVID-19 vaccine (Pfizer or Moderna).  Find the recommendation here.

Health Policy News

• The CDC is seeking comment on proposed updated recommendations for hepatitis B virus infection screening and testing.  Learn more from this Federal Register notice.  Comments are due by June 3.
• The CDC is seeking nominations for membership on its Healthcare Infection Control Practices Advisory Committee.  This committee consists of 14 experts in fields including but not limited to infectious diseases, infection prevention, health care epidemiology, nursing, clinical microbiology, surgery, hospitalist medicine, internal medicine, epidemiology, health policy, health services research, public health, and related medical fields.  Learn more about the committee and what the CDC seeks from its membership in this Federal Register notice.  Nominations are due by September 17.

Food and Drug Administration

• The FDA has announced that the monoclonal antibody sotrovimab is no longer authorized to treat COVID-19 due to increases in the proportion of COVID-19 cases caused by the Omicron BA.2 sub-variant.  CDC data estimates that the proportion of COVID-19 cases caused by the Omicron BA.2 variant is greater than 50 percent in the U.S. and the FDA has concluded that the authorized dose of sotrovimab is unlikely to be effective against this variant.  Learn more from this FDA statement.

National Academies of Sciences, Engineering, and Medicine

• Wide-ranging systemic changes are needed to transform nursing homes to meet the needs of their residents, families, and staff, according to a new report from the National Academies of Sciences, Engineering, and Medicine.  “The way in which the United States finances, delivers, and regulates care in nursing home settings is ineffective, inefficient, fragmented, and unsustainable,” the group concludes in its review of nursing home care in the U.S.; the report also includes recommendations for improvements.  Learn more from this news release and the report “The National Imperative to Improve Nursing Home Quality.”

Patient-Centered Outcomes Research Institute (PCORI)

• The Government Accountability Office (GAO) is seeking nominations for individuals to serve on the 21-member board of governors of the Patient-Centered Outcomes Research Institute (PCORI).  GAO is accepting nominations in the following categories:  a surgeon, a state-licensed integrative health care practitioner, a representative of patients and health care consumers, a representative of device manufacturers or developers, a representative of pharmaceutical manufacturers or developers, and a representative of private payers who represents health insurance issuers.  Learn more from this Federal Register notice.  Nominations are due by May 10.

Stakeholder Events

Medicare Payment Advisory Commission (MedPAC) – April 8

MedPAC will hold the second day of its two-day virtual April meeting on Friday, April 8 at 9:00 (eastern).  Go here to see the meeting’s agenda.  To register to participate in the Friday 9:00 session, go here.

Medicaid and CHIP Payment and Access Commission (MACPAC) – April 8

MACPAC will hold the second day of its two-day virtual April meeting on Friday, April 8 beginning at 10:30 (eastern).  To see the meeting’s agenda go here and to register to participate go here.

CMS/CMMI – ACO REACH General Office Hours – April 12

CMMI’s ACO REACH model team will host a general office hours session on Tuesday, April 12 at 3:00 p.m. (eastern) to answer questions as a follow-up to the financial and health equity webinars.  Go here to register to participate.

CMS – Medicare Cost Report E-Filing System: Interim Rate & Settlement Documentation Webinar – April 26

CMS will hold a webinar to provide information about new functionality in the Medicare Cost Report E-Filing system to Medicare Part A providers and organization that files cost reports on Tuesday, April 26 at 1:00 (eastern).  Go here to learn more about the webinar, including what it will cover and how to submit questions in advance, and go here to register to participate.