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

The Courts

Hospitals may sue state Medicaid programs for failing to ensure that private insurers – such as Medicaid managed care plans – pay hospitals in a timely manner for the care they provide to their Medicaid patients, a federal appeals court has ruled.  See the court’s decision in this case.

Centers for Medicare & Medicaid Services

  • CMS has proposed a series of changes in the Medicare cost report, including but not limited to changes in the S-10 form.  Go here for a link to a zip file of seven documents explaining what CMS proposes.  Stakeholder comments are due July 22.
  • CMS has unveiled a suite of new resources to improve CMS and state oversight of Medicaid and CHIP managed care programs.  Released in a Center for Medicaid and CHIP Services Informational Bulletin, this new information includes tools, templates, and updates on tactics to improve states’ reporting on their Medicaid and CHIP managed care programs.  The bulletin outlines the latest updates of a new web-based portal for state reporting on managed care programs to CMS.  It also offers additional reporting templates and a new technical assistance toolkit to help states improve their overall monitoring and oversight of managed care.  CMS also released a toolkit to support program monitoring for Medicaid enrollees in managed long-term services and supports that can help ensure that more people with long-term-care needs transition from institutions to home and community-based settings.  Learn more from this HHS news release and from the bulletin sent by CMS to state Medicaid programs, which in turn includes links to various resources that are part of this initiative.
  • CMS has published proposed Medicare conditions of participation for rural emergency hospitals, a new provider type created by Congress in late 2020.  Rural emergency hospitals will not provide inpatient care but will provide 24-hour emergency services and will be reimbursed at 105 percent of Medicare outpatient prospective payment system rates.  This new type of hospital was created to help ensure access to care in rural areas where hospitals are closing.  The proposed rule also calls for updating conditions of participation for critical access hospitals.  Learn more about rural emergency hospitals – what they can and cannot do, how a provider can qualify for this status, how they will be paid, and the conditions of participation for both rural emergency hospitals and critical access hospitals – from this CMS news release; from an accompanying CMS fact sheet; and from the proposed regulation itself.  Comments are due by August 29.
  • CMS has released the latest edition of MLN Connects, its online publication addressing Medicare reimbursement issues.  In this issue are items about ICD-10 codes for Long COVID and other aspects of COVID-related illness, revised billing codes for ambulatory surgical centers, and updated guidelines for teaching physicians, residents, and interns.  Find this and more in this week’s MLN Connects.
  • CMS’s Center for Medicare & Medicaid Innovation has conducted a review of three of its current alternative payment and service delivery models to determine whether implicit bias may be present and, if so, whether such bias has led to the unintentional exclusion of certain beneficiary groups from the models.  The agency introduces its review of three models – its Kidney Care Choice Model, Comprehensive Care for Joint Replacement Model, and Million Hearts Model – in the CMS blog and presents an analysis that identifies examples of the biases it found in the Health Affairs article “CMS Innovation Center Tackles Implicit Bias.”
  • In February CMS released a Request for Applications for new providers interested in participating in the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model in performance year 2023; this model is a redesign of the Global and Professional Direct Contracting Model, which began in 2021.  Now, the agency has published the results of that request for applications, outlining the methodology it employed to evaluate applications and explaining the next steps for applicants that have provisionally been approved to participate.  See that CMS explanation here and learn more from an accompanying FAQ.

Department of Health and Human Services

  • HHS and its Health Resources and Services Administration (HRSA) have announced more than $155 million in awards for 72 teaching health centers that operate primary care medical and dental residency programs that include high-need specialties such as psychiatry as part of a broader effort to address the nation’s mental health crisis.  HRSA’s Teaching Health Center Graduate Medical Education program focuses on supporting residents in primary care residency training programs to meet the medical and mental health care needs of rural and underserved communities.  The awards include $135 million to support existing and new teaching health centers to support additional resident positions and $20 million to support existing Teaching Health Center Graduate Medical Education residency programs to continue resident training in the upcoming academic year.  Learn more about this initiative from this HHS news release and go here to see a list of the grant recipients.
  • HHS’s Office of Population Affairs has announced nearly $3 million in new funding to bolster training and technical assistance for the nationwide network of Title X family planning providers.  The Reproductive Health National Training Center will receive $2 million to support Title X grantee staff and the National Clinical Training Center for Family Planning will receive $750,000 to support Title X clinical service providers.  Learn more from this HHS news release.
  • HHS has begun delivering additional doses of monkeypox vaccine as part of an enhanced nationwide vaccination strategy to mitigate the spread of monkeypox in communities where transmission is highest and with populations most at risk.  As new orders come in from individual jurisdictions HHS will ship doses to those jurisdictions within one business day of the CDC’s approval of a request.  To learn more about the vaccines and the process for requesting and receiving doses of different vaccines and to find a list of HHS’s shipments of vaccines under this process so far see this HHS news release.
  • Even as these doses are being shipped, HHS has ordered an additional 2.5 million doses of Bavarian Nordic’s JYNNEOS, an FDA-licensed vaccine indicated for prevention of smallpox and monkeypox, for use in responding to current and future monkeypox outbreaks and as part of U.S. smallpox preparedness.  Deliveries from this latest order will begin arriving at the Strategic National Stockpile later this year and will continue through early 2023.  Learn more about this new supply and how it fits into the broader national strategy from this HHS news release.
  • HRSA has updated its lists of all geographic areas, population groups, and facilities designated as primary medical care, dental health, and mental health professional shortage areas (HPSAs) as of April 29, 2022.  Go here for HRSA’s gateway to its lists of shortage areas.

Centers for Disease Control and Prevention

  • The CDC has updated its information about the effects of COVID-19 on pregnancy and provided a summary of current research on this issue.  Go here to learn more.
  • The CDC has updated its information about adverse effects of COVID-19 vaccines.
  • The CDC has published a study on factors associated with severe outcomes among immunocompromised adults hospitalized for COVID-19.  Find it here.
  • The CDC has posted information about who should report cases of monkeypox and how they should do that reporting.  Find it here.
  • The CDC has posted an updated map showing the distribution of 605 confirmed cases of monkeypox in the U.S. as of July 6.
  • The CDC announced that LabCorp has begun analyzing the CDC’s own monkeypox test.  LabCorp will accept specimens from anywhere in the country and expects to be able to perform up to 10,000 tests a week, which will double the current testing capacity provided by the CDC.  Learn more from this CDC announcement.

Food and Drug Administration

  • The FDA has revised its emergency use authorization for Paxlovid, a combination of monoclonal antibodies used to treat COVID-19, to authorize state-licensed pharmacists to prescribe Paxlovid to eligible patients, with certain limitations to ensure appropriate patient assessment and prescribing.  Learn more about this policy, including the circumstances under which pharmacists can prescribe the drug, from this FDA news release.
  • The FDA has revised its recommendations for the use of Evusheld, a combination of monoclonal antibodies used to treat COVID-19, to call for repeat dosing every six months if patients need continuing protection.  Learn more from this FDA notice (scroll down to the third bullet) and from the revised Evusheld fact sheet.
  • The FDA announced a request for nominations for consumer representatives to serve on advisory committees and panels for which vacancies currently exist or are expected to occur in the near future.  Learn more about what the FDA seeks and how to nominate candidates from this Federal Register notice.  Nominations are due by August 15, 2022.

Occupational Safety and Health Administration (OSHA)

OSHA is extending its Revised National Emphasis Program for COVID-19 until further notice.  The program focuses enforcement efforts on companies that put the largest number of workers at serious risk of contracting COVID-19 and on employers that engage in retaliation against workers who complain about unsafe or unhealthful conditions or exercise other rights under the Occupational Safety and Health Act.  As part of this extension OSHA also is temporarily increasing its COVID-19 inspection goal from five percent of inspections to ten percent while it works to finalize a permanent COVID-19 health care standard.  Among the entities specifically targeted by the program are skilled nursing facilities, assisted living facilities, and home health care services.  The program was set to expire July 7, 2022.  Learn more from this OSHA news release.

Stakeholder Events

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.