The following is the latest health policy news from the federal government as of 2:45 p.m. on Tuesday, June 21. Some of the language used below is taken directly from government documents.
Centers for Medicare & Medicaid Services
- The Supreme Court has ruled that CMS acted inappropriately when it reduced 340B payments to hospitals. In a unanimous decision, the court found that the law creating the program gives the federal government two ways to set 340B payments for outpatient drugs for qualified providers and that the manner in which CMS cut those payments in 2018 followed neither. Learn more from the Supreme Court opinion.
- CMS has approved requests from Maine, Minnesota, New Mexico, and Washington, D.C. to expand from 60 days to 12 months postpartum Medicaid and CHIP coverage, as authorized temporarily by the American Rescue Plan. This brings to 14 the number of states that have taken advantage of this option. Learn more from this HHS news release.
- The latest edition of MLN Connects, CMS’s online newsletter about Medicare reimbursement issues, includes items about FY 2023 ICD-10 diagnosis codes, the July update of the ambulatory surgical center payment system, revised requirements for mental health visits via telecommunications for rural health centers and FQHCs, and more. Find it here.
- While maintaining its focus on the delivery of primary care to Medicare beneficiaries, CMS also is exploring pathways for specialty care coordination and integration in its population-based accountable care organization (ACO) models. Learn about how the agency is approaching this challenge in the latest installment of the CMS blog.
- CMS has issued its calendar year 2023 home health prospective payment system rate update proposed rule, which would update Medicare payment policies and reduce rates for home health agencies. The proposed rule includes proposals and routine updates of the Medicare home health prospective payment system and home infusion therapy services rates; calls for applying a permanent prospective payment adjustment to the home health 30-day period payment rate to account for any increases or decreases in aggregate expenditures resulting from the difference between assumed behavior changes and actual behavior changes due to the implementation of the Patient-Driven Groupings Model and 30-day unit of payment; solicits stakeholder comment on a number of other issues; and proposes other measures. For further information see this CMS fact sheet and the proposed rule itself. Stakeholder comments are due by August 16.
- CMS has updated its Medicaid managed care enrollment reports, which provide plan-specific enrollment statistics on Medicaid managed care programs, with 2020 managed care enrollment data. Go here to learn more about what the reports include and to find the new 2020 data.
- CMS has published a brief case study on making the business case for addressing health-related social needs. Find it here.
Department of Health and Human Services
- HHS and its Health Resources and Services Administration (HRSA) have awarded nearly $115 million to 60 recipients to help implement the agency’s “Ending the HIV Epidemic in the U.S.” initiative, which seeks to reduce the number of new HIV infections in the U.S. by at least 90 percent by 2030. Awards will support innovative strategies that help people with HIV find care, support, and treatment. Learn more about the program and find a link to a list of grant recipients from this HHS news release.
- HHS and HRSA have announced the availability of $10 million in substance misuse grant funding through the HRSA Rural Communities Opioid Response Program. This funding will seek to help rural communities establish new treatment access points to connect individuals to medication to treat opioid use. Learn more about the new funding and its purpose in this HHS news release and this grant opportunity notice. Applications are due July 29.
- HRSA and its Early Hearing Detection and Intervention Program have issued a request for comment on ten issues that involve future program development. Learn more about the information the agency seeks, find questions that address the ten issues, and learn how to submit comments from this Federal Register notice. Comments are due by July 18.
- HHS has launched a national campaign called “I am a Work of ART” to encourage people with HIV who are not in care to seek and stay in care and achieve viral suppression. People with HIV who take ART– antiretroviral therapy – as prescribed can live long, healthy lives and will not transmit HIV to their HIV-negative partners through sex. Learn more about the program from this HHS news release and the “I am a Work of ART” web page.
- HHS’s Office of the National Coordinator for Health Information Technology (ONC) has established a Health Information Technology Advisory Committee (HITAC) Adopted Standards Task Force to review and make recommendations on the existing set of ONC-adopted standards and implementation specifications. Members of the task force will include current HITAC members and industry experts; task force meetings will be open to the public. The task force’s final report and recommendations from the HITAC are expected in the fall and will inform ONC’s future work. Learn more from this ONC notice.
- The ONC has established a funding opportunity as part of its Leading Edge Acceleration Projects to advance health IT standards and tools to improve social determinants of health data exchange and research and to develop tools for making electronic health record data for research artificial intelligence-ready. Learn more about the program here and find the notice of the funding opportunity here. Applications are due by August 15.
- HHS’s Office of the Inspector General has published the new report “Inaccuracies in Medicare’s Race and Ethnicity Data Hinder the Ability To Assess Health Disparities.” Find a summary of the report here and the full report here.
- HHS’s Agency for Healthcare Research and Quality has published the new report “Transitions of Care From Pediatric to Adult Services for Children With Special Healthcare Needs.” Find a summary of the report here and the full report here.
- HHS and the Department of Agriculture are inviting nominations to the 2025 Dietary Guidelines Advisory Committee. The committee will review scientific evidence to help inform the Dietary Guidelines for Americans, 2025-2030. Learn more about the committee and its work from this HHS news release and go here for information about how to submit nominations. Nominations are due by July 15.
Medicare Payment Advisory Commission (MedPAC)
- MedPAC has submitted formal comments to CMS in response to the latter’s proposed FY 2023 inpatient prospective payment system and long-term-care hospital prospective payment system regulation. In its letter MedPAC comments on CMS’s proposed use of 2019 data instead of 2020 data for rate-setting in both the hospital inpatient prospective payment system and long-term-care hospital prospective payment system; on its proposal to repeal its plan to use “market-based” data to set Medicare severity–diagnosis related group (MS–DRG) relative weights; on changes in rural reclassification cancellation requirements; and on several issues related to CAR-T technologies. Go here to see MedPAC’s letter to CMS.
- MedPAC has released its June 2022 “Report to the Congress: Medicare and the Health Care Delivery System.” Each June, as part of its mandate from Congress, MedPAC reports on issues affecting Medicare and broader changes in health care delivery and the market for health care services. This year’s report includes seven chapters:
- An approach to streamline and harmonize Medicare’s portfolio of alternative payment
- Congressional request: Vulnerable Medicare beneficiaries’ access to care (final report).
- Supporting safety-net providers.
- Addressing high prices of drugs covered under Medicare Part B.
- Improving the accuracy of Medicare Advantage payments by limiting the influence of
outliers in CMS’s risk-adjustment model.
- Aligning fee-for-service payment rates across ambulatory settings.
- Segmentation in the stand-alone Part D plan market.
Centers for Disease Control and Prevention
- The CDC has published new research on the dispensing of oral antiviral drugs for the treatment of COVID-19 by zip code between December 23, 2021 and May 21, 2022. The study found that while the quantity of antivirals dispensed had increased, by the end of the study period the dispensing rates were lowest in zip codes with the greatest social vulnerability even though those areas had the largest number of dispensing sites. Find the study here.
- On Thursday, June 16 the CDC held a webinar for clinicians in which it reviewed the therapeutic options for treating COVID-19. A recording of that webinar and a link to the materials that accompanied it can be found here. This event qualifies for free continuing education credit. To learn how to get that credit, go here.
- The CDC has updated its information for clinicians on outpatient treatment for COVID-19.
- The CDC has updated its information about underlying medical conditions that pose special risks for those who contract COVID-19.
- The CDC has published an analysis of COVID-19 cases and hospitalizations among Medicare beneficiaries who do and do not have disabilities. The study found that hospitalization rates among Medicare beneficiaries with disabilities were 50 percent higher. Find the report here.
- The CDC has released updated information about monkeypox that includes the status of cases in the U.S. today; information about the virus, including updated case definitions; recommendations for clinicians; directions for public health departments; recommendations for the public; and links to additional sources of information.
Food and Drug Administration
- The FDA has authorized emergency use of the Moderna COVID-19 vaccine and the Pfizer COVID-19 vaccine for children down to six months of age. Learn more about this decision from this FDA news release.
- The FDA has issued emergency use authorization for the first COVID-19 test that also identifies the COVID variation of the sample. The test, a LabCorp product, is intended for use when a health care provider decides, based on a patient’s medical history and other diagnostic information, that the test results may help in deciding the appropriate clinical care for the patient. Learn more from this FDA announcement and the FDA emergency use authorization letter.
CDC – Supporting Approval for Vaccines for Children Ages Six Months and Older – June 22
The CDC will hold a webinar on Wednesday, June 22 at 2:00 (eastern) to discuss the FDA’s approval of the Pfizer and Moderna COVID-19 vaccines for children six months of age and older; how to talk to parents about the need for these vaccines; and where to look for additional information about the vaccines. For further information about the webinar and how to join it, go here.
CMS – CMS and HHS Medicaid and CHIP Continuous Enrollment Unwinding – June 22
CMS will hold a Medicaid and CHIP Continuous Enrollment Unwinding partner education webinar on Wednesday, June 22 at noon (eastern). This is a monthly webinar series that covers different topics related to Medicaid and CHIP continuous enrollment unwinding each month. Topics to be addressed during this month’s webinar will include strategies to engage states and local stakeholders; actions states can take to keep people connected to health insurance coverage; and strategies and best practices on how states and stakeholders are working to prepare for the Medicaid and CHIP continuous enrollment unwinding. For information about how to join the webinar and find other materials about the process of unwinding from the continuous Medicaid and CHIP eligibility during the current public health emergency, go here.
NIH – Office of AIDS Research Advisory Council – June 23
The NIH’s Office of AIDS Research Advisory Council will meet virtually at noon (eastern) on Thursday, June 23. The meeting’s agenda includes a report from the director of the Office of AIDS Research; an update from that office’s clinical guidelines working groups; updates from the NIH’s HIV-related advisory councils; presentations and discussions on data science and NIH-wide programs and initiatives; and public comment. Learn more about how to submit comments and participate in this meeting from this Federal Register 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.
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.