The following is the latest health policy news from the federal government for May 28 – June 8.  Some of the language used below is taken directly from government documents.

Centers for Medicare & Medicaid Services

  • CMS has announced a new primary care model – the Making Care Primary Model – that will be tested by the Center for Medicare and Medicaid Innovation in eight states.  The model seeks to improve care for patients by expanding and enhancing care management and care coordination, equipping primary care clinicians with tools to form partnerships with health care specialists, and leveraging community-based connections to address patients’ health needs as well as their health-related social needs.  The goals of the Making Care Primary Model are to ensure that patients receive primary care that is integrated, coordinated, person-centered, and accountable; to create a pathway for primary care organizations and practices – especially small, independent, rural, and safety-net organizations – to enter into value-based care arrangements; and to improve the quality of care and health outcomes of patients while reducing program expenditures.  The Making Care Primary Model will provide participants with additional revenue to build infrastructure, make primary care services more accessible, and better coordinate care with specialists.  The model will run for 10.5 years, from July 1, 2024 to December 31, 2034.  CMS will test this model in Colorado, Massachusetts, Minnesota, New Jersey, New Mexico, New York, North Carolina, and Washington and will work with model participants to address priorities specific to their communities.  Primary care organizations within participating states may apply when the application opens in late summer of 2023 and the model will launch on July 1, 2024.  Learn more about the model from this CMS news release; the new program’s web page; and this CMS video about the model.  CMS plans to release a request for applications and begin the application period for this model later this summer.  More technical detail on the model design is forthcoming.
  • CMS will implement a new policy governing the treatment of patient days associated with individuals enrolled in Medicare Advantage plans for purposes of calculating hospitals’ Medicare disproportionate share (Medicare DSH) patient percentages for cost reporting periods starting before FY 2014.  CMS has adopted this rule in response to the Supreme Court’s ruling in Azar v. Allina Health Services, 139 S. Ct. 1804 (June 3, 2019).  Learn more from this preview version of the final regulation.  The rule will take effect 60 days after its official publication, which is scheduled for June 9.
  • CMS has published a final regulation that withdraws a series of staff vaccination and testing requirements for long-term care and intermediate-care facilities for individuals with intellectual disabilities that were established by regulation in response to the COVID-19 public health emergency.  Learn more from this CMS announcement, which includes a link to a Federal Register notice.
  • CMS has posted a notice about a new Medicare claims modifier requirement for drugs and biologicals from single-dose containers or single-use packages.  Find that notice here.
  • CMS has posted a notice describing changes in its ambulatory surgical center payment system that will take effect on July 1.  Find that notice here.
  • CMS has announced how Medicare beneficiaries will be able to obtain the new Alzheimer’s disease drug leqembi if that drug is approved by the FDA.  Learn more from this CMS news release.
  • CMS has published a series of health equity data briefs that describe the national Medicaid and Children’s Health Insurance Program (CHIP) populations and their key social and demographic characteristics.  Find those documents here.
  • CMS’s Center for Medicare and Medicaid Innovation has posted annual evaluation reports and associated reports for its Oncology Care Model, Comprehensive Care for Joint Replacement Model, and Maternal Opioid Misuse Model.

Department of Health and Human Services

  • HHS and its Substance Abuse and Mental Health Services Administration (SAMHSA) have published national model standards for peer support certification for substance use, mental health, and family peer workers.  Learn more from this HHS news release, which includes a link to the model standards document.
  • Medicare sometimes pays higher non-facility rates rather than lower facility rates for physician services for beneficiaries who are Part A skilled nursing facility or hospital inpatients, HHS’s Office of the Inspector General has concluded in a new audit.  For calendar years 2019 and 2020, the audit identified 2.1 million physician service claim lines at risk of overpayment because of non-compliance with the place-of-service policy and estimates overpayments of more than $22 million.  Learn more about the audit, its findings, and recommendations from this audit summary, which includes a link to the complete Office of Inspector General report.
  • HHS and its Health Resources and Services Administration (HRSA) have announced they are making approximately $65 million available to help ensure that communities in hurricane-prone areas have continuous access to primary care services during future emergencies.  This funding will be available for new construction, renovations, and infrastructure repairs at health centers in Florida, North Carolina, South Carolina, and Puerto Rico to prevent flooding, upgrade emergency generators, and improve communication and mechanical systems ahead of future disasters.  Learn more about this funding from this HHS news release, which includes a link to information about the funding opportunity.

HHS Newsletters

  • MLN Connects (CMS) – June 1 and June 8
  • AHRQ News Now  – June 6
  • HRSA eNews – June 1
  • CMS Expanded Home Health Value-Based Purchasing Model newsletter – May

Provider Relief Fund

With the passage of the Fiscal Responsibility Act of 2023 and related rescission of program funds, no further payments will be made to providers under the Provider Relief Fund or the American Rescue Plan Rural Distribution, including no reconsideration payments.  Likewise, no additional claims payments will be made under the Uninsured Program or Coverage Assistance Fund.  Per the Terms and Conditions of each Program, all reporting and auditing requirements will continue without disruption.

  • HRSA has posted the following deadlines for certain Provider Relief Fund-related activities.
    • June 30 – deadline to apply Provider Relief Fund and/or American Rescue Plan rural funds to lost revenues.
    • July 1 – reporting period 5 begins

Centers for Disease Control and Prevention

  • The CDC has updated its guidance on the use of tecovirimat for the treatment of mpox.  Find the updated guidance here and additional information about the use of tecovirimat here.
  • The CDC is seeking nominations for membership on its Advisory Committee on Immunization Practices (ACIP).  The ACIP consists of up to 20 experts in fields associated with immunization practices and public health, use of vaccines and other immunobiologic agents in clinical practice or preventive medicine, clinical or laboratory vaccine research, and assessment of vaccine efficacy and safety or who have knowledge about consumer perspectives and/or the social and community aspects of immunization programs.  Learn more about ACIP and the process of submitting nominations from this CDC notice.  Applications are due by August 1.

 Medicare Payment Advisory Commission (MedPAC)

MedPAC has submitted comments to CMS in response to several Medicare payment regulations the agency has proposed in recent months.  Learn more from MedPAC’s letters to CMS on payments to:

Government Accountability Office (GAO)

 The GAO has submitted testimony to the House Energy and Commerce Committee’s Subcommittee on Oversight and Investigations about practices that could help guide HHS’s efforts to address and improve preparedness for and response to public health emergencies such as extreme weather, infectious disease outbreaks and pandemics, and intentional acts.  Find that testimony here.

Stakeholder Events

CDC – Long COVID Webinar – June 15

The CDC will hold webinar on Long COVID on “Evaluating and Supporting Patients With Long COVID in Returning to Work” during which it will review some of the complex symptoms specific to Long COVID, discuss medical considerations for recommending return to work, and review accommodations to support patients returning to the workplace.  The webinar will be held on Thursday, June 15 at 2:00 (eastern).  Registration is not required.  For call material and information about continuing medical education credits and how to participate in the webinar, see this CDC notice.

CMS – Skilled Nursing Facility MDS 3.0 RAI v1.18.11 Guidance Training Program – June 21

CMS is offering a virtual training program that provides instruction on its updated guidance for the Skilled Nursing Facility Minimum Data Set 3.0 Resident Assessment Instrument (RAI) v1.18.11 Manual and Item Set.  The program includes recorded training webinars and live, virtual workshop sessions that provide practice coding scenarios on selected data elements.  The live component will be held on Wednesday, June 21 at 12:30 (eastern).  Learn more about the program from this CMS announcement and go here to register to participate.

HHS – Agency for Healthcare Research and Quality – Meeting of the National Advisory Council for Healthcare Research and Quality – July 12

The Agency for Healthcare Research and Quality’s National Advisory Council for Healthcare and Research and Quality will meet virtually on Wednesday, July 12 at 11:15 (eastern).  For information about the council, the meeting’s agenda, and how to participate, see this agency notice.