Policy Updates

Federal Health Policy Update for September 12

The following is the latest health policy news from the federal government for September 6-12. Some of the language used below is taken directly from government documents. 340B A federal court has declined to issue a preliminary order to block implementation of a Maryland law that requires pharmaceutical companies to provide discounts on drugs dispensed by eligible 340B providers by contract pharmacies. The challenge to the Maryland law, filed by Pharmaceutical Research and Manufacturers of America (PhRMA) and several pharmaceutical companies, will be heard without a temporary order suspending the law’s implementation. Learn more from the court order. Centers for [...]

joe2024-09-12T15:22:15-04:00September 12, 2024|340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, COVID-19, hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare regulations, Medicare reimbursement policy, MedPAC|

Clock Ticking on Some Telehealth Prescribing?

The COVID-inspired flexibility to prescribe some medicines via telehealth will soon expire – and it is not clear whether the practice will be extended. While there is general support for telehealth prescribing, policymakers appear to be divided over whether to permit continued use of telehealth to prescribe Schedule 2 drugs such as Adderall. The next step in clearing the path to extending the flexibility was supposed to be a proposed regulation from the Drug Enforcement Agency. The DEA has submitted a draft to the Office of Management and Budget for review but published reports suggest that the Department of Health [...]

joe2024-09-11T12:32:44-04:00September 12, 2024|Telehealth|

Federal Health Policy Update for September 5

The following is the latest health policy news from the federal government for August 31 – September 5. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has posted a bulletin outlining changes coming in the FY 2025 inpatient and long-term-care hospital prospective payment system. Find that bulletin here. The changes it presents take effect on October 1. CMS has posted a bulletin about new waived laboratory tests that outlines Clinical Laboratory Improvement Amendments (CLIA) requirements, new CLIA-waived tests approved by the FDA, and use of the modifier QW for [...]

joe2024-09-05T15:20:05-04:00September 5, 2024|Centers for Medicare & Medicaid Services, COVID-19, Medicare, Medicare regulations, Medicare reimbursement policy|

Telehealth Gains in Jeopardy?

The ability of doctors to use telehealth to prescribe medicines like buprenorphine for patients with opioid use disorder may be in jeopardy. While COVID-19 inspired an expanded use for caring for patients using telehealth, the regulatory flexibility that made remote prescribing possible expires at the end of 2024 and the federal Drug Enforcement Agency appears reluctant to call for its extension without modification. In particular, an unreleased DEA proposal reportedly would limit individual physicians to issuing no more than half of their prescriptions virtually. Some people think this would detract from the overall effectiveness of telehealth in treating opioid use [...]

joe2024-09-03T17:44:07-04:00September 4, 2024|Telehealth|

Federal Health Policy Update for August 30

The following is the latest health policy news from the federal government for August 23-30. Some of the language used below is taken directly from government documents. 340B Johnson & Johnson, the pharmaceutical, biotechnology, and medical technologies company, told health care providers this week that it would shift from the long-time 340B upfront discount approach to a rebate model for two of its drugs and that eligible 340B hospitals and other providers will need to purchase the prescription drugs Stelara and Xarelto at list price and then, after dispensing them to patients, will need to submit 340B rebate claims to [...]

joe2024-08-30T15:03:18-04:00August 30, 2024|340b, Centers for Medicare & Medicaid Services, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid long-term services and supports, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, social determinants of health|

States Stepping Into Prior Authorization Void

While federal lawmakers continue to weigh how to address the problem of prior authorization requirements that cause delays in the delivery of health care, many state governments are acting more decisively by implementing prior authorization reforms of their own. This year, 10 states have enacted 18 laws designed to facilitate prior authorization of medical services and in 2023, nine states and the District of Columbia did so. In all, 23 states have introduced prior authorization reforms in recent years. At the same time, some health insurers have reduced the number of medical services for which they require prior authorization. The [...]

joe2024-08-28T10:39:07-04:00August 29, 2024|Medicare|

Federal Health Policy Update for August 22

The following is the latest health policy news from the federal government for August 16-22. Some of the language used below is taken directly from government documents. The Courts The federal government must include uninsured patients whom hospitals serve under state Medicaid waivers when calculating hospitals’ Medicare DSH payments, a federal court has ruled. In the case of Baylor All Saints Medical Center, et al. v. Xavier Becerra, federal policymakers had invoked a 2023 regulation that excluded counting care provided to patients served by DSH-eligible hospitals providing care through state Medicaid waivers – generally, through uncompensated care pools. A group [...]

joe2024-08-22T15:11:48-04:00August 22, 2024|Alternative payment models, Center for Medicare and Medicaid Innovation, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy, Telehealth|

Jury Still Out on Revised 2-Midnight Rule

A regulation that requires Medicare Advantage plans to comply with Medicare’s 2-midnight rule in the same manner as traditional Medicare as of 2024 is bringing mixed results for hospitals. Some hospitals report increased admissions – and inpatient revenue – as they admit Medicare patients previously kept under observation status. Others, though, report that with those increased admissions has come a reduction of case-mix index because these newly admitted patients are not as acutely ill as the typical hospital patient. Still others report no clear impact yet of the requirement that Medicare Advantage plans treat the 2-midnight rule the same as [...]

joe2024-08-21T12:30:42-04:00August 22, 2024|Medicare regulations, Medicare reimbursement policy|

Court Rejects Non-Compete Ban

A federal court has rejected a Federal Trade Commission regulation that banned non-compete agreements between employers and employees under most circumstances. In a suit brought in Texas by the U.S. Chamber of Commerce, the Business Roundtable, the Texas Association of Business, and others, the court found that the FTC exceeded its authority in promulgating the regulation and that the rule itself was “arbitrary and capricious,” based on limited evidence, and without either a rationale for such a sweeping approach nor any evidence that the agency considered a more limited approach to the challenges it identified as the basis for advancing [...]

joe2024-08-21T11:42:58-04:00August 21, 2024|Uncategorized|

Federal Court Rejects Medicare DSH Regulation

The federal government must include uninsured patients that hospitals serve under state Medicaid waivers when calculating hospitals’ Medicare DSH payments, a federal court has ruled. In the case of Baylor All Saints Medical Center, et al. v. Xavier Becerra, federal policymakers had invoked a 2023 regulation that excluded counting care provided to patients serve by DSH-eligible hospitals providing care through state Medicaid waivers – generally, through uncompensated care pools. A group of DSH-eligible hospitals in Texas sued over the regulation because its implementation reduced their Medicare DSH funding – money intended to help hospitals that care for especially large numbers [...]

joe2024-08-20T16:50:08-04:00August 21, 2024|Medicare disproportionate share, Medicare DSH, Medicare regulations|