The following is the latest health policy news from the federal government as of 3:30 p.m. on Tuesday, March 30.

Medicare Sequestration

In anticipation of possible congressional action to extend the two percent sequester reduction suspension, CMS has instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021 for a short period without affecting providers’ cash flow.  This will minimize the volume of claims the MACs must reprocess if Congress extends the suspension.  The MACs will automatically reprocess any claims paid with the reduction applied if necessary.

The White House

COVID-19

• The White House has posted a fact sheet explaining that President Biden will announce that 90 percent of the adult U.S. population will be eligible for vaccination and 90 percent will have a vaccination site within five miles of their home by April 19.  The key elements of the plan are:
• Expanding vaccines to 20,000 more local pharmacies, bringing the total to nearly 40,000 pharmacies across the country by April 19.
• Launching a new effort to get the most vulnerable and at-risk seniors and people with disabilities vaccinated.
• Expanding the number of mass vaccination centers across the country.
• The

The new administration has delayed the planned launch of several new Medicare payment models and ultimately may choose not to move forward with some or to alter them.

The models currently under review by the Centers for Medicare & Medicaid Services are:

• Primary Care First
• Kidney Care Choices
• Geographic Direct Contracting
• Part D Payment Modernization Model

Learn more from the Becker’s Hospital Review article “CMS payment models that are under review, delayed.”…

Beginning this week, DeBrunner & Associates is expanding its regular updates to encompass a broader scope of federal health policy endeavors to include other matters of importance to providers.  Feel free to share this newsletter with others in your organization or to send us the email addresses of those you think might be interested and we will send it directly to them.

The following is the latest such information from the federal government as of 2:30 p.m. on Friday, March 26.

The White House

COVID-19

• With funding in large part from the American Rescue Plan, the White House announced that HHS will spend nearly $10 billion to expand access to vaccines and better serve communities of color, rural areas, low-income populations, and other underserved communities in the COVID-19 response.  The money will be spent in the following manner:
• $6 billion for community health centers to expand access to vaccines in underserved communities.  Go here for more information about the distribution of this money.
• $3 billion to “strengthen vaccine confidence.”  This funding will go directly to states, territories, and some large cities.
• A partnership with dialysis clinics to vaccinate dialysis patients.  The CDC issued two statements on its role in

Beginning today, DeBrunner & Associates is expanding its regular updates to encompass a broader scope of federal health policy endeavors to include other matters of importance to providers.  Feel free to share this newsletter with others in your organization or to send us the email addresses of those you think might be interested and we will send it directly to them.

The following is the latest such information from the federal government as of 2:45 p.m. on Wednesday, March 24.

Congress

The temporary delay of implementation of the Medicare two percent sequester expires at the end of the month and amid considerable advocacy by the health care community, Congress is considering extending this delay.  Last week the House passed a bill that would extend the current moratorium through December 31, 2021 and would waive “PAYGO” rules that apply to the American Rescue Plan Act that would necessitate an additional two percent sequester on Medicare payments starting in January, which would be added to the existing sequester to result in a four percent sequester. The Senate will not take up the House bill but could take up S. 748, which would extend the current moratorium for the duration of the COVID-19 …

A new Medicare policy expected to save money for the federal government may end up doing so at the expense of Medicare beneficiaries who may find themselves faced with costs that Medicare previously paid.

Under the new policy, selected procedures that Medicare once authorized only when performed on an inpatient basis can now be performed on an outpatient basis.  The underlying rationale for the policy, which took effect on January 1 and will be phased in over the next three years, is that such an approach should foster competition and possibly lower Medicare costs.

But some of those procedures still require meaningful after-care that can range from prescription drugs to post-surgical monitoring to facility fees to home care and more – costs included in Medicare reimbursement for inpatient surgery but not included in the price of outpatient surgery.  Thus, while patients generally face the same maximum deductible for inpatient and outpatient procedures, they may be more likely to be forced to spend that full deductible if they choose to have the surgery performed on an outpatient basis.

Learn more about how this situation came about, its implications for Medicare beneficiaries, and the possibility of this unusual situation being corrected in …