Archive for November, 2022


States Seek Certainty on End of PHE

The country’s states want a clearer idea of when the official COVID-19 public health emergency will end – and along with it, the continuous Medicaid eligibility that remains a major component of the federal attempt to ensure health care coverage for millions of Americans during the pandemic.

Even though two administrations have now regularly renewed the PHE for three-month periods and the current administration has promised governors 60 days’ notice of when the PHE will end, the nation’s Medicaid directors have written to congressional leaders asking for Congress to “…provide states with certainty around the end of the Medicaid continuous enrollment requirement.”

Declaring the current need to wait for the end of this period “untenable,” they seek 120 days’ notice of the official end of the PHE.

Their concern centers around the unwinding of the continuous eligibility for Medicaid that was a major part of the Families First Coronavirus Response Act.  In exchange for expanded Medicaid eligibility and an increase in federal Medicaid matching funds, states were prohibited from reviewing the eligibility of people on their Medicaid rolls and removing those who no longer qualify.  Now, states are concerned about the uncertainty surrounding the loss of the additional federal Medicaid …

Federal Health Policy Update for November 17

The following is the latest health policy news from the federal government for the week of November 11 to 17.  Some of the language used below is taken directly from government documents.

Provider Relief Fund

  • Providers that cited extenuating circumstances for failing to submit Provider Relief Fund financial reports on time for reporting period 3 and were approved to submit their reports late must submit those late reports by December 2.  Learn more here.

Centers for Medicare & Medicaid Services

  • CMS has posted three downloadable sample formats that hospitals can use to meet federal requirements for posting in a machine-readable format their prices for a selected range of medical services.  Find them here (scroll down to the first three listings under “Resources”).
  • CMS has written to state Medicaid and CHIP officials describing 2023 and 2024 updates to the Core Set of children’s health care quality measures for Medicaid and the Children’s Health Insurance Program and the Core Set of health care quality measures for adults enrolled in Medicaid.  CMS encourages states to use Core Set data to identify disparities in care and to develop targeted quality improvement efforts to advance health equity, so these updates could affect the data

117th Congress’s Waning Hours

In addition to its biggest challenge – funding the federal government, authorization for which ends on December 16 – Congress has a number of health care issues on its agenda that at least some lawmakers and health care industry stakeholders would like to see it address before the year ends.

Those issues include the cut in Medicare payments to physicians scheduled to take place on January 1; the desire of many to make permanent some of the flexibilities to use telehealth that were temporarily authorized in response to the COVID-19 public health emergency; additional pandemic funding for new vaccines, new treatments, and more; reorganization of the Food and Drug and Administration; and more.

Learn more about these priorities in the Washington Post article “It’s lame-duck time.  Here are Congress’s health priorities.”…

Medicaid and Children’s Behavioral Health

In response to the growing behavioral health challenges children face, including the need for inpatient hospitalization, the country’s Medicaid directors recently addressed the question of how Medicaid can best help tackle this challenge.

The directors thought their programs could be most helpful in three ways:

  • preventing crises by providing care and supports
  • improving specialized inpatient psychiatric care
  • supporting the return of patients to the community

Learn more about how the Medicaid directors think this can be done and what some of them already are doing in the National Association of Medicaid Directors blog articleHow Medicaid is Making a Difference for Kids with Complex Behavioral Health Needs.”…

Federal Health Policy Update for November 10

The following is the latest health policy news from the federal government for the week of November 7 to 10.  Some of the language used below is taken directly from government documents.

Centers for Medicare & Medicaid Services

  • CMS has published a notice advising teaching hospitals that they have until November 18 to ask Medicare to reconsider their per resident amounts or resident caps as shown in the Hospital Cost Report Information System (HCRIS) associated with cost reports that, as of July 1, 2022, were not reopenable.  Learn more from this CMS notice.
  • Due to an unplanned system outage of the No Surprises Act Independent Dispute Resolution (IDR) portal on November 8 and 9, initiating parties may not have been able to submit a Notice of IDR Initiation webform, complete IDR entity selection responses via the webform, and/or submit their IDR Notice of Offer webform.  This system issue has now been resolved.  The Departments have granted a four-day extension for initiating parties to get the Notice of IDR Initiation webform to submit IDR payment disputes where the open negotiation period expired on November 8, 9, or 10; a four-day extension for non-initiating parties of affected disputes to gain access the IDR Entity