Archive for February, 2023


Some Surprise Billing Dispute Decisions to Resume

The Independent Dispute Resolution entities empowered by the No Surprises Act of 2020 to adjudicate disagreements between providers and payers may resume their work – but only some of it.

According to the Centers for Medicare & Medicaid Services,

On February 24, 2023, certified IDR entities were instructed to resume processing payment determinations on February 27, 2023, for disputes involving items or services furnished before October 25, 2022.

But CMS also announced that

Certified IDR entities will continue to hold issuance of payment determinations that involve items or services furnished on or after October 25, 2022 until the Departments issue further guidance.

The work of IDRs was brought to a halt by a federal court ruling earlier this month that found that the process created by federal agencies to implement the No Surprises Act violated the terms of that law by unduly favoring health care payers over providers.

Learn more about where the dispute resolution process stands and what providers and payers can expect from the federal agencies charged with responsibility for implementing the No Surprises Act from this CMS notice.…

The Emergence of “Food as Medicine”

In both the public and private sectors, a growing movement is working to integrate food as part of medical treatment – and have health care payers foot the bill.

From the administration’s granting of Medicaid waivers to Arkansas, Massachusetts, and Oregon to use state and federal money to pay for food for some beneficiaries to Congress tucking $2 million into an appropriations bill for a “food is medicine pilot program” to the NIH developing a $140 million grant program that will lead to the designation of “food is medicine centers of excellence,” providers and policy-makers are showing unprecedented interest in the effects of nutrition on health and questioning whether medicine alone meets the needs of patients.  Some Medicare and Medicaid patients already receive what are known as “medically-tailored meals” or “medically-tailored groceries” and some Medicare Advantage plans are offering food and produce benefits to members with certain chronic medical conditions.

Impeding further development of greater use of food as medicine, and as a possible means of addressing social determinants of health and facilitating greater health equity, are the lack of research into the effectiveness of such endeavors; the lack of integration of food into medical practice; and the cost of …

Federal Health Policy Update for February 23

The following is the latest health policy news from the federal government for February 17-23.  Some of the language used below is taken directly from government documents.

Centers for Medicare & Medicaid Services

  • CMS has issued an informational bulletin to states reiterating certain federal requirements that pertain to health care-related taxes.  Recently, CMS became aware that some health care-related tax programs appear to involve agreements among providers to redistribute their Medicaid payments to hold taxpayers harmless for the cost of the tax.  The bulletin reminds states that such arrangements are prohibited.  Find the CMS bulletin here.
  • CMS has posted a presentation on accessibility requirements in Medicaid and CHIP.  Find it here.
  • As required by law, HHS has published a semi-annual list of rule-making actions under development throughout the department.  Find that list here, along with a link to a formal Federal Register notice.
  • Writing in the journal Health Affairs, CMS officials report that in a limited review of hospital compliance with the agency’s hospital price transparency rule, the proportion of hospitals in compliance with both parts of the rule rose from 27 percent in 2021 to 70 percent in 2022 and more than 80 percent currently

Most Medicaid Participants Don’t Know About Looming Eligibility Redetermination

With the COVID-19 pandemic’s continuous Medicaid eligibility set to expire in a little more than a month, nearly two-thirds of the current Medicaid population is unaware their continued participation in the program will soon be subject to review and could result in their loss of health care benefits.

According to a survey conducted for the Robert Wood Johnson Foundation, “In December 2022, more than 6 in 10 adults in Medicaid-enrolled families were not aware of an upcoming return to the regular Medicaid renewal processes…”

This could pose a major challenge both for those who lose their Medicaid coverage and may need to forego seeking treatment and those who care for current Medicaid patients and face the prospect of providing care for which they will not be paid.

Learn more about one of the major obstacles to Medicaid eligibility redetermination from this summary of the foundation survey.…

End of PHE Spells End of Additional Money to Care for COVID Patients

When the COVID-19 public health emergency ends on May 11, the 20 percent increase in Medicare payments to hospitals caring for Medicare patients suffering from the disease will end as well.

In the first two years under this payment policy, which took effect in January of 2020, the federal government paid more than $23 billion to hospitals caring for COVID patients.  Of that amount, 20 percent consisted of the supplemental payment.

Learn more about the end of these additional payments and what it may mean for hospitals and Medicare beneficiaries from the Becker Hospital Review article “The 20% cut coming for hospitals.”…