The following is the latest health policy news from the federal government for March 24-30.  Some of the language used below is taken directly from government documents.

Centers for Medicare & Medicaid Services

• CMS’s Center for Medicare and Medicaid Innovation (CMMI) has extended its Medicare Advantage Value-Based Insurance Design (VBID) Model for calendar years 2025 through 2030 and will introduce changes intended to address more fully the health-related social needs of patients, advance health equity, and improve care for patients with serious illness.  Learn more from this CMS announcement, which includes a link to additional information about the program.
• CMS has published an update to its 2023 CMS quality reporting document architecture category I implementation guide and its schematron for hospital quality reporting.  This is an update to the implementation guide version 1.1 published in January and it outlines requirements for eligible hospitals and critical access hospitals to report electronic clinical quality measures (eCQMs) for the calendar year 2023 reporting period for its Hospital Inpatient Quality Reporting Program, Medicare Promoting Interoperability Program, and Outpatient Quality Reporting Program.  Find the updated guide here and go here for the schematron (the schematron link opens to a zip file download).
• CMS has

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

No Surprises Act

After a February ruling in federal court that aspects of CMS’s implementation of the 2020 No Surprises Act contradicted the language of the act itself and unfairly favored payers over providers, CMS ordered a moratorium on new arbitration decisions for disputes filed on or after October 25, 2022 while it reviewed and revised its guidance on how payment disputes should be decided.  Now, CMS has completed that task and issued new guidance to the Independent Dispute Resolution entities that adjudicate the disputes and to the parties in those disputes and ordered the resumption of the arbitration of disputed cases.  Go here to see the new CMS guidance to the parties in disputes and here for the new guidance to the Independent Dispute Resolution entities.

Department of Health and Human Services

• HHS has published a notice explaining that even though the COVID-19 public health emergency is expected to end formally on May 11, the continued prevalence of COVID-19 and its variants merits the continuation of FDA emergency use authorizations that would

The Medicaid and CHIP Payment and Access Commission has issued its annual report to Congress on the state of Medicaid and the Children’s Health Insurance Program.

The commission, a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the Department of Health and Human Services, and the states on a wide array of subjects, issues a report every year at this time.  This year’s report focuses primarily on:

• Medicaid race and ethnicity data collection and reporting
• principles for assessing Medicaid nursing facility payment programs
• strengthening evidence under Medicaid drug coverage
• MACPAC’s statutorily required review of hospital payment policy for the nation’s safety-net hospitals – specifically, to report on Medicaid disproportionate share hospital (Medicaid DSH) allotments to states.

On the subject of Medicaid DSH, MedPAC states that

As in prior years, the Commission continues to find little meaningful relationship between state DSH allotments and the number of uninsured individuals; the amounts and sources of hospitals’ uncompensated care costs; and the number of hospitals with high levels of uncompensated care that also provide essential community services for low-income and uninsured populations.

Learn more about MACPAC’s perspective on Medicaid and CHIP in its …

After revising its guidelines on how certain medical fee disputes should be resolved, the Centers for Medicare & Medicaid Services has directed the Independent Dispute Resolution entities responsible for arbitrating fee disputes between payers and providers to resume making and issuing their decisions.

After a February ruling in federal court that aspects of CMS’s implementation of the 2020 No Surprises Act contradicted the language of the act itself and unfairly favored payers over providers, CMS ordered a moratorium on new arbitration decisions for disputes filed on or after October 25, 2022 while it reviewed and revised its guidance on how those disputes should be decided.  Now, CMS has completed that task and issued new guidance to the Independent Dispute Resolution entities that adjudicate the disputes and to the parties in those disputes.

Go here to see the new CMS guidance to the parties in disputes and here for the guidance to the Independent Dispute Resolution entities.

 …

Medicare rates would rise for some providers and fall for others based on recommendations made to Congress last week by the Medicare Payment Advisory Commission, the independent congressional agency that advises Congress on Medicare reimbursement matters.

MedPAC’s rate recommendations to Congress and the administration, which it approved at its January 2023 meeting, are:

• Outpatient and inpatient prospective payment systems – under current law, the estimated increase would be about 2.9 percent; MedPAC proposes 2.9 percent plus one percent.
• Physician services – increase fees 50 percent of the projected increase in the medical economic index (MEI).
• Skilled nursing facilities – reduce the current base rate three percent.
• Home health services – reduce the current base rate seven percent.
• Hospice services – a complex proposal to increase some payments 2.9 percent but to reduce payments “for providers with very long lengths of stay and lost costs relative to payments.”
• Outpatient dialysis – MedPAC endorses the current law’s call for a 1.8 percent increase.

Breaking with recent years, MedPAC has discontinued its practice of offering rate recommendations for long-term-care hospitals (LTCHs) and ambulatory surgical centers, citing inadequate data on which to base recommendations.

In addition, MedPAC offers recommendations for redistributing current Medicare disproportionate …