Posted
on December 22, 2022
The following is the latest health policy news from the federal government for the week of December 19-22. Some of the language used below is taken directly from government documents.
Congress
As of this writing, Congress continues to work on an FY 2023 omnibus spending bill: the Senate has passed it but the House has not yet addressed it. Highlights of what negotiators have agreed to – but that have not yet been adopted – include:
- Preventing the additional four percent Medicare sequester for two years.
- Reducing by more than half the 4.5 percent cut in Medicare payments to physicians that was scheduled to take effect on January 1. The agreement calls for reducing that 4.5 percent cut to just two percent in 2023 and then imposing a 3.5 percent cut in 2024.
- Extending COVID-19 public health emergency Medicare telehealth policies for two years, through 2024.
- Ending the maintenance-of-effort requirement from the Families First Coronavirus Response Act that prohibited states from removing ineligible individuals from their Medicaid rolls. Under that law, states were prohibited from reviewing the eligibility of Medicaid beneficiaries for the duration of the COVID-19 public health emergency in exchange for a 6.2 percentage point increase in FMAP.
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Filed under:
Affordable Care Act,
Alternative payment models,
Centers for Medicare & Medicaid Services,
CMMI,
Congress,
COVID-19,
hospitals,
Medicaid,
Medicare,
Medicare bad debt reimbursement,
Medicare regulations,
Medicare reimbursement policy,
Telehealth
Posted
on December 1, 2022
The following is the latest health policy news from the federal government for the week of November 28 to December 1. Some of the language used below is taken directly from government documents.
340B
- HHS and its Health Resources and Services Administration (HRSA) have proposed revising the current 340B administrative dispute resolution process. Since the current process was introduced in 2020 HRSA has encountered policy and operational challenges with its implementation and now proposes revising it and is soliciting comment on its proposed new approach. Changes include changing the nature of the dispute resolution process, using different kinds of professionals to adjudicate disputes, moving the process closer to certain legislative requirements, and creating a process for reconsideration for those unhappy with decisions. Learn more about how the proposed rule would change the administrative dispute resolution process from this HHS notice, which also includes a link to a more detailed Federal Register notice. Comments are due by January 30.
Confidentiality of Substance Use Disorder Patient Records
- HHS and its Office for Civil Rights and the Substance Abuse and Mental Health Services Administration (SAMHSA) have proposed changes in the Confidentiality of Substance Use Disorder Patient Records under 42 CFR part 2,
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Filed under:
340b,
Affordable Care Act,
Center for Medicare and Medicaid Innovation,
Centers for Medicare & Medicaid Services,
CMMI,
Congress,
COVID-19,
health equity,
hospitals,
MACPAC,
Medicaid,
Medicaid and CHIP Payment and Access Commission,
Medicaid and housing,
Medicaid long-term services and supports,
Medicaid regulations,
Medicare,
MedPAC,
Telehealth
Posted
on November 10, 2022
The health insurance market was highly concentrated in 42 of the 50 states in 2019 and 2020 – the continuation of a trend identified in 2010 that has persisted ever since, according to a new report by the U.S. Government Accountability Office.
The GAO considers a market concentrated if three or fewer insurers in a state have 80 percent of that market. Using Centers for Medicare & Medicaid Services health insurance enrollment data, the GAO looked at three distinct aspects of markets – individual policies, small group policies, and large group coverage – and found that
- Each of the three markets in 2020 was concentrated in at least 42 states (including the District of Columbia).
- The individual and small group markets generally became more concentrated in recent years. The median market share of the top three issuers in each market increased by 12 and 10 percentage points, respectively, from 2011 through 2020. With these increases, their median market share was at least 97 percent in both markets in 2020.
Learn more about the study’s origins in the Affordable Care Act and why its findings matter in the GAO report “Private Health Insurance: Markets Remained Concentrated through 2020, with Increases …
Posted
on August 8, 2022
The following is the latest health policy news from the federal government as of 2:30 p.m. on Monday, August 8. Some of the language used below is taken directly from government documents.
Congress
On Sunday, the Senate passed the Democrats’ health care, climate, and tax bill, H.R. 5376, The Inflation Reduction Act, by a vote of 51-50, with Vice President Harris casting the tie-breaking vote. Health care provisions in the reconciliation bill include:
- allowing Medicare to negotiate prescription drug prices
- limiting out-of-pocket prescription drug costs for Medicare enrollees to $2,000 a year
- extending for three years enhanced Affordable Care Act subsidies for individuals to buy health insurance on the marketplace.
The bill now heads to the House, which expects to pass it Friday. Find the Democrats’ summary of the bill’s health care provisions here.
White House
President Biden has issued an “Executive Order on Securing Access to Reproductive and Other Healthcare Services” to build on action the administration has taken to protect access to reproductive health care services. The executive order coincides with the first meeting of the Task Force on Reproductive Healthcare Access and includes actions to support patients traveling out of state for medical care, even raising …
Posted
on August 2, 2022
The following is the latest health policy news from the federal government as of 2:45 p.m. on Tuesday, August 2. Some of the language used below is taken directly from government documents.
White House
The White House has announced two new actions to address the youth mental health crisis: it will award nearly $300 million from the FY 2022 bipartisan omnibus agreement to expand access to mental health services in schools and it will encourage governors to invest more in school-based mental health services. Learn more about this effort, including the individual funding components of the $300 million in new spending, from this White House fact sheet.
Medicare Payment Regulations
- CMS has issued its final Medicare inpatient prospective payment system and long-term care prospective payment system regulation for FY 2023. Highlights of the final rule include a 4.3 percent increase in Medicare hospital inpatient rates and a 2.3 percent increase in LTCH rates; a reduction of $318 million in the Medicare DSH uncompensated care payment pool; introduction of a new “birthing-friendly hospital” designation for hospitals that meet certain criteria; the introduction of three new health equity measures; a permanent five percent cap on year-to-year wage index reductions; and more.
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