Posted
on April 7, 2023
The following is the latest health policy news from the federal government for March 31 – April 7. Some of the language used below is taken directly from government documents.
The White House
President Biden has signed an executive order calling for the modernization of the regulatory review process. Among other objectives, the order seeks to improve the effectiveness of the regulatory review process and promote inclusive regulatory policy and public participation. The order gives the Office of Management and Budget, through its Office of Information and Regulatory Affairs and in consultation with the Council of Economic Advisers and representatives of relevant agencies, one year to revise and update the regulatory review process. Find the executive order here.
Medicare Payment Regulations
- CMS has released its proposed Medicare inpatient rehabilitation facility (IRF) prospective payment system rule for FY 2024. The proposed rule calls for increasing IRF rates three percent and adjusting the outlier threshold to maintain outlier payments at three percent of total IRF payments. CMS also proposes permitting hospitals to open new IRF units at any time during the cost reporting period that would be paid under the IRF prospective payment system if the hospital notifies the CMS regional office
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Filed under:
Alternative payment models,
Center for Medicare and Medicaid Innovation,
Centers for Medicare & Medicaid Services,
CMMI,
COVID-19,
health equity,
Medicaid,
Medicare,
Medicare post-acute care,
Medicare regulations,
Medicare reimbursement policy,
MedPAC,
social determinants of health
Posted
on March 30, 2023
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
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Filed under:
Alternative payment models,
Center for Medicare and Medicaid Innovation,
Centers for Medicare & Medicaid Services,
CMMI,
COVID-19,
MACPAC,
Medicaid,
Medicaid and CHIP Payment and Access Commission,
Medicare,
Medicare reimbursement policy,
Telehealth
Posted
on February 16, 2023
The following is the latest health policy news from the federal government for February 6-16. Some of the language used below is taken directly from government documents.
No Surprises Act
- A federal judge in Texas has vacated parts of a regulation governing the arbitration process that is a major aspect of implementation of the No Surprises Act. In his ruling, the judge found that the arbitration process unfairly favored payers over providers, most notably by placing undue emphasis on the qualified payment amount (QPA) that is a major part of the arbitration process. The decision explains that “The Court first held that the interim rule improperly ‘places its thumb on the scale for the QPA, requiring arbitrators to presume the correctness of the QPA and then imposing a heightened burden on the remaining statutory factors to overcome the presumption.’” It adds that “The interim rule, moreover, characterized the non-QPA factors as ‘permissible additional factors’ that an arbitrator may consider only ‘when appropriate’ and concludes that “The interim rule thus conflicted with the Act, which unambiguously requires arbitrators to consider ‘all the specified information in determining which offer to select’ and nowhere instructs them ‘to weigh any one factor or circumstance
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Filed under:
Center for Medicare and Medicaid Innovation,
Centers for Medicare & Medicaid Services,
CMMI,
COVID-19,
health equity,
MACPAC,
Medicaid,
Medicaid and CHIP Payment and Access Commission,
Medicare,
Medicare post-acute care,
Medicare regulations
Posted
on December 15, 2022
The following is the latest health policy news from the federal government for the week of December 12-15. Some of the language used below is taken directly from government documents.
White House
- The White House has unveiled its “COVID-19 Winter Preparedness Plan,” the major components of which are expanding easy access to free COVID-19 testing options in the winter; making vaccinations and treatments readily available as cases rise; preparing personnel and resources; and focusing on protecting the highest-risk Americans. Learn more about the plan from this White House fact sheet and go here for a transcript of the White House press briefing about the plan.
Congress
- Yesterday the House passed a one-week continuing resolution (CR) that will prevent the federal government from shutting down when the current CR ends tomorrow, December 16; the Senate will take up that bill although some senators have expressed their objection to a short-term CR. Appropriators have agreed on the spending limits for FY 2023 spending bills and hope to pass an omnibus spending bill encompassing all 12 appropriations bills before next Friday, December 23. House minority leader Kevin McCarthy, backed by other House Republicans, objects to passing an omnibus spending bill before the end of
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Filed under:
Center for Medicare and Medicaid Innovation,
Centers for Medicare & Medicaid Services,
CMMI,
Congress,
COVID-19,
hospitals,
MACPAC,
Medicaid,
Medicaid and CHIP Payment and Access Commission,
Medicaid disproportionate share,
Medicaid DSH,
Medicaid managed care,
Medicaid regulations,
Medicare,
Medicare cuts,
Medicare reimbursement policy,
MedPAC,
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
