The following is the latest health policy news from the federal government for September 1-7.  Some of the language used below is taken directly from government documents.

Congress

House Republicans plan to introduce the Lower Cost, More Transparency Act for consideration before the end of the year.  This bill includes provisions passed by three committees with health care jurisdiction:  House Ways & Means, Energy & Commerce, and Education & Workforce.   Some of the bill’s provisions would:

• eliminate scheduled Medicaid DSH cuts for FY 2024 and FY 2025;
• reauthorize and extend funding for the Community Health Center program, the National Health Service Corps, and the Teaching Health Centers that Operate GME program;
• establishing site-neutral payments by reducing Medicare payments for drug administration services at all hospital outpatient departments (HOPDs) to the same rate paid in non-hospital-based physician offices; and
• increase reporting requirements for pharmacy benefit managers (PBMs) and ban certain spread pricing practices.

A few provisions included in bills already approved by Ways & Means and Energy & Commerce are excluded from this proposed legislation.  The draft of the Lower Cost, More Transparency Act does not include provisions that would:

• require providers to obtain location-specific National Provider Identifiers (NPIs) for each

The following is the latest health policy news from the federal government for August 11-24.  Some of the language used below is taken directly from government documents.

Centers for Medicare & Medicaid Services

• After suspending the No Surprises Act-created Independent Dispute Resolution process in the wake of a court ruling striking down a recent increase in fees for that process, CMS has established a new rate structure for initiating the adjudication of payment disagreements between providers and payers.  It explains the new rate structure in this new FAQ, which nevertheless notes that despite the creation of new rates, the Independent Dispute Resolution process remains suspended until further notice.
• CMS has updated the ICD-10 MS-DRG grouper version 41 with changes that will take effect on October 1.  Go here for further information, additional resources, and links to downloads.
• CMS has posted a brief animated explainer video, “Social Determinants of Health Items:  Determining When a Proxy Response is Allowed,” to help home health, hospice, and long-term-care hospitals determine when the use of a proxy response is permitted for the following social determinants of health items:  A1005 – ethnicity; A1010 – race; A1110 – language; A1250 – transportation; B1300 – health literacy;

The following is the latest health policy news from the federal government for July 29-August 3.  Some of the language used below is taken directly from government documents.

Medicare Payment Regulations

• CMS has issued a final rule updating Medicare payment policies and rates for inpatient and long-term-care hospital services under its inpatient prospective payment system and long-term care prospective payment system for FY 2024.  The final rule increases hospital inpatient rates 3.1 percent and LTCH rates 3.3 percent in FY 2024.  Other highlights include a nearly $1 billion cut in Medicare disproportionate share (Medicare DSH) and Medicare DSH uncompensated care payments; changes in diagnosis codes and health equity hospital categorizations to address health equity and a program that will pay bonuses to hospitals that provide excellent care to especially large numbers of dually eligible (Medicare and Medicaid) patients; continuation of Medicare’s low-wage hospital policy and changes in its rural wage index calculation methodology; and more.  Learn about these and other aspects of the final FY 2024 inpatient prospective payment system and long-term care prospective payment system from this CMS news release; a CMS fact sheet; and a pre-publication version of the final rule.
• CMS has issued a

Federal efforts to develop and improve payment models and other programs designed to foster health equity are often hamstrung by poor data:  inconsistent data requests from program to program and flawed and incomplete data reporting by those participating in those programs.

As a result, federal policymakers often are unable to tell whether programs – both those developed specifically to address health equity and those that are not – are having the desired effect on health equity.

The result, according to a new study from the Centers for Medicare & Medicaid Services’ Center for Medicare and Medicaid Innovation, is that

1) The variable quality of race/ethnicity data in Medicare and Medicaid claims data presents a challenge for understanding whether models reach and enroll underserved individuals; 2) Model designs have not always considered needs specific to underserved individuals; and, 3) Model designs that do not prioritize the inclusion of underserved individuals may have small sample sizes for these populations that limits the ability to draw conclusions.

Learn more about the challenges federal policymakers faces in developing Medicare and Medicaid payment models that address health equity in its new analysis “Assessing Equity to Drive Health Care Improvements:  Learnings from the CMS Innovation …

The following is the latest health policy news from the federal government for June 30 – July 13.  Some of the language used below is taken directly from government documents.

340B

CMS has published a proposed regulation outlining how it plans to reimburse hospitals for reductions in 340B prescription drug payments that it implemented from 2018 to 2022 but that a federal court found to be illegal.  The agency calculates that it owes participating 340B providers $9 billion, which it proposes paying to those providers in single lump-sum payments.  CMS also proposes offsetting these payments through reductions in future non-drug and service outpatient payments that would be in effect for 16 years.  Learn more from this CMS fact sheet; this CMS regulatory announcement about the proposed regulation, which includes a link to a formal Federal Register notice; and this CMS web page that includes downloadable files that list the payments CMS intends to make to eligible providers.  The deadline for submitting comments on the proposed rule is September 11.

No Surprises Act

• HHS and its Office of the Assistant Secretary for Planning and Evaluation (ASPE) have issued a report to Congress on the impact of the