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 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 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
Posted
on November 17, 2022
The following is the latest health policy news from the federal government for the week of November 11 to 17. Some of the language used below is taken directly from government documents.
Provider Relief Fund
- Providers that cited extenuating circumstances for failing to submit Provider Relief Fund financial reports on time for reporting period 3 and were approved to submit their reports late must submit those late reports by December 2. Learn more here.
Centers for Medicare & Medicaid Services
- CMS has posted three downloadable sample formats that hospitals can use to meet federal requirements for posting in a machine-readable format their prices for a selected range of medical services. Find them here (scroll down to the first three listings under “Resources”).
- CMS has written to state Medicaid and CHIP officials describing 2023 and 2024 updates to the Core Set of children’s health care quality measures for Medicaid and the Children’s Health Insurance Program and the Core Set of health care quality measures for adults enrolled in Medicaid. CMS encourages states to use Core Set data to identify disparities in care and to develop targeted quality improvement efforts to advance health equity, so these updates could affect the data
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