The following is the latest health policy news from the federal government for February 27 to March 3.  Some of the language used below is taken directly from government documents.

No Surprises Act

• The Independent Dispute Resolution (IDR) entities empowered by the No Surprises Act to adjudicate disagreements between providers and payers may resume their work – but only some of it.  CMS has directed IDRs entities to resume processing payment determinations on February 27 for disputes involving items or services furnished before October 25, 2022 but not to issue decisions involving items or services furnished on or after October 25, 2022 until federal agencies can provide additional direction.  The work of IDRs was brought to a halt by a federal court ruling last month that found that the process created by federal agencies to implement the No Surprises Act violated the terms of that law by unduly favoring health care payers over providers.  Learn more about where the dispute resolution process stands and what providers and payers can expect from the federal agencies charged with responsibility for implementing the No Surprises Act from this CMS notice.
• The Congressional Research Service has published a brief overview of the No Surprises

In both the public and private sectors, a growing movement is working to integrate food as part of medical treatment – and have health care payers foot the bill.

From the administration’s granting of Medicaid waivers to Arkansas, Massachusetts, and Oregon to use state and federal money to pay for food for some beneficiaries to Congress tucking $2 million into an appropriations bill for a “food is medicine pilot program” to the NIH developing a $140 million grant program that will lead to the designation of “food is medicine centers of excellence,” providers and policy-makers are showing unprecedented interest in the effects of nutrition on health and questioning whether medicine alone meets the needs of patients.  Some Medicare and Medicaid patients already receive what are known as “medically-tailored meals” or “medically-tailored groceries” and some Medicare Advantage plans are offering food and produce benefits to members with certain chronic medical conditions.

Impeding further development of greater use of food as medicine, and as a possible means of addressing social determinants of health and facilitating greater health equity, are the lack of research into the effectiveness of such endeavors; the lack of integration of food into medical practice; and the cost of …

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

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,

The following is the latest health policy news from the federal government for the week of September 12-16.  Some of the language used below is taken directly from government documents.

No Surprises Act

• The Department of Health and Human Services, the federal Office of Personnel Management, the Internal Revenue Service, the Department of the Treasury, the Department of Labor, and the Employee Benefits Security Administration have issued a request for information (RFI) seeking stakeholder comment on how to implement the No Surprises Act’s requirement that health care providers and payers give explanations of benefits and good-faith estimates of costs for services and items that are scheduled at least three days in advance to individuals who have health insurance.  Previous regulations have focused on the delivery of this information to uninsured and self-pay patients and those obtaining services from out-of-network providers, but providers and payers asked regulators to delay implementation of the law’s requirements for the provision of such information to insured patients so they could address the technical infrastructure needed to transfer data effectively and in a timely manner between and among providers and payers.  Learn more this Federal Register notice.  Comments in response to the RFI are due