The following is the latest health policy news from the federal government for March 17-23.  Some of the language used below is taken directly from government documents.

No Surprises Act

After a February ruling in federal court that aspects of CMS’s implementation of the 2020 No Surprises Act contradicted the language of the act itself and unfairly favored payers over providers, CMS ordered a moratorium on new arbitration decisions for disputes filed on or after October 25, 2022 while it reviewed and revised its guidance on how payment disputes should be decided.  Now, CMS has completed that task and issued new guidance to the Independent Dispute Resolution entities that adjudicate the disputes and to the parties in those disputes and ordered the resumption of the arbitration of disputed cases.  Go here to see the new CMS guidance to the parties in disputes and here for the new guidance to the Independent Dispute Resolution entities.

Department of Health and Human Services

• HHS has published a notice explaining that even though the COVID-19 public health emergency is expected to end formally on May 11, the continued prevalence of COVID-19 and its variants merits the continuation of FDA emergency use authorizations that would

The Medicaid and CHIP Payment and Access Commission has issued its annual report to Congress on the state of Medicaid and the Children’s Health Insurance Program.

The commission, a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the Department of Health and Human Services, and the states on a wide array of subjects, issues a report every year at this time.  This year’s report focuses primarily on:

• Medicaid race and ethnicity data collection and reporting
• principles for assessing Medicaid nursing facility payment programs
• strengthening evidence under Medicaid drug coverage
• MACPAC’s statutorily required review of hospital payment policy for the nation’s safety-net hospitals – specifically, to report on Medicaid disproportionate share hospital (Medicaid DSH) allotments to states.

On the subject of Medicaid DSH, MedPAC states that

As in prior years, the Commission continues to find little meaningful relationship between state DSH allotments and the number of uninsured individuals; the amounts and sources of hospitals’ uncompensated care costs; and the number of hospitals with high levels of uncompensated care that also provide essential community services for low-income and uninsured populations.

Learn more about MACPAC’s perspective on Medicaid and CHIP in its …

The following is the latest health policy news from the federal government for March 13-16.  Some of the language used below is taken directly from government documents.

Medicare Payment Advisory Commission (MedPAC)

MedPAC has published its “March 2023 Report to the Congress:  Medicare Payment Policy.”  In this year’s report MedPAC considers the context of the Medicare program, including the near-term consequences of COVID-19 and the longer-term effects of program spending on the federal budget and the program’s financial sustainability.  It evaluates payment adequacy and make recommendations concerning Medicare payment policy in 2024 for selected fee-for-service payment systems but explains that it has discontinued its practice of offering rate recommendations for long-term-care hospitals (LTCHs) and ambulatory surgical centers, citing inadequate data on which to base recommendations.  It offers recommendations to redistribute current Medicare disproportionate share hospital (Medicare DSH) and uncompensated care payments and to provide additional resources to Medicare safety-net hospitals and clinicians who furnish care to Medicare beneficiaries with low incomes.  Finally, MedPAC reviews the current state of the Medicare Advantage program (Part C) and its prescription drug program (Part D).

MedPAC’s rate recommendations to Congress and the administration, which it approved at its January 2023 meeting and which are …

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

The March 2023 MACPAC meeting began with a staff presentation on potential recommendations for countercyclical disproportionate share hospital (DSH) allotments. Medicaid DSH payments offset hospital uncompensated care costs for Medicaid-enrolled and uninsured patients. During economic recessions, Medicaid enrollment and the number of people who are uninsured increases.

During the October 2022 MACPAC meeting, Commissioners agreed that a countercyclical policy should be implemented during future economic recessions, and asked for additional analyses of the effects of making this policy permanent. This presentation looked at the state and federal effects of implementing this policy only during economic recessions versus also implementing this policy during periods of normal economic growth. The Commission will vote on recommendations to Congress during the April 2023 meeting.

Next, the Commission examined key implementation considerations for states looking to offer pre-release Medicaid services to justice-involved adults. The presentation included an overview of California’s recently approved Section 1115 demonstration to provide a set of pre-release services to certain individuals leaving incarceration. Staff also highlighted key takeaways regarding implementation considerations based on MACPAC’s …

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