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. 

The Congressional Budget Office periodically issues a compendium of policy options for changing federal tax and spending policies in particular areas and reducing federal spending.  For each option the CBO presents an estimate of its effect on the budget without making recommendations either in favor of or against those options.  The latest update of options includes a number with potential implications for health care providers, including:

• changing the cost-sharing rules for Medicare and restricting medigap insurance
• reducing Medicare Advantage benchmarks
• reducing Medicare’s coverage of bad debt
• consolidating and reducing federal payments for graduate medical education at teaching hospitals
• establishing caps on federal spending for Medicaid
• limiting state taxes on health care providers
• reducing federal Medicaid matching rates

Learn more about the CBO’s approach to identifying cost-cutting options and find other options from the agency’s “Options for Reducing the Deficit, 2023 to 2032” – volume one and volume two.…

The following is the latest health policy news from the federal government for the week of December 4-8.  Some of the language used below is taken directly from government documents.

No Surprises Act

• CMS has published an FAQ about implementation of good faith estimates for uninsured and self-pay patients under the No Surprises Act.  In the FAQ the agency explains that it will extend enforcement discretion for situations in which good faith estimates do not include expected charges from co-providers or co-facilities.  This enforcement discretion was expected to end on January 1 but CMS now writes that it will remain suspended pending future rulemaking.  Find the FAQ here.

Centers for Medicare & Medicaid Services

• CMS has published a proposed rule for improving prior authorization processes for Medicare Advantage plans, Medicaid managed care plans, state Medicaid agencies, and other payers by making greater use of advanced interoperability and better data-sharing.  Learn more about the proposed rule from this CMS news release; a CMS fact sheet; and a pre-publication version of the proposed rule itself.  Stakeholder comments are due by March 13.
• CMS has posted information on changes in the Medicare inpatient and long-term care prospective payment system

Every year the Congressional Budget Office publishes a menu of options for reducing federal spending and the federal budget deficit.  As in the past, this year’s compendium includes a number of options to reduce federal health care spending and raises federal revenue through health care initiatives.

The cost-cutting options include:

• establish caps on federal spending for Medicaid
• limit states’ taxes on health care providers
• reduce federal Medicaid matching rates
• change the cost-sharing rules for Medicare and restrict Medigap insurance
• raise the age of eligibility for Medicare to 67
• reduce Medicare’s coverage of bad debt
• consolidate and reduce federal payments for graduate medical education at teaching hospitals
• use an alternative measure of inflation to index social security and other mandatory programs

Options to raise additional revenue include:

• increase premiums for Parts B and D of Medicare
• reduce tax subsidies for employment-based health insurance
• increase the payroll tax rate for Medicare hospital insurance

Learn more about the CBO’s recommendations, how they might be implemented, and their potential implications in the CBO report Options for Reducing the Deficit: 2019 to 2028.…

Higher Medicare Part B and Part D premiums for wealthier beneficiaries.   Reduced Medicare bad debt reimbursement.  Raising the Medicare eligibility age.  Reducing the scope of Medigap policies.

These were among the entitlement “reforms” discussed when Treasury Secretary Jacob Lew testified recently before the Senate Finance Committee.

Learn more about Mr. Lew’s testimony and the potential Medicare cuts discussed by committee members in this CQ HealthBeat article presented by the Commonwealth Fund.…