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

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

The following is the latest health policy news from the federal government as of 2:30 p.m. on Thursday, December 9.  Some of the language used below is taken directly from government documents.

Update on Efforts to Delay Medicare Sequestration Cuts

The Senate has advanced S 610, a bill that would:

• Extend the COVID-19-driven moratorium on the long-time two percent Medicare sequestration until the end of March 2022, reducing that sequestration from two percent to one percent from the beginning of April through the end of June 2022.
• Avoid the additional four percent sequestration necessitated by federal PAYGO rules by moving the additional spending PAYGO cuts need to offset onto the federal balance sheet for FY 2023.
• Include a procedural provision that would enable the Senate to pass legislation to lift the debt ceiling with only 50 votes (addressing the debt ceiling will require separate legislation).
• Reduce the 3.75 percent cut in Medicare evaluation and management rates, which Congress halted last year but that was scheduled to resume on January 1, to a 0.75 percent cut.
• Delay certain Medicare laboratory payment cuts.
• Delay the launch of the Radiation Oncology Model until 2023.

Final passage of this bill is expected by the end …

The moratorium on the two percent sequestration of Medicare payments could be extended under a bill the House may consider this week.

If adopted, the bill would extend the sequester delay for nine months, providing financial relief that many health care providers seek as they continue to deal with the financial challenges posed by COVID-19.

The sequester delay was implemented early in the pandemic as a means of providing additional Medicare revenue to hospitals and other health care providers at a time when many people were delaying seeking medical attention out of fear of contracting COVID-19.

Without action by Congress, the current delay of the Medicare sequester will expire at the end of March.

Learn more about the latest effort to extend the Medicare sequester delay in the Fierce Healthcare article “House to vote later this week on bill to delay Medicare sequestration payment cuts.”…

Medicare cut hospital payments $840 million a year more than it should have and now, hospitals are suing to get their money back.

According to the lawsuit, Congress authorized Medicare to include a cut of 0.7 percent in hospital inpatient payments through FY 2017 to recoup past Medicare overpayments but Medicare continued the cut, without Congress’s approval, in FY 2018 and FY 2019.

The 600 hospitals that filed the suit estimate that the allegedly illegal cut cost them about $200,000 each and now, they want their money back – with interest.

Learn more in the Becker’s Hospital Review article “622 hospitals sue HHS, accused of illegally allowing reimbursement cut.”…