The following is the latest health policy news from the federal government for September 15 – 21.  Some of the language used below is taken directly from government documents.

Congress

• With only nine days left in the current federal fiscal year, Congress still has not agreed on any kind of spending bill to keep the federal government operating past September 30.  If the federal government shuts down, the Department of Health and Human Services (HHS) will “use the full extent of the authority under the Antideficiency Act (ADA) to maintain existing HHS activities…”  In previous shutdowns, Medicare has continued to pay providers and that policy is not expected to change.  You can review the HHS contingency staffing plan here.
• The House of Representatives planned to vote this week on H.R. 5378, the Lower Costs, More Transparency Act that called for the elimination of Medicaid DSH cuts for two years; increased requirements for hospital price transparency; and a number of site-neutral payment policies.  House leaders ultimately pulled the bill from consideration this week but have signaled that they intend to return to the legislation later this year.  View a section-by-section summary of H.R. 5378 here.

Centers for Medicare & Medicaid

The following is the latest health policy news from the federal government for September 1-7.  Some of the language used below is taken directly from government documents.

Congress

House Republicans plan to introduce the Lower Cost, More Transparency Act for consideration before the end of the year.  This bill includes provisions passed by three committees with health care jurisdiction:  House Ways & Means, Energy & Commerce, and Education & Workforce.   Some of the bill’s provisions would:

• eliminate scheduled Medicaid DSH cuts for FY 2024 and FY 2025;
• reauthorize and extend funding for the Community Health Center program, the National Health Service Corps, and the Teaching Health Centers that Operate GME program;
• establishing site-neutral payments by reducing Medicare payments for drug administration services at all hospital outpatient departments (HOPDs) to the same rate paid in non-hospital-based physician offices; and
• increase reporting requirements for pharmacy benefit managers (PBMs) and ban certain spread pricing practices.

A few provisions included in bills already approved by Ways & Means and Energy & Commerce are excluded from this proposed legislation.  The draft of the Lower Cost, More Transparency Act does not include provisions that would:

• require providers to obtain location-specific National Provider Identifiers (NPIs) for each

The following is the latest health policy news from the federal government for August 11-24.  Some of the language used below is taken directly from government documents.

Centers for Medicare & Medicaid Services

• After suspending the No Surprises Act-created Independent Dispute Resolution process in the wake of a court ruling striking down a recent increase in fees for that process, CMS has established a new rate structure for initiating the adjudication of payment disagreements between providers and payers.  It explains the new rate structure in this new FAQ, which nevertheless notes that despite the creation of new rates, the Independent Dispute Resolution process remains suspended until further notice.
• CMS has updated the ICD-10 MS-DRG grouper version 41 with changes that will take effect on October 1.  Go here for further information, additional resources, and links to downloads.
• CMS has posted a brief animated explainer video, “Social Determinants of Health Items:  Determining When a Proxy Response is Allowed,” to help home health, hospice, and long-term-care hospitals determine when the use of a proxy response is permitted for the following social determinants of health items:  A1005 – ethnicity; A1010 – race; A1110 – language; A1250 – transportation; B1300 – health literacy;

The regulation has already been finalized but hospitals continue to protest Medicare’s intention to reduce their Medicare disproportionate share (Medicare DSH) uncompensated care payments.

The cut, proposed at $115 million in April, when the Centers for Medicare & Medicaid Services proposed it, ended up just shy of $1 billion in the final regulation.  The major change, according to CMS, comes because the agency’s actuaries have projected a lower uninsured rate than when CMS proposed the $115 million cut in the spring.

Medicare DSH payments are intended to help hospitals that care for especially large numbers of uninsured patients with the cost of providing such care.

Protesting hospitals point to the end of the COVID-19 pandemic’s continuous Medicaid eligibility, which has already removed four million people from the Medicaid rolls, to support their continued need for Medicare DSH uncompensated care money.  CMS counters that many of those people will find alternative health insurance.

Even though CMS has already finalized the Medicare DSH cut, opponents of the cut maintain that the agency has the authority to reverse course in time for FY 2024.

Learn more about the hospital industry’s continued fight to reverse FY 2024 Medicare DSH cuts from the Axios article …

The following is the latest health policy news from the federal government for August 4-10.  Some of the language used below is taken directly from government documents.

Centers for Medicare & Medicaid Services

• CMS has temporarily suspended the federal Independent Dispute Resolution process, which adjudicates problems involving surprise medical bills, in the wake of a federal court ruling that found some of the process’s underlying regulations invalid.  CMS has directed the certified Independent Dispute Resolution entities to pause all dispute resolution activities.  As a result, providers and insurers temporarily cannot initiate new disputes.  Learn more from this CMS notice.
• CMS has written to all 50 states with its review of their progress toward redetermining Medicaid eligibility as part of the Medicaid unwinding process.  Its letters include data on states’ call center performance, renewal application processing times, and procedural termination rates.  The letters point out areas where states are not meeting performance expectations and offer suggestions for improving that performance.  Find the letters here.
• CMS has issued a toolkit for Medicaid and CHIP agencies to foster improvements in access, quality, and equity in postpartum care in their Medicaid and CHIP programs.  This technical assistance has two components:  quality improvement