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 25-31.  Some of the language used below is taken directly from government documents.

No Surprises Act

For the second time in less than a month a court has rejected how federal agencies are implementing the Independent Dispute Resolution process of the No Surprises Act.  A federal court concluded that the process for establishing the Qualifying Payment Amount, or QPA – the median rate insurers pay for in-network services and a critical factor in settling payment disputes – inappropriately permits insurers to depress that rate and unfairly favors payers over providers.  Learn more about this latest setback to implementation of the No Surprises Act, which was already suspended after another federal court ruling in early August and remains suspended today, from the federal court decision.

Centers for Medicare & Medicaid Services

• CMS has sent a letter to all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands requiring them to determine whether they have an eligibility systems issue that could cause people, especially children, to be disenrolled from Medicaid or CHIP even if they are still eligible for coverage and requiring

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 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

Medicare should pay for outpatient care on a site-neutral basis, MedPAC has told Congress in its annual recommendations.

Proponents of such a change – including the Medicare Payment Advisory Commission – argue that Medicare should not pay more for services than it needs to and can, if it believes hospital-associated facilities deserve more money, find better ways to provide such additional resources.  They also believe such a policy encourages the acquisition of independent medical practices by operators that then increase the price of the same services and that site-neutral payments would help preserve such independent practices while also driving down patient health care costs.

Opponents maintain that hospital-affiliated outpatient practices have greater capabilities than typical independent medical practices and also need to contribute to maintaining hospital infrastructure and services that benefit entire communities and would otherwise be in jeopardy without the greater Medicare payments.

Learn more about MedPAC’s recommendation that Congress compel Medicare to pay for outpatient services on a site-neutral basis from the new MedPAC report to Congress “Medicare and the Health Care Delivery System” and from the Medical Economics article  MedPAC Urges Congress to Embrace Site-Neutral Medicare Outpatient Payments.…