The following is the latest health policy news from the federal government for January 12-16. Some of the language used below is taken directly from government documents.
Congress
Medicaid DSH
With a partial government shutdown looming on Friday, January 19, congressional leaders have agreed to extend the current stopgap legislation temporarily funding the federal government. Under this agreement, the four spending bills scheduled to expire this Friday would be extended until March 1 and the eight bills set to expire on February 2 would be extended until March 8. The appropriations bill that funds health and human services is included in the March 8 group.
Under this agreement the current, temporary delay of Medicare DSH cuts and other health care extenders would run through March 8.
Both the House and Senate are expected to pass this continuing resolution before the current resolution expires on Friday. Find further details from the text of the bill.
Other Legislative Activity
Leaders of the House Ways and Means Committee and the Senate Finance Committee have agreed on a tax deal. They hope to attach provisions containing their agreement to the March 1 or March 8 spending bills.
Leaders of the House Energy and Commerce Committee and the Senate Finance Committee continue to negotiate health care price transparency legislation. Such a bill would include new reporting requirements for hospitals, insurers, and pharmacy benefit managers. Negotiators also continue to discuss hospital site-neutral payment policies. Congress is not expected to vote on these matters this week.
MedPAC – 2025 Rate Recommendations
Last week members of the Medicare Payment Advisory Commission met in Washington, D.C. Among the items on the group’s agenda were recommendations for changes in Medicare payments for 2025.
After hearing presentations on the various Medicare payment systems and discussing the adequacy of current Medicare reimbursement, MedPAC’s commissioners voted to recommend the following changes in 2025 Medicare payments.
- Inpatient and outpatient services – an update provided for in current law plus 1.5 percent and a shift to a safety-net index policy that would pay safety-net hospitals another $4 billion.
- Physicians and other health professionals – an increase of 50 percent of the Medicare economic index and introduction of an add-on payment for services provided to low-income Medicare patients.
- Inpatient rehabilitation hospital services – a payment reduction of five percent.
- Skilled nursing facilities – a payment reduction of three percent.
- Home health services – a payment reduction of seven percent.
During the two-day meeting MedPAC’s commissioners also received status reports from their staff on Medicare Part D, ambulatory surgical centers, and the Medicare Advantage program and reviewed policy options for standardized benefits in Medicare Advantage plans.
For a summary of the issues and MedPAC actions and for links to the presentations delivered during the meeting go here. Find a transcript of the two days of meetings here.
CMS – Prior Authorization and Health Information Final Rule
CMS – Prior Authorization and Health Information Final RuleCMS has issued its interoperability and prior authorization final rule, setting requirements for Medicare Advantage organizations, Medicaid and the Children’s Health Insurance Program (CHIP) fee-for-service programs, Medicaid managed care plans, CHIP managed care entities, and issuers of Qualified Health Plans offered on the federal health insurance exchange, to improve the electronic exchange of health information and prior authorization processes for medical items and services. Together, these policies seek to improve prior authorization processes and reduce the burden on patients, providers, and payers. Among other changes introduced by the new rule, beginning primarily in 2026 affected payers will be required to send prior authorization decisions within 72 hours for expedited (urgent) requests and seven calendar days for standard (non-urgent) requests for medical items and services. For some payers this new time frame for standard requests cuts current decision time frames in half. The rule also requires all affected payers to include a specific reason for denying prior authorization requests, which should help facilitate resubmission of requests or appeals when needed. Finally, affected payers will be required to publicly report prior authorization metrics. Learn more about the new rule from this CMS news release; a CMS fact sheet; and this pre-publication version of the final rule.
Stakeholder Events
CMS – Medicaid and CHIP Renewals – January 24
CMS will hold a webinar on “Medicaid and CHIP Renewals: What to Know and How to Prepare” on Wednesday, January 24 at noon (eastern). The purpose of the webinar is to provide stakeholders with information to prepare for Medicaid and CHIP renewals. Go here to register to participate.
MACPAC – January 25-26
The Medicaid and CHIP Payment and Access Commission will hold its next public meeting on Thursday, January 25 and Friday, January 26. Go here to register to participate in the virtual meeting.
CMS – Health Equity Conference – May 29-30
CMS will hold its second annual CMS Health Equity Conference on Wednesday, May 29 and Thursday, May 30. The free, hybrid conference will be held in person in Bethesda, Maryland and available online for virtual participation and involve health equity leaders from federal and local agencies, health provider organizations, academia, community-based organizations, and others. Conference participants will hear from CMS leadership on recent developments and updates to CMS programs; explore the latest health equity research; discuss promising practices and creative solutions; and collaborate on community engagement strategies. CMS is now accepting proposals for breakout session speakers and poster presenters. Learn more from the conference web page.
Stakeholder Events: Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) Final Rule
HHS’s Office of the National Coordinator for Health Information Technology (ONC) will host the following information sessions to explain the Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HT1-1) final rule.
HTI-1 Final Rule Information Blocking Information Session
Thursday, January 25, 2024 at 1:00 pm (eastern) – register here
HTI-1 Final Rule Overview with Question & Answer Information Session #2
Thursday, February 1, 2024 at 1:00 pm (eastern) – register here
