The following is the latest health policy news from the federal government for May 10-17.  Some of the language used below is taken directly from government documents.

Centers for Medicare & Medicaid Services

  • CMS has announced a further extension of deadlines for fulfilling certain Medicaid unwinding requirements.  Some current deadlines will be extended to December 31, 2024 and others through June 30, 2025.  States also may seek to extend selected COVID-19-related flexibilities through June 30, 2025.  Among the deadlines affected by this announcement are those for using ex parte information to determine eligibility; permitting Medicaid managed care organizations to help current beneficiaries apply for continued eligibility; retroactive reinstatement of benefits after individuals have their eligibility terminated for procedural reasons and are later found to be eligible; and others.  Learn more about what deadlines apply to which requirements from this CMS memo to state Medicaid agencies.
  • CMS has sent a memo to state Medicaid programs reminding them of their obligation to process Medicaid and Children’s Health Insurance Program applications in compliance with all existing federal requirements and to do so accurately and in a timely manner.  The CMS memo also offers strategies and tips for fulfilling those requirements.  Find the memo here.  CMS also has posted a slide deck to help the states complete these tasks.
  • CMS has sent a memo to state Medicaid programs encouraging them to leverage available Medicaid and CHIP opportunities to improve access to mental health and substance use disorder services for individuals experiencing homelessness.  The memo outlines several existing mechanisms for doing so.  Learn more from this CMS memo to state Medicaid programs.
  • CMS has published a bulletin describing its October 2024 update of ICD-10 and other coding revisions to national coverage determinations.  Find that bulletin here.
  • CMS has posted a bulletin explaining to providers how to bill for social determinants of health risk assessments as part of Medicare-covered annual wellness visits.  Find that bulletin here.
  • CMS has posted a bulletin presenting the quarterly update of its clinical laboratory fee schedule and laboratory services reasonable charge payments.  Find that bulletin here.  The changes it presents take effect on July 1.
  • CMS has posted an expanded diabetes screening and diabetes definitions policy update for the calendar year 2024 physician fee schedule.  Find this CMS bulletin here.
  • CMS has published a bulletin presenting its quarterly update of its end-stage renal disease (ESRD) payment system.  Find that bulletin here.  The changes take effect on July 1.
  • CMS has posted a bulletin updating its policy for billing for Medicare-covered split or shared evaluation and management (E/M) visits.  Find that bulletin here.
  • CMS has updated its master list of durable medical equipment, prosthetics, orthotics, and supplies (DEMPOS) items that are potentially subject to conditions of payment.  Go here for links to a master list, a list of items that require prior authorization, and a list of items that require a face-to-face encounter between providers and patients and a written order prior to delivery.
  • Earlier this year CMS issued a final decision expanding coverage for allogeneic hematopoietic stem cell transplantation using bone marrow, peripheral blood, or umbilical cord blood stem cell products for Medicare patients with certain prognosis risk scores.  Now, CMS has posted a bulletin explaining this national coverage determination, outlining the risk scores that qualify for Medicare coverage of the procedures, and explaining how to code such procedures.  Find that bulletin here.  The new policy took effect on March 6.
  • CMS has posted an animated video for skilled nursing facility providers demonstrating how to know when they are permitted to use sources other than their residents when evaluating and coding for social determinants of health.  Find that video here.
  • CMS has posted materials from a March webinar for skilled nursing facilities on how to gain a full annual payment update.  Find the webinar’s presentation here and a post-webinar FAQ here.

Department of Health and Human Services

  • HHS has unveiled its maternal mental health task force’s national strategy to improve maternal mental health care amid the current public health crisis of maternal mental health and substance use issues.  The strategy calls for a seamless integration of perinatal mental health and substance use care across medical, community, and social systems that increases equity and access, improves federal coordination, and elevates culturally relevant supports and trauma-informed approaches.  The strategy calls for building around five pillars:  building a national infrastructure that prioritizes perinatal mental health and well-being with a focus on reducing disparities; making care and services accessible, affordable, and equitable; using data and research to improve outcomes and accountability; promoting prevention and engaging, educating, and partnering with communities; and lifting the voices of people with lived experience.  Learn more about the strategy from this HHS news release; the task force’s report to Congress; and the task force’s strategy document.
  • HHS and its Office of the National Coordinator for Health Information Technology (ONC) have published funding opportunities for work in two areas:  to develop innovative ways to evaluate and improve the quality of health care data used by artificial intelligence tools in health care, with an emphasis on developing scalable solutions to evaluate and improve the quality of health care data available in electronic health record technologies used by AI tools; and to accelerate the adoption of health IT in behavioral health, with a focus on designing, developing, and piloting lightweight health IT solutions that can enhance health IT capabilities in behavioral health settings and improve care coordination between behavioral health and clinical health care settings.  Learn more about these funding opportunities from this HHS news release and these notices about the funding opportunities.  The deadline for submitting applications is July 12.
  • HHS’s ONC has published a statement reminding health care providers about how HHS information-blocking regulations recognize privacy rules and how providers can ensure their compliance with those regulations.  Find that statement here.
  • HHS and the Department of Agriculture have posted a fact sheet describing new actions they are taking to reduce the impact and spread of avian flu.  Find that fact sheet here.
  • HHS’s Office of the Assistant Secretary for Planning and Evaluation has published three new reports:
  • HHS, the FBI, the Cybersecurity and Infrastructure Security Agency (CISA), and the Multi-State Information Sharing and Analysis Center have released a joint cybersecurity advisory providing information about Black Basta, a ransomware variant whose actors have encrypted and stolen data from the health care and other sectors.  The advisory presents tactics, techniques, and procedures and indicators of compromise used by known Black Basta ransomware affiliates.  Health care organizations are considered attractive targets for cybercrime actors due to their size, technological dependence, access to personal health information, and the unique effects of patient care disruptions.  Go here for an overview of the advisory and a link to the full report.
  • HHS’s Health Resources and Services Administration (HRSA) has published an updated version of its notice of reporting requirements, which describes how providers must report on their use of Provider Relief Fund and American Rescue Plan rural payments for lost revenue incurred within the period of availability up to June 30, 2023.  Learn more from the updated HRSA document “Provider Relief Fund Distributions and American Rescue Plan Rural Distribution Post-Payment Notice of Reporting Requirements.”
  • HHS’s Office of the Inspector General (OIG) has published a report on potential vulnerabilities in CMS oversight of Medicare add-on payments for COVID-19 tests.  In the report, the OIG concluded that CMS should improve its oversight of incentive payments.  Go here for an overview of the report and a link to the complete OIG assessment.
  • State agencies could be receiving hundreds of millions of dollars’ worth of additional Medicaid rebates associated with physician-administered drugs, HHS’s OIG has concluded in a new report.  The OIG traces past inability to obtain these rebates to the failure of state Medicaid agencies to comply with federal guidelines for properly invoicing and collecting those rebates, the OIG audit found.  Learn more from this overview of the OIG’s findings, which includes a link to its full report.
  • HHS’s OIG has updated its schedule of audits and reviews for the month of May.  Find the updated schedule here.

HHS Newsletters

Justice Department

The Justice Department has established a Task Force on Health Care Monopolies and Collusion in its Antitrust Division.  The task force will guide the division’s enforcement strategy and policy approach in health care, including by facilitating policy advocacy, investigations and, where warranted, civil and criminal enforcement in health care markets.  The group will consider widespread competition concerns shared by patients, health care professionals, businesses, and entrepreneurs, including issues involving payer-provider consolidation, serial acquisitions, labor and quality of care, medical billing, health care IT services, access to and misuse of health care data, and more.  The task force will bring together civil and criminal prosecutors, economists, health care industry experts, technologists, data scientists, investigators, and policy advisors from across the division’s civil, criminal, litigation, and policy units to identify and address antitrust problems in health care markets.  Learn more from this Justice Department news release.

Centers for Disease Control and Prevention

The CDC and the Department of Agriculture have eased guidelines for how health care facilities and public health labs handle, transport, and store bird flu samples.  Ordinarily such matters are subject to strict guidelines because bird flu is a high-risk pathogen but the CDC and Department of Agriculture agreed to a request by public laboratories for greater latitude in their work because of the current bird flu situation, and in particular because of the recent spread of the disease to cattle.  Learn more from this CDC/Department of Agriculture announcement.

Government Accountability Office (GAO)

The GAO has published a Q&A report reviewing the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Policy Lab, which is a support office that works across the agency to support its efforts to implement policy change, coordinate programs, and publish evidence-based information about substance misuse and mental health.  Learn more from the GAO report “Behavioral Health: Activities of the National Mental Health and Substance Use Policy Laboratory.”

Stakeholder Events

CMS – Home Health, Hospice, and DME Open Door Forum – May 22

CMS will hold an open-door forum for home health, hospice, and durable medical equipment providers on Wednesday, May 22   at 2:00 (eastern).  Go here to register to participate.

CMS – Physicians, Nurses, and Allied Health Professionals Open Door Forum – May 23

CMS will hold an open-door forum for physicians, nurses, and allied health professionals on Thursday, May 23 at 2:00 (eastern).  Go here to register to participate.

CMS – Healthcare Common Procedure Coding System Public Meeting – May 28-30

CMS will hold virtual Healthcare Common Procedure Coding System (HCPCS) public meetings on Tuesday, May 28 through Thursday, May 30 to discuss its preliminary coding, Medicare benefit category, and payment determinations, if applicable, for new revisions to the HCPCS Level II code set for non-drug and non-biological items and services.  Learn more about the meetings, including how to participate, from this CMS notice.

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.  Go here for information about how to register to participate and here to find the conference agenda.

CMS – Overcoming COVID-19 Vaccine Payment Challenges Webinar – May 30

The commercialization of COVID-19 vaccines following the end of the public health emergency has led to vaccine payment challenges for nursing homes.  On Thursday, May 30 at 2:00 (eastern) CMS will hold a webinar for Quality Innovation Network-Quality Improvement Organizations, nursing home leaders, medical directors, directors of nursing, and billing supervisors interested in learning more about how to overcome vaccine payment challenges to maximize immunization rates for COVID-19 at their facilities.  Go here to register to participate.

CMS – Rural Health Open Door Forum – May 30

CMS will hold an open-door forum for rural hospitals on Thursday, May 30 at 2:00 (eastern).  Go here to register to participate.

CMS – Hospital Open Door Forum – June 4

CMS will hold an open-door forum for hospitals on Tuesday, June 4 at 2:00 (eastern).  Go here to register to participate.

HHS – Administration for Strategic Preparedness and Response (ASPR) – June 5

HHS’s Administration for Strategic Preparedness and Response and others within HHS will hold a webinar on health care facility extreme weather resilience and mitigation on Wednesday, June 5 at 1:30 (eastern).  Speakers will share their experiences and agency staff will highlight related efforts and priorities in building climate-resilient health care facilities. Go here to register to participate.

CMS – Annual Public Meeting About New and Reconsidered Clinical Diagnostic Laboratory Test Codes for 2025 – June 25

CMS will hold a public meeting on Tuesday, June 25 at 9:00 (eastern) to receive comments and recommendations on the appropriate basis for establishing payment amounts for new or substantially revised Healthcare Common Procedure Coding System codes being considered for Medicare payment under the Clinical Laboratory Fee Schedule for calendar year 2025.  This meeting also will provide a forum for those who submitted certain reconsideration requests regarding final determinations made last year on new test codes and for the public to provide comment on the requests.  Go here to learn more about the meeting, including how to submit information and questions and register to participate.

CMS – Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests – July 25-26

CMS’s Medicare Advisory Panel on Clinical Diagnostic Laboratory Tests will hold public meetings on Thursday, July 25 and Friday, July 26.  The panel advises the Secretary of the Department of Health and Human Services and the CMS Administrator on issues involving clinical diagnostic laboratory tests.  Learn more about the meetings and how to participate from this CMS notice.