The following is the latest health policy news from the federal government for December 6-12.  Some of the language used below is taken directly from government documents.

ASH Advocacy

With Congress negotiating a new continuing resolution to fund the federal government when current spending authorization expires on December 20, ASH wrote to federal lawmakers asking them to:

  • Eliminate $8 billion in scheduled cuts to Medicaid disproportionate share hospital payments (Medicaid DSH), which are made to hospitals that serve especially large numbers of economically vulnerable patients.
  • Eliminate CMS’s planned 2.8 percent cut in Medicare payments to doctors in 2025.
  • Reject proposals that would reduce Medicare payments to hospital outpatient departments through the introduction of a site-neutral Medicare outpatient payment system because hospital outpatient departments are required by law to meet stricter, more costly regulatory requirements than other physician offices.

Learn more about the protections ASH seeks for community safety-net hospitals and why it seeks them from ASH’s letter to members of Congress.

Congress

 

Funding the Federal Government

With funding for the federal government set to expire in eight days, Congress is still negotiating the details of the next continuing resolution.  Speaker Johnson has indicated that the next continuing resolution will extend until an unspecified date in March.  Last week, the House majority and House minority exchanged proposals for additional items to include in the next continuing resolution and both parties listed health care extenders – Medicaid DSH, telehealth, the Acute Hospital Care at Home program, and others – as priorities, though with different lengths of time for the extensions.  Negotiations continue and we expect to see the details of the continuing resolution this weekend.

Committee Leadership in the 119th Congress

Party leadership and steering committees in both chambers have begun identifying the leaders of key committees with jurisdiction over health care matters.  Subcommittee leaders have not been finalized.

  • House Ways and Means Committee – Rep. Jason Smith (R-MO), chair; Rep. Richie Neal (D-MA), ranking member
  • House Energy and Commerce Committee – Rep. Brett Guthrie (R-KY), chair; Rep. Frank Pallone (D-NJ), ranking member
  • Senate Finance Committee – Sen. Mike Crapo (R-ID), chair; Sen. Ron Wyden (D-OR), ranking member
  • Senate Health, Education, Labor, and Pensions (HELP) Committee – Sen. Bill Cassidy (R-LA), chair; Sen. Bernie Sanders (I-VT), ranking member

Department of Health and Human Services

  • HHS’s Office of the Assistant Secretary for Technology Policy (ASTP), formerly the Office of the National Coordinator for Health Information Technology, has finalized a regulation proposed in August revising the Health Data, Technology, and Interoperability:  Trusted Exchange Framework and Common Agreement (TEFCA).  This final rule seeks to advance interoperability and support the access, exchange, and use of electronic health information by amending information-blocking regulations; by including definitions related to the TEFCA Manner Exception; by implementing provisions related to TEFCA that support the reliability, privacy, security, and trust within TEFCA; and by including corrections and updates of current regulatory provisions.  Learn more from this pre-publication version of the final rule, which is scheduled for official publication on December 16 and will take effect 30 days later.
  • Last month, ASTP published a new standard operating procedure to guide vetting for organizations seeking to participate in specific exchange purposes within TEFCA.  In a new blog post, ASTP outlines how the new standard operating procedure should strengthen trust among those who use TEFCA.  Learn more from the new standard operating procedure and from this ASTP blog post.
  • HHS’s Office for Civil Rights has written to the health care community to help federally funded providers, plan grantees, and others better understand their civil rights obligations under the new final rule on Section 1557 of the Affordable Care Act, which provides non-discrimination protections by requiring covered entities – recipients of federal financial assistance, programs administered by HHS, and entities established under Title I of the Affordable Care Act (ACA) – to provide language assistance to individuals with limited English proficiency or disability.  In issuing this letter, the office notes that it has “… continually found a lack of compliance with federal law requirements for language access and has prioritized this work because it is directly tied to health equity, patient safety, and effective communication” and outlines how health care organizations can comply with this requirement.  Learn more about why HHS’s Office for Civil Rights sent this letter and find resources for additional information and assistance and a link to the letter itself in this HHS news release.
  • HHS’s Administration for Strategic Preparedness and Response (ASPR) seeks public comment to inform its Hospital Preparedness Program funding formula.  The Hospital Preparedness Program is a cooperative agreement program that prepares the health care delivery system to save lives during emergencies that exceed the day-to-day capacity of health care and emergency response systems.  The program is the primary source of federal funding for health care preparedness and response, providing funding to 62 recipients, including the governments of all states, U.S. territories and freely associated states, the District of Columbia, Chicago, New York City, and Los Angeles County.  The program’s funding formula is statutorily required and determines the distribution of cooperative agreement funding to recipients, and through this request for information ASPR seeks feedback on how it might change the data sources and information the agency uses to determine the formula’s risk component.  Learn more about the Hospital Preparedness Program from this HHS news release; this ASPR notice; and the full request for information.  The deadline for submitting comments is December 20.
  • ASPR is inviting interested individuals to apply to serve on three advisory boards it administers:  the National Advisory Committee on Individuals with Disabilities and Disasters, the National Advisory Committee on Seniors and Disasters, and the National Biodefense Science Board.  Learn more about the boards and their work, the responsibilities of individual members, and how to apply to participate from this ASPR notice.  The deadline for submitting applications is January 11.
  • HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) is seeking approval for the introduction of the new SAMHSA Unified Performance Reporting Tool (SUPRT).  SUPRT seeks to combine and align the existing client-level performance instrument for the SAMHSA Center for Substance Abuse Treatment and National Outcomes Measures instrument for the SAMHSA Center for Mental Health Services and to create a two-component tool that will enable clients (or caregivers) to take a self-administered questionnaire and grantees to complete an administrative data reporting tool.  HRSA believes SUPRT will reduce the scope and associated burden of questions requiring responses directly from clients; standardize questions across programs wherever possible; and elicit programmatic information that will help assess the impact of discretionary grant programs.  Learn more about what SAMHSA proposes and how to submit comments from this SAMHSA notice.  The deadline for submitting comments is January 6.
  • HRSA’s Maternal and Child Health Bureau Sickle Cell Disease Programs has published a notice of request for public comment to inform future sickle cell disease program development.  Learn more about the specific issues HRSA hopes interested parties will address from this notice of request for public comment.  The deadline for submitting comments is January 6.
  • The National Action Alliance for Patient and Workforce Safety, a collective of federal agencies and private partners led by the HHS’s Agency for Healthcare Research and Quality (AHRQ) and established in September, has launched the National Healthcare Safety Dashboard, an online resource that aggregates hospital safety data from four primary measurement sources, creating one comprehensive resource for understanding the current state of patient and workforce safety.  The initial version of the dashboard offers access to hospital safety data and will expand to include other health care settings, such as ambulatory clinics and nursing homes.  Learn more about the new dashboard from this HHS news release and go here to see the dashboard itself.
  • HHS’s Office of the Inspector General, in cooperation with the Justice Department, has published its mandated Health Care Fraud and Abuse Control Program annual report for FY 2023.  According to the report, FY 2023 civil health care fraud settlements and judgments under the False Claims Act exceeded $1.8 billion and more than $3.4 billion was returned to the federal government or paid to private persons in FY 2023.  Find the report here.
  • HHS has updated its national plan to address Alzheimer’s disease.  Find the updated plan here.
  • HHS has extended through the end of 2029 its declaration invoking the Public Readiness and Emergency Preparedness (PREP) Act, which authorizes the Secretary of Health and Human Services to issue a declaration providing liability immunity to certain individuals and entities against any claim of loss caused by, arising out of, relating to, or resulting from the manufacture, distribution, administration, or use of medical countermeasures except for claims involving “willful misconduct” as defined in the PREP Act.  The declaration was issued at the start of the COVID-19 pandemic, and now, with HHS finding that COVID-19 remains a threat, the act’s protections have been extended for licensed pharmacists, pharmacy interns, and qualified pharmacy technicians.  To the extent that any state law would otherwise prohibit these health care professionals from prescribing, dispensing, or administering COVID-19 vaccines and seasonal influenza vaccines or COVID-19 tests, that law is preempted.  Learn more from this HHS announcement.

HHS/Office of the Assistant Secretary for Planning and Evaluation (ASPE)

  • The COVID-19 pandemic-driven decision by HHS and the Drug Enforcement Administration to permit health care practitioners to initiate controlled medications via a telehealth visit without first conducting an in-person medical evaluation represented a substantial change in how these medications, and the conditions they are used to treat, can be managed.  With the question of whether to continue, revise, or eliminate this practice still undecided, HHS’s Office of the Assistant Secretary for Planning and Evaluation (ASPE) has published a brief that presents trends in the initiations of selected, frequently prescribed controlled medications among individuals with private health insurance coverage.  Learn more about the study and its findings from this ASPE research brief.
  • In another report, ASPE explores the optimal balance between using telehealth and in-person services to support adults with serious mental illness and children with serious emotional disturbance.  Find the latest ASPE issue brief here.
  • ASPE has published the findings of its literature review and focus group interviews on the adoption and use of health information technology in behavioral health settings.  Find the study here.
  • Amid growing recognition of the benefit of integrated treatment for people with co-occurring mental health and substance use disorders, ASPE has undertaken research to examine changes from 2014 to 2020 in the proportion of outpatient behavioral health facilities with a special program for co-occurring disorders and identified the characteristics of facilities with these programs.  Learn more about why and how ASPE did this research and what it found from its new report “Availability and Correlates of Integrated Treatment for People with Co-Occurring Disorders in Outpatient Behavioral Health Treatment Facilities.”

Centers for Medicare & Medicaid Services

  • CMS will add 50 new procedure codes to the ICD-10-PCS effective April 1, 2025.  Learn more about the new codes from this CMS announcement, which also includes a link to the code tables, index, and related addenda files for the new codes.
  • CMS has posted a notice advising 340B-covered entities about the use of the “JG” modifier.  The JG modifier will be discontinued after December 31, 2024; starting January 1, 2025, 340B-covered entities should report the “TB” modifier on claim lines for drugs acquired through the 340B program.  Find that notice here.
  • CMS has sent an informational bulletin to state Medicaid and CHIP program administrators about coverage of services and supports to address health-related social needs (HRSN) through those programs.  CMS supports states in addressing HRSN through multiple Medicaid and CHIP authorities and mechanisms, including coverage of clinically appropriate and evidence-based HRSN services and supports; care delivery transformations, including improvements in data-sharing; and performance measurement to create accountability for HRSN screening and connecting to needed supports as part of successful care management.  The memo includes an HRSN framework that describes terms and names specific types of services and interventions and their eligibility for Medicaid and CHIP coverage.  Learn more from this CMS memo to state Medicaid and CHIP program administrators.
  • CMS has written to state Medicaid agencies to provide guidance on protecting Medicaid beneficiaries from impermissible sanctions and penalties related to Medicaid beneficiary eligibility-related fraud and abuse.  Find that letter here.
  • CMS has posted draft electronic clinical quality measure (eCQM) specifications, including draft logic and header changes, and invites EHR vendors and interested parties to review and provide feedback on draft eCQM specifications under consideration for CMS quality reporting and payment programs.  Go here for links to the draft specifications and information about submitting comments.
  • CMS has updated its Home Health Change of Care Notice.  Starting February 1, 2025, providers must use the revised form to notify Medicare fee-for-service patients receiving home health care benefits of plan of care changes.  Learn more from this CMS notice.

HHS Newsletters and Reports

HHS Videos

HHS has posted a series of eight videos encompassing discussions, presentations, and listening sessions from a two-day meeting of its Physician-Focused Payment Model Technical Advisory Committee on the subject of how to increase participation in population-based total cost of care models.  Find those videos here.

Congressional Budget Office

The CBO has published an estimate of how expanding certain children’s eligibility for Medicaid or the Children’s Health Insurance Program over the next 10 years would affect the U.S. economy and the federal budget through the end of the century.  Find the CBO analysis here.

Stakeholder Events

MedPAC – Commissioners Meeting – December 12-13

MedPAC’s commissioners are holding their last public meeting of the year on Thursday, December 12 and Friday, December 13.  Go here for the meeting agenda and to find links to participate virtually.

MACPAC – Commissioners Meeting – December 12-13

MACPAC’s commissioners are holding their last public meeting of the year on Thursday, December 12 and Friday, December 13.  Go h  ere to register to participate virtually.