The following is the latest health policy news from the federal government for March 22-28.  Some of the language used below is taken directly from government documents.

The Cyberattack on Change Healthcare

HHS, its Administration for Strategic Preparedness and Response, and CMS have published a resource guide for providers seeking assistance in response to the Change Healthcare cyberattack.  Find that guide here.

Centers for Medicare & Medicaid Services

  • CMS has issued a proposed rule to update Medicare payment policies and rates under its Inpatient Rehabilitation Facility (IRF) Prospective Payment System and the IRF Quality Reporting Program (QRP) for FY 2025.  The proposed rule calls for a 2.8 percent rate increase; annual updates to the outlier threshold, the case-mix-group relative weights and average length of stay values, the wage index, and associated impact analysis.  In addition, the rule includes a proposal to update the IRF wage index using Core-Based Statistical Areas and to provide a transition for IRFs that lose the rural adjustment due to their labor market area transitioning from rural to urban.  The proposed rule also includes requests for information seeking stakeholder input on future measure concepts for the IRF QRP and creation of an IRF QRP star rating system.  Learn more from this CMS fact sheet and the proposed rule itself.  The deadline for stakeholders to submit written comments is 60 days after official publication of the rule, which is currently scheduled for March 29.
  • CMS has published a final rule that seeks to protect and improve how millions of eligible people apply for, renew, and maintain health care coverage through Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program.  The regulation seeks to remove red tape and barriers to enrollment, update and build on the Affordable Care Act’s coverage protections, and ensure that people can get and keep their coverage.  The regulation includes provisions that:
    • Eliminate annual and lifetime limits on children’s coverage in CH  IP.
    • End the practice of locking children out of CHIP coverage if a family is unable to pay premiums.
    • Eliminate waiting periods for CHIP coverage so children can gain access to care immediately.
    • Improve the transfer of children seamlessly from Medicaid to CHIP when a family’s income rises.
    • Require states to give individuals at least 15 days to provide any additional information when applying for the first time and 30 days to return documentation when renewing coverage.
    • Prohibit states from conducting renewals more frequently than every 12 months and requiring in-person interviews for older adults and those with disabilities.

Learn more about the rule from this HHS news release; this CMS fact sheet; and this pre-publication version of the final rule, which is scheduled for official publication on April 2.  The rule takes effect in 60 days.

  • HHS has announced that 41 prescription drugs available through Medicare Part B will have a reduced Part B coinsurance rate from April 1 through June 30, 2024 because drug companies raised prices faster than the rate of inflation.  An estimated 763,700 people with Medicare use one or more of these drugs annually and those who use these drugs during that period may save between $1 and $3,575 per average dose depending on their individual coverage.  Learn more from this HHS news release and this CMS fact sheet, which also lists the affected drugs.
  • CMS has posted its April 2024 integrated outpatient code editor files.  Find those files here and go here for CMS’s instructions to the Medicare administrative contractors (MACs) about these changes.
  • CMS has posted a bulletin describing the April quarterly update for the 2024 durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule.  Find the bulletin here.
  • CMS has posted a bulletin about changes in electronic medical documentation requests submitted via the electronic submission of medical documentation system.  Find the bulletin here.
  • A new CMS blog post, titled “Update on the Medicare Value-Based Care Strategy: Alignment, Growth, Equity,” has been posted on the Health Affairs web site.  The post offers a progress report on accomplishments and a look toward the future for CMS’s value-based care strategy.  It also covers CMS’s strategy to move toward value-based payment, a focus on alignment across payers, growth in accountable care, and promoting equity.  Find the post here.
  • CMS did not ensure that all states complied with Medicaid managed care mental health and substance use disorder parity requirements, HHS’s Office of the Inspector General has concluded in a new report.  Go here for an overview of that report and a link to the complete report.

Department of Health and Human Services

  • HHS and the departments of Labor and the Treasury have released final rules regarding short-term, limited-duration health insurance (STLDI) and independent, non-coordinated excepted benefits coverage.  STLDI is a type of health insurance coverage that is primarily designed to fill temporary gaps in coverage when an individual is transitioning from one plan or coverage to another.  The rule’s major provisions include:
    • Amending the federal definition of STLDI to limit the length of the initial contract term to no more than three months and the maximum coverage period to no more than four months, taking into account any renewals or extensions.
    • Banning the practice of “stacking” in which an insurer issues consecutive policies to the same party to evade duration limits.
    • Amending the federal notice standard to help consumers better distinguish between comprehensive coverage and STLDI and get information about their health coverage options.
    • Requiring insurers to highlight the differences between STLDI and comprehensive coverage in their marketing, application, and enrollment materials.

Learn more about the final rule from this CMS news release; this CMS fact sheet; this White House fact sheet on the rule; and this pre-publication version of the final rule, which is currently scheduled for publication on April 3.

  • HHS’s Advanced Research Projects Agency (ARPA-H) has published a draft of a solicitation for proposals to participate in its planned Health Care Rewards to Achieve Improved Outcomes (HEROES) program, which will seek to evaluate a new payment model to create incentives for community-based interventions to improve health outcomes in specific geographic areas.  This is a draft version of the solicitation for which ARPA-H seeks feedback and that it currently plans to release in its final form by mid-April, with abstracts from interested parties due by June 17.  Go here to learn more.  In addition, ARPA-H is holding a series of webinars for interested parties.  Go here to register to participate in an April 2 webinar; go here to participate in an April 9 webinar; and go here to participate in an April 17 webinar.
  • HHS and its Substance Abuse and Mental Health Services Administration (SAMHSA) have announced notices of funding opportunities for $39.4 million in grant programs to address behavioral health across the country.  The grant programs are divided into six categories:  building communities of recovery ($6 million); promoting the integration of primary behavioral care ($6 million – states only); assisted outpatient treatment program for individuals with serious mental illness ($15.2 million); promoting the integration of primary and behavioral health care through a collaborative care model ($5.2 million – states only); Sober Truth on Preventing Underage Drinking Act (STOP Act) grant program ($4.6 million); and the Garrett Lee Smith Campus Suicide Prevention Grant Program ($2.4 million).  Learn more from this HHS news release, which includes links to the individual grant programs and provides information about eligibility to participate, application deadlines, and grant size.

  • HHS’s Office of the National Coordinator for Health Information Technology (ONC) has released a draft of its 2024-2030 federal health IT strategic plan.  The draft plan:
    • Outlines federal health IT goals and objectives that are focused on improving access to health data, delivering a better, more equitable health care experience, and modernizing public health data infrastructure.
    • Places an emphasis on the policy and technology components necessary to support the diverse data needs of all health IT users.
    • Supports HHS’s recent health data, technology, and interoperability final rule to advance the access, exchange, and use of electronic health information and deliver more transparent and equitable care for individuals.
    • Aligns with the HHS Health Care Sector Cybersecurity concept paper and voluntary health care-specific cybersecurity performance goals and helps health care organizations prioritize implementation of high-impact cybersecurity practices.

Learn more from this HHS news release; HHS’s draft “2024-2030 Federal Health IT Strategic Plan”; and from the web page HHS has established for the draft plan.  Stakeholder comments are due by May 28.

  • As required by the 2022 Cyber Incident Reporting for Critical Infrastructure Act, the Department of Homeland Security and its Cybersecurity and Infrastructure Security Agency (CISA) have issued a proposed rule addressing how covered entities, including hospitals and health systems, will report to CISA within certain prescribed time frames any covered cyber incidents, ransom payments made in response to a ransomware attack, and any substantial new or different information they learn about a previously submitted report.  Under the rule, covered entities would be required to report incidents to CISA within 72 hours and ransom payments within 24 hours.  Learn more about the proposed rule from this Department of Homeland Security news release and from a pre-publication version of the proposed rule.  Stakeholder comments are due no later than 60 days after publication of the final rule, currently scheduled for April 4.
  • HHS’s Health Care Cybersecurity Coordination Center and its Office of Information Security have issued a health sector alert on credential harvesting and mitigations.  Credential harvesting, also known as credential stealing or credential phishing, is a technique that cybercriminals use to obtain sensitive login credentials like usernames, passwords, and personal information.  The alert describes the various types of credential harvesting attacks, offers strategies for protecting against them and responding to them, and directs readers to additional resources.  Find the credential harvesting and mitigations health sector alert here.
  • HHS’s Office of the Inspector General has published a toolkit to help HHS leaders improve or maintain effective cybersecurity posture for systems or applications HHS is introducing.  As a resource, the toolkit identifies key questions and considerations that, in the view of the Office of the Inspector General, HHS leaders should think about.  These questions and considerations are based on cybersecurity standards that HHS’s Office of the Inspector General has used in its work assessing HHS’s information systems.   Find the toolkit here.

HHS Newsletters

Food and Drug Administration

The FDA has issued emergency use authorization for Pemgarda (pemivibart) for the pre-exposure prevention of COVID-19 in certain adults and adolescents.  Pemgarda is authorized for individuals who are not currently infected with COVID-19 and who have not had a known recent exposure to an individual infected with COVID-19 and those and who have moderate-to-severe immune compromise due to a medical condition or due to taking immunosuppressive medications or treatments and are unlikely to be able to mount an adequate immune response to COVID-19 vaccination.   Learn more from this FDA letter issuing the emergency use authorization.

Medicaid and CHIP Payment and Access Commission (MACPAC)

MACPAC has published an issue brief about school-based services covered by Medicaid and recent federal actions to reduce administrative burden and improve access to care in schools.  The brief offers an overview of those services, describes key concepts of the financing and payment of school-based services and factors affecting billing and claiming, and discusses considerations for further expanding access to care and Medicaid billing in schools.  Go here for an overview of the issue brief and a link to the complete document.

Government Accountability Office (GAO)

  • At a time when the U.S. has the highest rates of maternal and infant death among developed, high-income countries, the GAO has published “Maternal and Infant Health:  HHS Should Strengthen Processes for Measuring Program Performance,” which documents the extent of the challenge and offers recommendations for addressing it.  Go here for an overview of the report and a link to the complete report.
  • The new GAO report “Improper Payments:  Information on Agencies’ Fiscal Year 2023 Estimates” describes $236 billion in federal government overpayments in FY 2023, including $51.1 billion in Medicare overpayments and $50.3 billion in Medicaid overpayments.  Go here for an overview of the report and a link to the complete report.

Congressional Budget Office (CBO)

On January 31 the House Energy and Commerce Committee’s Health Subcommittee held a hearing at which CBO staff testified about federal subsidies for health insurance and policies to reduce the prices paid by commercial insurers.  After the hearing, members submitted questions for the record.  The CBO now has published its answers to those questions, which addressed artificial intelligence and machine learning; pharmacy benefit managers; CBO’s estimate for the Reconciliation Act of 2022; health insurance and small businesses; consolidation among health care providers; health care costs and transparency; the Rehabilitation and Recovery During Incarceration Act; and the Accelerating Kids’ Access to Care Act.  Find the CBO’s answers to those questions here.

Stakeholder Events

CMS – Skilled Nursing Facilities/Long-Term Care Open Door Forum – April 2

CMS will hold an open-door forum for skilled nursing and long-term-care facilities on Tuesday, April 2 at 2:00 (eastern).  Go here to register to participate.

CMS – Home Health, Hospice, and DME Open Door Forum – April 3

CMS will hold an open-door forum for home health, hospice, and durable medical equipment providers on Wednesday, April 3 at 2:00 (eastern).  Go here to register to participate.

CMS – Overview of the ACO Primary Care Flex Model – April 4

CMS will hold a webinar to present an overview of its new ACO Primary Care Flex Model on Thursday, April 4 at 2:00 (eastern).  Go here to register to participate.

CMS – Value-Based Insurance Design (VBID) Model Office Hours Webinar – April 4

CMS will host an office hours session on Thursday, April 4 at 3:00 (eastern) to discuss its Value-Based Insurance Design (VBID) Model.  Participants will receive an overview of the 2025 application process and have an opportunity for questions and answers with CMS’s CBID model staff.  Go here for the link to register to participate.

HHS – Office of Climate Change and Health Equity – Webinars on Taking Advantage of Provisions in the Inflation Reduction Act –April 4 and 18

HHS’s Office of Climate Change and Health Equity is holding a series of webinars to help health care providers, and especially safety-net organization, take advantage of the tax credits, grants and other supports made available by the Inflation Reduction Act, which creates opportunities for health sector organizations to invest in clean energy, building efficiency, infrastructure resilience, and more.  The next webinar will be held on Thursday, February 8, with additional events scheduled on February 22, March 7 and 21, and April 4 and 18.  Separate break-out sessions will be held for essential hospitals, community health centers, and rural providers.  Go here to learn more about the webinar series, future events, and the break-out sessions; go here for a recording of a November briefing on Inflation Reduction Act resources available to health care providers; and go here to register to participate.

CMS – Physicians, Nurses and Allied Health Professionals Open Door Forum – April 10

CMS will hold an open-door forum for physicians, nurses, and allied health professionals on Wednesday, April 10 at 2:30 (eastern).  Go here to register to participate.

CMS – Ambulance Open Door Forum – April 11

CMS will hold an open-door forum for ambulance service providers on Thursday, April 11 at 2:00 (eastern).  Go here to register to participate.

MedPAC – Commissioners Meeting – April 11-12

MedPAC’s commissioners will hold their next public meeting on Thursday, April 11 and Friday, April 12.  An agenda and directions on how to participate in the meeting are not yet available but when that information is announced it will be posted here.

MACPAC – Commissioners Meeting – April 11-12

MACPAC’s commissioners will hold their next public meeting on Thursday, April 11 and Friday, April 12.  Go here to register to participate remotely.

CMS – Hospital Open Door Forum – April 16

CMS will hold an open-door forum for hospitals on Tuesday, April 16 at 2:00 (eastern).  Go here to register to participate.

CMS – Long-Term Care Support and Services Open Door Forum – April 23

CMS will hold an open-door forum for long-term-care support and services providers on Tuesday, April 23 at 2:00 (eastern).  Go here to register to participate.

CMS – Rural Hospitals Open Door Forum – April 25

CMS will hold an open-door forum for rural hospitals on Thursday, April 25 at 2:00 (eastern).  Go here to register to participate.

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.