The following is the latest health policy news from the federal government for May 3-9.  Some of the language used below is taken directly from government documents.

Centers for Medicare & Medicaid Services

  • HHS and CMS have announced the Increasing Organ Transplant Access Model, which seeks to increase access to kidney transplants for people living with end-stage renal disease (ESRD), improve the quality of care for people seeking kidney transplants, reduce disparities among individuals undergoing the process of receiving a kidney transplant, and increase the efficiency and capability of transplant hospitals selected to participate.  Hospitals eligible to be selected for the proposed model are non-pediatric facilities that conduct a minimum of 11 transplants each during a three-year baseline period.  Out of the 257 transplant hospitals in the country, an estimated 90 would be required to participate in the proposed six-year model beginning on January 1, 2025.  CMS would select approximately half of the donation service areas and all eligible kidney transplant hospitals within those areas to participate in the mandatory model.  Participants would receive upside risk payments from CMS, fall into a neutral zone, or owe downside risk payments to CMS based on a final performance score.  The model would offer performance incentives to participating hospitals to improve equity in the transplant process and participants would have flexibility to address social drivers of health.  Learn more about the proposed model from the following resources:

The deadline for submitting comments about the proposed program is 60 days after official publication of notice of the proposed program, which is currently scheduled for May 17.

  • CMS has published a final rule that makes young individuals residing in the U.S. who are authorized to work in the country under the Deferred Action for Childhood Arrivals program (DACA) eligible to purchase health insurance through the health insurance marketplace and to qualify, if they meet income eligibility criteria, for federal subsidies to purchase such insurance.  Learn more from this HHS news release; this HHS fact sheet; and this HHS official notice.  The rule will take effect on November 1, when the next open enrollment period begins.
  • CMS has posted the electronic clinical quality measure (eCQM) specifications for the 2025 performance/reporting period for eligible hospitals and critical access hospitals, outpatient quality reporting, and eligible clinician quality reporting programs.  Find information about the updated eCQM specifications from the eCQI Resource Center web site.
  • CMS has issued a statement detailing the actions it has taken and will continue to take to address and resolve unauthorized health insurance plan switches and unauthorized enrollments performed by agents and brokers in the marketplaces that use the platform.  Find that statement here.
  • CMS has published an overview of Part B drug payment limits that explains its average sales price payment limit calculation and other Medicare Part B drug payment methodologies.  Find the publication here.
  • CMS has published draft guidance describing how it intends to implement the second cycle of the Medicare Drug Price Negotiation Program and manufacturer implementation of the maximum fair price for 2026 and 2027 under the Inflation Reduction Act.  Learn more about the negotiation program from this CMS notice.  The deadline for submitting comments is July 2.
  • A new report from CMS’s Office of Minority Health describes and quantifies disparities in health care in Medicare Advantage based on race, ethnicity, and sex.  Find that report here.
  • CMS has published a resource of health equity-related data definitions, standards, and stratification practices.  Find it here.

Department of Health and Human Services

  • HHS and its Substance Abuse and Mental Health Services Administration (SAMHSA) have published a notice of funding opportunity through which they will provide nearly $1.5 billion to states, territories, and the District of Columbia and $63 million to Tribes in FY 2024 to address the overdose crisis.  This funding will support evidence-based, holistic practices that address the overdose crisis, including prevention and harm reduction; treatment, such as the use of medications for opioid use disorder, naloxone, and other opioid overdose reversal medications; and recovery supports.  Learn more from this HHS news release and the formal notice of the funding opportunity.  While only government entities are eligible to apply, those applicants are encouraged to include qualified providers in their applications, which are due by July 1.
  • HHS and its Substance Abuse and Mental Health Services Administration (SAMHSA) have published notices of funding opportunities offering $46.8 million in grants to promote youth mental health, grow the behavioral health workforce, improve access to culturally competent behavioral care, and strengthen peer recovery and recovery support.  The proposed investments include a minority fellowship program; cooperative agreements for a state/tribal youth suicide prevention and early intervention program; additional technology transfer center cooperative agreements; and a National Center for Mental Health Dissemination, Implementation, and Sustainment cooperative agreement.  Learn more about the new funding and find links to the individual notices of the funding opportunities, with information about available funding, eligibility, and application deadlines, from this HHS news release.
  • After soliciting and reviewing public feedback following the release of draft requests for proposals in February, HHS’s Health Resources and Services Administration (HRSA) has issued final requests for proposals to support multiple contract awards for administering its Organ Procurement and Transplantation Network (OPTN) as part of its Organ Procurement and Transplantation Network Modernization Initiative.  Learn more about this latest step in HRSA’s modernization process from this notice and this past announcement about the modernization project.

HHS Newsletters

  • CMS – MLN Connects – May 9
  • AHRQ News Now – May 7
  • HRSA eNews – May 2 (includes funding opportunities)

Centers for Disease Control and Prevention

The CDC seeks nominations for membership on its Advisory Committee to the Director, which consists of up to 15 individuals with expertise in the fields of public health, global health, frontline experience, and experience relevant to the committee’s areas of endeavor, communication science, health systems and prevention research, and public health core capabilities such as data, lab, and workforce.  The deadline for submitting nominations is June 7.  Learn more about the committee, the qualities it seeks in potential members, and how to submit nominations from this formal announcement.

National Institutes of Health

  • The NIH has published updated, significant changes that were made to the NIH grants policy statement in fiscal year 2023 that will be reflected in its FY 2024 grants policy statement.  That statement provides both up-to-date policy guidance that serves as NIH standard terms and conditions of award for all NIH grants and cooperative agreements and extensive guidance to those who are interested in pursuing NIH grants.  Learn more from this NIH notice.
  • The NIH invites feedback from the scientific research community, clinical practice communities, patient and family advocates, scientific and professional organizations, federal partners, internal NIH stakeholders, and other interested constituents on the development of its FY 2026-2030 strategic plan for sexual and gender minority health research.  This plan will describe future directions in sexual and gender minority health and research to optimize NIH’s research investments.  Learn more about what the NIH seeks and how to submit feedback from this NIH notice.  The deadline for submitting comments is June 26.

Government Accountability Office (GAO)

  • Medicare is required to monitor hospices through surveys every three years.  According to a new GAO report, about 15 percent of hospices were cited with serious quality issues from 2020 through 2022 but Medicare has not fully implemented enforcement tools to help bring hospices like these into compliance.  In addition, 10 percent of hospices were overdue for a survey.  Learn more about what the GAO found and what it recommends for addressing these problems in its report “Medicare Hospice:  CMS Needs to Fully Implement Statutory Provisions and Prioritize Certain Overdue Surveys.”
  • In a review of the performance of the Strategic National Stockpile during the COVID-19 public health emergency, the GAO has recommended that HHS define and share Strategic National Stockpile roles, develop procedures for updating guidance, and assess unique tribal issues.  HHS has concurred with these recommendations.  Learn more from the overview of the GAO report
    “Public Health Preparedness:  HHS Should Address Strategic National Stockpile Coordination Challenges,” which includes links to report highlights and the complete report.

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 – Hospital Open Door Forum – May 28

CMS will hold an open-door forum for hospitals on Tuesday, May 28 25 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 – 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 – 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.