Federal Health Policy Update for Wednesday, March 24

Beginning today, NASH is expanding its regular updates to encompass a broader scope of federal health policy endeavors to include other matters of importance to providers.  Feel free to share this newsletter with others in your organization or to send us the email addresses of those you think might be interested and we will send it directly to them.

The following is the latest such information from the federal government as of 2:45 p.m. on Wednesday, March 24.

Congress

The temporary delay of implementation of the Medicare two percent sequester expires at the end of the month and amid considerable advocacy by the health care community, Congress is considering extending this delay.  Last week the House passed a bill that would extend the current moratorium through December 31, 2021 and would waive “PAYGO” rules that apply to the American Rescue Plan Act that would necessitate an additional two percent sequester on Medicare payments starting in January, which would be added to the existing sequester to result in a four percent sequester. The Senate will not take up the House bill but could take up S. 748, which would extend the current moratorium for the duration of the COVID-19 public health emergency.  Even if it does take up S. 748 this week the House is unlikely to address it immediately because both chambers will recess after Friday until April 9.  It is possible CMS may hold claims for a short period after March 31 if it appears Congress will act on this matter without much delay.

Provider Relief Fund

New Provider Relief Fund reporting requirements – PDF* were issued on January 15, 2021 in accordance with the Coronavirus Response and Relief Supplemental Appropriations Act of 2021.  In response to stakeholder feedback, HHS is currently reviewing this guidance and Provider Relief Fund reporting timelines.  We will post any updates on this website as soon as they are available.  We continue to encourage recipients of $10,000 or more in aggregate Provider Relief Fund payments to register in the Provider Relief Fund Reporting Portal.

White House

COVID-19

  • The White House has posted transcripts of the March 19, March 22, and March 24 press briefings provided by its COVID-19 response team and public health officials.

Department of Health and Human Services

Health Policy News

  • The Biden administration has nominated the following individuals to positions in the Department of Health and Human Services.

Office of the Secretary
Kristina Schake, Counselor to the Secretary for Strategic Communications

Office of the Assistant Secretary for Public Affairs
Israel Igualate, Deputy Speechwriter

Office of the General Counsel
Barbara McGarey, Deputy General Counsel

Office of the Assistant Secretary for Planning and Evaluation
Rebecca Haffajee, Principal Deputy Assistant Secretary for Planning and Evaluation
Miranda Lynch, Deputy Assistant Secretary for Planning and Evaluation (Human Services Policy)

Office of the Assistant Secretary for Preparedness and Response
Jonathan Warsh, Senior Policy Advisor COVID Response
Leni Hirsch, Special Assistant COVID Response

Office of the Assistant Secretary for Administration
Cheryl Campbell, Principal Deputy Assistant Secretary for Administration

Office of Global Affairs
Stephanie Psaki, Senior Advisor on Human Rights and Gender Equity

Substance Abuse and Mental Health Services Administration
Trina Dutta, Senior Advisor

See this HHS news release for further information.

  • HHS announced that it is extending access to the special enrollment period of the Affordable Care Act’s health insurance marketplace until August 15.  The purpose of this extension is to give consumers additional time to take advantage of new savings made available through the American Rescue Plan and give new and current enrollees an additional three months to enroll or re-evaluate their coverage needs with increased tax credits available to reduce premiums.  Learn more from this HHS announcement.HH  Find additional information in this accompanying HHS fact sheet.
  • HHS’s Office of the Inspector General has published the report “Hospitals Reported that the COVID-19 Pandemic Has Significantly Strained Health Care Delivery.”  HHS describes the report as “…a national snapshot, from the perspective of front-line hospital administrators, on how responding to the COVID-19 pandemic has affected their capacity to care for patients, staff, and communities.  This is not a review of the HHS response to the COVID-19 pandemic.”

Centers for Medicare & Medicaid Services

COVID-19

National Nursing Home Stakeholder Call

On Thursday, March 25, 2021 at 4:00pm (eastern), CMS will address questions about its updated nursing home visitation guidance.  In addition, participants will hear from a nursing home administrator currently implementing the new guidance.   Register for this Zoom call here.  Resources for the call are:

Centers for Disease Control and Prevention

COVID-19

Food and Drug Administration – COVID-19

COVID-19

  • The FDA has issued emergency use authorization for the first machine learning-based COVID-19 non-diagnostic screening device that identifies certain biomarkers that are indicative of some types of conditions, such as hypercoagulation.  The device is worn as an arm band and uses artificial intelligence.  See the FDA’s announcement and its emergency use authorization letter.

National Institutes of Health

COVID-19

  • In a news release, the NIH announced that “Results from a large clinical trial in the United States and South America indicate that AstraZeneca’s COVID-19 vaccine, AZD1222, is well-tolerated and protects against symptomatic COVID-19 disease, including severe disease or hospitalization. The independent Data and Safety Monitoring Board (DSMB) overseeing the trial identified no safety concerns related to the vaccine.”
  • Later the same day, the NIH’s Data and Safety Monitoring Board (DSMB) announced that it has notified NIAID (the National Institute of Allergy and Infectious Diseases), BARDA (the Biomedical Advanced Research and Development Authority), and AstraZeneca that “it was concerned by information released by AstraZeneca on initial data from its COVID-19 vaccine clinical trial.  The DSMB expressed concern that AstraZeneca may have included outdated information from that trial, which may have provided an incomplete view of the efficacy data.”

 

ACA Medicaid Expansion Cut Young Adult Uninsurance in Half

The number of uninsured young adults fell nearly 50 percent after the Affordable Care Act authorized states to expand their Medicaid programs, a new study has found.

According to the Urban Institute, the uninsured rate among people between the ages of 19 and 25 fell from 30.2 percent to 16 percent between 2011 and 2018, with most of the decline coming between 2013 and 2016, when the first round of states expanded their Medicaid programs.

The decline in the rate of uninsured young adults mirrored declines in the overall U.S. uninsured rate, which fell from 27.7 percent to 11.3 percent in states that expanded their Medicaid programs.  This decline has contributed greatly to the ability of private safety-net hospitals to serve their communities.

Learn more about how implementation of the Affordable Care Act affected the insurance status of young adults in the Urban Institute report “Impacts of the ACA’s Medicaid Expansion on Health Insurance Coverage and Health Care Access Among Young Adults.”

Coronavirus Update for Friday, January 29

The following is the latest COVID-19 information from the federal government as of 2:30 p.m. on Friday, January 29.

The Biden Administration

The Biden administration has issued an “Executive Order on Strengthening Medicaid and the Affordable Care Act” to make it easier for the uninsured to get coverage during the COVID-19 pandemic.  The order:

  • reopens access to the federal Affordable Care Act health insurance marketplace for three months, from February 15 through May 15, and restores some of the Affordable Care Act exchange marketing funds that had been eliminated by the previous administration and
  • calls for the review of all existing regulations, orders, guidance documents, policies, and any other agency actions that may be inconsistent with the administration’s desire to enhance access to health insurance through the Affordable Care Act, including policies that undermine protections for people with pre-existing conditions and policies that make it harder for people to get insurance coverage or to enroll in Medicaid.

Resources for learning more about this executive order are:

Provider Relief Fund

HHS has updated its Provider Relief Fund FAQ with 19 new and modified questions.  The new information, marked “Modified 1/28/2021” or “Added 1/28/2021,” addresses the relationship between parent and subsidiary organizations receiving Provider Relief Fund grants, financial reporting and accounting requirements, the use of Provider Relief Fund money, and more.  The new information can be found on pages 10, 11, 16, 26, 28, 40, 41, 56, and 57 of the revised FAQ.  Providers that have received Provider Relief Fund grants or seek to receive such grants should review the new information carefully.

Department of Health and Human Services

  • HHS has established parameters under which retired and inactive health care providers may return to work to administer COVID-19 vaccinations.  It did so by amending the current COVID-19 emergency declaration under the Public Readiness and Emergency Preparedness Act (PREP Act).  See the HHS announcement of the new policy here and find the PREP Act amendment itself here.

HHS and CMS COVID-19 Stakeholder Calls

HHS Clinical Rounds Peer-to-Peer Virtual Communities of Practice

HHS’s Office of the Assistant Secretary for Preparedness and Response sponsors COVID-19 Clinical Rounds Peer-to-Peer Virtual Communities of Practice that are interactive virtual learning sessions that seek to create a peer-to-peer learning network in which clinicians from the U.S. and abroad who have experience treating patients with COVID-19 share their challenges and successes.  These webinar topics are covered every week:

  • EMS:  Patient Care and Operations (Mondays, 12:00-1:00 PM eastern)
  • Critical Care:  Lifesaving Treatment and Clinical Operations (Tuesdays, 12:00-1:00 PM eastern)
  • Emergency Department:  Patient Care and Clinical Operations (Thursdays, 12:00-1:00 PM eastern)

Go here for information about signing up to participate in the sessions and go here for access to materials and video recordings of past sessions.

CMS Stakeholder Calls

CMS hosts recurring stakeholder engagement sessions to share information about the agency’s response to COVID-19.  These sessions are open to members of the health care community and are intended to provide updates, share best practices among peers, and offer participants an opportunity to ask questions of CMS and other subject matter experts.

CMS COVID-19 Office Hours Calls

Tuesday, February 23 at 5:00 – 6:00 PM (eastern)

Toll Free Attendee Dial In:  833-614-0820; Access Passcode:  2528725

Audio Webcast link:  go here

Tuesday, March 16 at 5:00 – 6:00 PM (eastern)

Toll Free Attendee Dial In:  833-614-0820; Access Passcode:  4177586

Audio Webcast link:  go here

Tuesday, April 6 at 5:00 – 6:00 PM (eastern)

Toll Free Attendee Dial In:  833-614-0820; Access Passcode:  2769397

Audio Webcast link:  go here

Centers for Disease Control and Prevention

National Institutes of Health

  • An NIH news release explains that “An investigational COVID-19 vaccine developed by Janssen Pharmaceuticals appears to be safe and effective at preventing moderate and severe COVID-19 in adults, according to an interim analysis of Phase 3 clinical data conducted Jan. 21.”  This is a single-dose vaccine.  Learn more from the NIH news release.
  • Pregnant women who experienced severe symptoms of COVID-19 had a higher risk of complications during and after pregnancy, according to the preliminary findings of an NIH-funded study.  Compared to COVID-19 patients without symptoms, those with severe symptoms were at higher risk for cesarean delivery, postpartum hemorrhage, hypertensive disorders of pregnancy and preterm birth.  The study also suggests that mother-to-infant transmission of COVID-19 appears to be rare.

Food and Drug Administration

Department of Labor

Eliminate Medicaid DSH Cut, NASH Asks Congress

A Continuing Resolution to fund the federal government in FY 2021 should eliminate a cut in Medicaid disproportionate share (Medicaid DSH) allotments to the states, the National Alliance of Safety-Net Hospitals has written in a letter to congressional leaders.

The cut was mandated by the 2010 Affordable Care Act but has never been implemented.

In its letter to congressional leaders, NASH wrote that

The Medicaid DSH cut was predicated on the expectation that the Affordable Care Act would greatly reduce the number of uninsured Americans, and while it has, millions remain uninsured. Just this week the Centers for Disease Control and Prevention reported that the number of Americans without health insurance rose in 2019 – for the third consecutive year – and the job loss associated with COVID-19 is expected to continue this trend in 2020. As a result, private safety-net hospitals and others like them, serving communities with large numbers of low-income and uninsured residents, have never needed the resources afforded by Medicaid DSH more than they do today. Congress has always questioned the wisdom of this cut and has never allowed those cuts to go into effect. The most recent delay expires after November 30.

Learn more from NASH’s Medicaid DSH letter to congressional leaders.

Azar: Budget Proposes Reducing Medicaid Matching $

The federal government would reduce its financial commitment to state Medicaid programs under the FY 2021 budget the Trump administration proposed earlier this month.

While testifying before the Senate Appropriations Committee’s Subcommittee on Labor, Health and Human Services and Education, Health and Human Services Secretary Alex Azar acknowledged that the administration’s proposed FY 2021 would eliminate the enhanced rate at which the federal government matches state funds used to serve individuals who enrolled in Medicaid through the Affordable Care Act’s Medicaid expansion provision.  That enhanced rate calls for the federal government to pay 100 percent of the costs associated with the Medicaid population during the first year of Medicaid expansion, eventually scaling down to 90 percent after 2020.  Nationally, the federal government’s matching rate for the pre-expansion population is 57 percent; that matching rate would not be affected by this proposal.

This aspect of the administration’s proposed FY 2021 budget has mostly flown under the radar since the budget’s release and has received little public attention.

In explaining the proposal, Azar said that enhanced funding for the Affordable Care Act’s Medicaid expansion population was biased against the disabled, women, and children.

Such a policy change could be a blow to private safety-net hospitals in Medicaid expansion states.

Learn more about what Secretary Azar said about federal matching funds for state Medicaid programs in the McKnight’s Long-Term Care News article “Official confirms Trump budget proposed to eliminate enhanced Medicaid match.”

 

NASH Unveils 2020 Advocacy Agenda

The National Alliance of Safety-Net Hospitals has published its 2020 advocacy agenda.

To advance the interests of private safety-net hospitals, in the coming year NASH will:

  • Continue to address the major policy challenges of 2019 that had not been resolved as that year ended:  an extended delay of Medicaid disproportionate share (Medicaid DSH) cuts, surprise medical bills, and prescription drug prices.
  • Respond to administration-driven policies such as the calculation of Medicare disproportionate share (Medicare DSH) payments, reduced payments for prescription drugs under the 340B prescription drug discount program, and efforts to reduce Medicaid eligibility and benefits and to limit the means through which states may finance their share of Medicaid payments.
  • Respond to expected judicial decisions addressing the extension of site-neutral Medicare outpatient payments to additional outpatient settings and the implementation of a new public charge regulation.

For a more detailed look at NASH’s advocacy plans for the coming year, see its complete 2020 advocacy agenda.

Interview With Seema Verma

In late December, PBS broadcast an interview with Centers for Medicare & Medicaid Services administrator Seema Verma.  Kaiser Health News has published a transcript of excerpts from that interview during which Verma discusses Medicaid – including enrollment, eligibility, services, and children – Medicare for all, administration attempts to reduce health care costs, protection for people with pre-existing conditions, and more.  Read those excerpts in the Kaiser Health News article “One-On-One With Trump’s Medicare And Medicaid Chief: Seema Verma.”

NASH Conveys End-of-Year Priorities to Congress

Preventing Medicaid DSH cuts, a fair approach to protecting patients from surprise medical bills, and reducing prescription drug costs are among the policy positions that the National Alliance of Safety-Net Hospitals recently shared with Congress.

In its message to Congress, NASH also asked lawmakers to protect 340B prescription drug discounts for private safety-net hospitals and to preserve dedicated funding for community health centers, the National Health Service Corps, and the Teaching Health Center Graduate Medical Education.

Learn more about NASH’s end-of-year policy priorities from the message “Protect Safety-Net Hospitals and the Communities They Serve in Upcoming Budget and Legislative Deliberations” that NASH delivered yesterday to all 535 members of Congress.

Administration Shares Regulatory Priorities for 2020

The Trump administration’s health care regulatory priorities for 2020 have been outlined by the Office of Management and Budget in a newly released “Statement of Regulatory Priorities for Fiscal Year 2020.”

The statement, an annual OMB document, organizes the priorities as follows:

  • Facilitating patient-centered markets
  • Fixing health care financing through protecting private insurance and Medicare
  • Fixing health care financing through reforming the individual market
  • Fixing health care financing through making the ACA and Medicaid fiscally sustainable
  • Bringing value to health care through price and quality transparency
  • Bringing value to health care through patient-centered health IT
  • Bringing value to health care through deregulation, especially for coordinated care
  • Bringing value to health care through tackling the high cost of prescription drugs
  • Bringing value to health care through accelerated drug and device approval and reimbursement
  1. Promoting health and protecting life
  • Addressing impactable health challenges: kidney health
  • Addressing impactable health challenges: combatting the opioid crisis
  • Protecting conscience and life at all stages
  • Reducing the disease and death associated with tobacco use
  1. Promoting independence
  • Returning TANF to promoting work, marriage and family
  • Supporting adoption
  • Empowering Americans to improve their nutrition
  • Promoting flexibility for states, grantees, and regulated entities

Learn more about the regulatory directions the administration intends to take for the rest of its 2020 fiscal year in the newly released “Statement of Regulatory Priorities for Fiscal Year 2020.”  Go here to see the complete list of regulations that the Department of Health and Human Services intends to pursue in FY 2020, including 55 by the Centers for Medicare & Medicaid Services (CMS).

 

Medicaid DSH Cut Delayed

Cuts in Medicaid DSH payments to hospitals will be delayed for another month after Congress passed, and the president signed, a continuing resolution to fund the federal government through December 20.

A cut in federal Medicaid disproportionate share (Medicaid DSH) allotments to the states is mandated by the Affordable Care Act and has been delayed several times by Congress.  If implemented, Medicaid DSH allotments to the states would be slashed $4 billion in FY 2020 and then $8 billion a year through FY 2025.

Cuts in allotments to the states would result in reductions of Medicaid DSH payments to DSH-eligible hospitals.

Medicaid DSH payments are a vital tool for helping private safety-net hospitals care for the low-income residents of their communities.  All private safety-net hospitals receive such payments.

The current cut is only temporary and expires when the continuing resolution expires after December 20.