Health Policy Update for Thursday, April 8

The following is the latest health policy news from the federal government as of 2:45 p.m. on Thursday, April 8.

Provider Relief Fund

  • The Provider Relief Fund web page has been updated to announce a webinar next Tuesday, April 13 about the HRSA COVID-19 uninsured program under which participating providers are reimbursed at Medicare rates for testing, treating, and administering COVID-19 vaccines to uninsured individuals.  Go here for further information (in the shaded box labeled “update”).

Centers for Medicare & Medicaid Services

COVID-19

  • CMS has added 24 new audiology and speech language pathology services to its list of telehealth services covered during the COVID-19 emergency.  Go here to find the updated list of telehealth services authorized during the pandemic.

Proposed Rules

  • CMS has published its proposed FY 2022 skilled nursing facility prospective payment system rule.  Learn more about the proposed rule from this CMS fact sheet and from the proposed rule itself.
  • CMS has published its proposed FY 2022 hospice wage index and payment update, hospice conditions of participation updates, and hospice and home health quality reporting program requirements.  Learn more the CMS fact sheet from this Federal Register notice.

Health Policy News

  • CMS will hold a webinar titled “Building Capacity in the Direct Service Workforce:  Moving Forward from the Summit” on Wednesday, April 28, 2021.  The purpose of the webinar is to advance learning and recommendations from the “Quality Jobs Equal Quality Care: Building Capacity in the Direct Care Workforce” event that was held at Advancing States’ HCBS Conference on December 3, 2020.  The webinar will highlight capacity-building strategies shared by states during the HCBS conference, is open to the public, and will focus on strategies for state Medicaid agencies, state agency partners, managed care plans, and home and community based services providers.  Go here for more information and here to register.

Department of Health and Human Services

Federal Funding Opportunity

  • HHS’s Administration for Community Living has published a notice about a funding opportunity.  The notice is titled “Aging and Disability Resource Center/No Wrong Door System COVID–19 Vaccine Access Supplemental Funding” and it states that “This funding opportunity is to support a new effort to get the nation’s most vulnerable and at-risk seniors and people with disabilities vaccinated.”  The notice was published today (April 8) and applications are due at 11:59 p.m. on Friday, April 9.  The notice also states that “Eligible Applicants for this award are existing ADRC/NWD COVID–19 CARES Act grantees that received funding on April 1, 2020.”  Learn more from the Federal Register notice.

Centers for Disease Control and Prevention

COVID-19

Health Policy News

  • The CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) announced that federal funding may now be used to purchase rapid fentanyl test strips in an effort to help curb the dramatic spike in drug overdose deaths largely driven by the use of strong synthetic opioids, including illicitly manufactured fentanyl.  Learn more about the new policy and the federal grantees to which it applies in this CDC news release.

Congressional Research Service

  • The Congressional Research Service has published a new report titled “State and Federal Authority to Mandate COVID-19 Vaccination.”  Find it here.

MedPAC Meets

The Medicare Payment Advisory Commission met in Washington, D.C. last week to discuss various Medicare payment issues.

Among the issues discussed at MedPAC’s April meeting were:

  • Medicare skilled nursing facility value-based purchased program.
  • Medicare alternative payment models (APMs).
  • Medicare Advantage benchmark policy.
  • Medicare indirect medical education (Medicare IME) payments.
  • Medicare vaccine coverage and payments.
  • Medicare payment for prescription drugs prescribed on an outpatient basis.
  • Private equity and Medicare.
  • Medicare clinical laboratory fee schedule.

MedPAC is an independent congressional agency that advises Congress on issues involving Medicare.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.  Because so many patients of private safety-net hospitals are insured by Medicare, MedPAC’s deliberations are especially important to those hospitals.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.

New Medicare Policy May Save Money for Government But Cost Patients More

A new Medicare policy expected to save money for the federal government may end up doing so at the expense of Medicare beneficiaries who may find themselves faced with costs that Medicare previously paid.

Under the new policy, selected procedures that Medicare once authorized only when performed on an inpatient basis can now be performed on an outpatient basis.  The underlying rationale for the policy, which took effect on January 1 and will be phased in over the next three years, is that such an approach should foster competition and possibly lower Medicare costs.

But some of those procedures still require meaningful after-care that can range from prescription drugs to post-surgical monitoring to facility fees to home care and more – costs included in Medicare reimbursement for inpatient surgery but not included in the price of outpatient surgery.  Thus, while patients generally face the same maximum deductible for inpatient and outpatient procedures, they may be more likely to be forced to spend that full deductible if they choose to have the surgery performed on an outpatient basis.

This also could pose a challenge for private safety-net hospitals, which serve especially large numbers of low-income patients.  Many of those patients already have difficulty paying their Medicare co-payments, and this could leave safety-net hospitals with additional uncompensated care costs.

Learn more about how this situation came about, its implications for Medicare beneficiaries, and the possibility of this unusual situation being corrected in the Washington Post article “New cost-cutting Medicare rule may add costs to patients.”

Administration to Review Public Charge Rule

President Biden has ordered a review of the federal public charge rule.

The controversial rule, which would limit immigration to the U.S. for people who might at some point become dependent on public aid programs, has been the subject of litigation since it was proposed in 2019.

The White House executive order directs

…the Secretary of State, the Attorney General, the Secretary of Homeland Security, and the heads of other relevant agencies, as appropriate…[to] review all agency actions related to implementation of the public charge ground of inadmissibility…

The officials were ordered to report their findings to the president within 60 days.

The public charge rule authorizes the U.S. Citizenship and Immigration Services to deny a green card to any immigrant who receives certain public benefits – such as food stamps, public housing vouchers, welfare, or Medicaid – for more than 12 months within any three-year period.  The expressed purpose of the rule is to deny green cards to individuals who may become dependent on publicly funded services – a so-called “public charge.”

Health care advocates feared the rule would discourage some immigrants to whom the rule does not even apply from seeking to participate in certain public aid programs and even encourage some to whom the rule does not apply to disenroll from the public aid programs, such as Medicaid, in which they are already legally enrolled.

NASH has expressed its opposition to the public charge rule on a number of occasions, including in this position statement.

Implementation of the rule, which was proposed in 2019 and took effect in September of last year, was delayed in November by a federal court.

Learn more about the administration’s latest action in this presidential executive order.

NASH Comments on Proposed Changes in S-10 Uncompensated Care Reporting

NASH has expressed support for several new federal proposals on hospital uncompensated care data reporting and conveyed its opposition to other proposed changes in federal data collection requirements in a new letter to the Centers for Medicare & Medicaid Services.

In response to changes CMS has proposed in the uncompensated care data hospitals must submit to the federal government, NASH expressed:

  • Support for CMS’s proposal to clarify aspects of how hospitals must report data on the uncompensated care they provide on the Medicare cost report’s S-10 form.
  • Expressed concern that some of the new data reporting requirements violate current HIPAA requirements.
  • Asked CMS to defer reporting on the rates hospitals negotiate with Medicare Advantage plans until after the end of the COVID-19 public health emergency.

NASH is especially interested in proposed changes in uncompensated care data reporting on the S-10 form because that form is used in the calculation of private safety-net hospitals’ Medicare disproportionate share payments (Medicare DSH).  Those Medicare DSH payments are a vital tool in helping these hospitals serve the low-income and uninsured residents of the communities in which they are located.

Learn more about NASH’s response to CMS’s proposed new information collection activities in this NASH letter to CMS.

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

MedPAC’s proposed Medicare 2021 payment recommendations dominated the December agenda, including:

  • hospital inpatient and outpatient payments
  • ambulatory surgical center payments
  • physician and health professional payments
  • hospice payments
  • home health care payments
  • inpatient rehabilitation facility payments
  • long-term care hospital payments

In addition, MedPAC discussed Medicare’s policy for transfers between post-acute-care facilities and hospice and received a staff update on the Medicare Advantage program.

MedPAC is an independent congressional agency that advises Congress on issues involving Medicare.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.  Because so many patients of private safety-net hospitals are insured by Medicare, MedPAC’s deliberations are especially important to those hospitals.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues and for a transcript of the two days of meetings.

MedPAC Meets

Earlier this week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

Among the issues on MedPAC’s November agenda were:

  • expansion of telehealth in Medicare
  • report on Medicare beneficiaries’ access to care in rural areas
  • effects of pharmaceutical rebates on Part D’s risk adjustment
  • improving competition among Medicare Part D’s benchmark plans
  • separately payable drugs in the hospital outpatient prospective payment system
  • Medicare Advantage payment and access for enrollees with end-stage renal disease

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.  Because so many patients of private safety-net hospitals are insured by Medicare, MedPAC’s deliberations are especially important to those hospitals.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.

Most Hospitals Fined by Medicare Over Readmissions

More than 80 percent of all hospitals subject to Medicare’s hospital readmissions reduction program, and half of all of hospitals in the country, will be penalized in FY 2021 under that program because they have what Medicare considers to be too many avoidable readmissions.

In all, 2556 of the 3080 hospitals subject to the Centers for Medicare & Medicaid Services program will be penalized.  More than 600 will see their inpatient payments cut one percent as a result and the average cut will be 0.69 percent.

The penalties are based on hospital performance with patients experiencing congestive heart failure, heart attacks, chronic obstructive pulmonary disease, coronary artery bypass graft surgery, pneumonia, and knee and hip replacement.  Such patients are considered readmitted if they return to the hospital within 30 days of their discharge for these conditions unless their return to the hospital was planned as part of their treatment.

Learn more about hospital performance under Medicare’s hospital readmissions reduction program and find links to tools to look up individual hospitals and download nation-wide hospital 2021 readmissions data in the Kaiser Health News article “Medicare Fines Half of Hospitals for Readmitting Too Many Patients.”

HHS Webinar Thursday

The Department of Health and Human Services will hold a webinar on Thursday, October 22 at 1:00 (eastern) about the Centers for Medicare & Medicaid Services’ recent guidance explaining how it will implement an interim final rule that makes the collection and reporting of COVID-19 data a condition of participation in Medicare for hospitals.

On August 24 CMS published an interim final rule establishing new requirements in the hospital conditions of participation in Medicare and on October 6 HHS published the updated document “COVID-19 Guidance for Hospital Reporting and FAQs For Hospitals, Hospital Laboratory, and Acute Care Facility Reporting.”  Among the data elements hospitals are required to report are their current count of lab-confirmed COVID-19 patients, number of staffed beds, number of occupied ICU beds, and information about personal protective equipment and ventilators.

The purpose of the webinar is to explain to providers how HHS will implement these requirements.

Go here to register for the webinar.

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

Among the issues on MedPAC’s October agenda were:

  • Medicare Advantage benchmark policy
  • indirect medical education:  current Medicare policy, concerns, and principles for revising
  • the evolution of Medicare’s advanced alternative payment models
  • vertical integration and Medicare payment policy

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.  Because so many patients of private safety-net hospitals are insured by Medicare, MedPAC’s deliberations are especially important to those hospitals.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues and here for a transcript of the proceedings.