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Federal Health Policy Update for Wednesday, May 19

The following is the latest health policy news from the federal government as of 2:15 p.m. on Wednesday, May 19.  Some of the language used below is taken directly from government documents.

NASH Advocacy

  • NASH has written to all members of Congress urging them to contact Health and Human Services Secretary Xavier Becerra about directing more of its remaining CARES Act Provider Relief Fund money to private safety-net hospitals to help them serve their diverse, predominantly low-income communities during the COVID-19 emergency.  Go here to see NASH’s message to Congress.

The White House

COVID-19

Centers for Medicare & Medicaid Services

Health Policy News

Go here for links to these and other items.

Department of Health and Human Services

COVID-19

  • HHS’s Substance Abuse and Mental Health Services Administration (SAMHSA) is distributing $3 billion in American Rescue Plan funding for its mental health and substance use block grant programs.  The Community Mental Health Services Block Grant Program and Substance Abuse Prevention and Treatment Block Grant Program are distributing $1.5 billion each to states and territories to help communities addressing mental health and substance use needs during the COVID-19 pandemic.  Learn more from HHS’s news release announcing the funding.
  • HHS’s Office of the Inspector General has updated its work plan for COVID-19-related audits, evaluations, and inspections scheduled for May.
  • In conjunction with the California Justice Department and the U.S. Attorney’s Office for the Eastern District of California, HHS’s Office of the Inspector General has issued a news release advising the public that they should not be asked by providers to pay for COVID-19 vaccines and reminding providers that they may not attempt to charge or bill consumers for administering those vaccines.  See the news release here.
  • HHS’s Office of the Assistant Secretary for Preparedness and Response has published information about the challenges of providing hospice care amid the COVID-19 pandemic and about providing home care during the public health emergency.

Health Policy News

Senate Finance Committee Hearing

The Senate Finance Committee held a hearing today on COVID-19 flexibilities.

  • Go here to read the opening statement of the committee chair, Senator Ron Wyden (D-OR) and go here to read the opening statement of the committee’s ranking minority member, Senator Mike Crapo (R-ID).
  • Go here to see the testimony of individuals who appeared at the hearing.
  • The Medicare Payment Advisory Commission has submitted a written statement to the committee.  The MedPAC statement notes that “While many of these actions have been helpful in addressing the short-term issues presented by the pandemic, continuing those changes indefinitely would have drawbacks.  Therefore, policymakers should be cautious about extending them beyond the duration of the public health emergency (PHE) or other scheduled expiration date.”  The statement pays particular attention to telehealth and post-acute care.  Go here to see the MedPAC submission “Temporary modifications of Medicare policies in response to the coronavirus public health emergency.”
  • The Government Accountability Office has submitted a report to the Senate Finance Committee on the same subject.  The GAO notes that it undertook this work, titled “Medicare and Medicaid:  COVID-19 Program Flexibilities and Considerations for Their Continuation,” because of a CARES Act provision that calls for the agency to “… conduct monitoring and oversight of the federal government’s response to the COVID-19 pandemic.”  Find the GAO submission here.

Centers for Disease Control and Prevention

COVID-19

Food and Drug Administration

COVID-19

National Institutes of Health

COVID-19

National Academy of Medicine

FEMA

Government Accountability Office

Medicaid Waiver Process Often Lacks Transparency, GAO Finds

States’ applications for federal Medicaid waivers often lack transparency, according to a new report by the U.S. Government Accountability Office.

According to the GAO, the chief problem with the transparency of state applications for Medicaid waivers arises when states either seek to amend waivers they have already obtained or amend waiver applications currently under review by the Centers for Medicare & Medicaid Services.  Too often, the GAO found, states neither subject such amendments to public review and comment nor adequately explain to stakeholders the implications of the amendments they are proposing.

To address this problem, the GAO recommends that CMS address these shortcomings.  CMS agrees with these recommendations.

States often use section 1115 Medicaid waivers to seek exemptions from selected aspects of federal Medicaid law so they can employ new approaches to the delivery of Medicaid services and to payment for those services. Because they serve so many more Medicaid patients than most hospitals, private safety-net hospitals have a much greater stake in changes in state Medicaid programs than other hospitals.

Learn more about why the GAO undertook this analysis and what it found in its report Medicaid Demonstrations:  Approvals of Major Changes Need Increased Transparency.

GAO Looks at Medicaid Managed Care Spending

The federal government should do more to help states ensure the accuracy and integrity of their payments to Medicaid managed care organizations and the payments those Medicaid managed care organizations make to health care providers.

This is the conclusion reached in a new study of Medicaid managed care performed by the U.S. Government Accountability Office at the request of the Permanent Subcommittee on Investigations of the Senate Committee on Homeland Security and Government Affairs.

The GAO study identified six payment risks among various transactions between state governments, Medicaid managed care organizations, and health care providers.  The two biggest risks, the GAO concluded, were:

  1. incorrect fee-for-service payments from MCOs, where the MCO paid providers for improper claims, such as claims for services not provided; and
  2. inaccurate state payments to MCOs resulting from using data that are not accurate or including costs that should be excluded in setting payment rates.

The GAO traces some of these problems to a delay in the Centers for Medicare & Medicaid Services’ planned Medicaid managed care guidance to states; limited implementation of new auditing practices CMS introduced in 2016; and CMS’s failure to account for overpayments to providers when it reviews state capitation rates for Medicaid managed care plans.

To address these shortcomings, the GAO report recommends that CMS:

  1. expedite issuing planned guidance on Medicaid managed care program integrity;
  2. address impediments to managed care audits; and
  3. ensure states account for overpayments in setting future MCO payments.

CMS agrees with these recommendations.

Learn more about the study – why it was undertaken, how it was conducted, what it found, and what it recommended – by going here to see the GAO report Medicaid Managed Care:  Improvements Needed to Better Oversee Payment Risks.

GAO Urges Medicare Action on Opioids

The Centers for Medicare & Medicaid Services is not doing enough to oversee the prescribing of opioids to Medicare beneficiaries.

Or so concludes the U.S. Government Accountability Office.

According to the GAO, CMS provides guidance to Medicare drug plans “…but does not analyze data specifically on opioids.”  Also, according to the GAO,

…CMS does not identify providers who may be inappropriately prescribing large amounts of opioids separately from other drugs, and does not require plan sponsors to report actions they take when they identify such providers.  As a result, CMS is lacking information that it could use to assess how opioid prescribing patterns are changing over time, and whether its efforts to reduce harm are effective.

To address these and other problems, the GAO report recommends that CMS

  • gather information on the full number of at-risk beneficiaries receiving high doses of opioids
  • identify providers who prescribe high amounts of opioids
  • require plan sponsors to report to CMS on actions related to providers who inappropriately prescribe opioids

Learn more in report Prescription Opioids:  Medicare Needs to Expand Oversight Efforts to Reduce the Risk of Harm, which can be found here, on the GAO web site.

HHS Needs to Do More on Physician Training

The federal government needs to do more to ensure an adequate supply of primary care physicians and their deployment in non-urban areas outside of the northeastern U.S.

Or so concludes a new study performed by the U.S. Governor Accountability Office.

According to the GAO report, efforts by the U.S. Department of Health and Human Services have resulted in progress toward meeting both of these goals – but not enough progress.  With the federal government spending $15 billion on graduate medical education, GAO believes, HHS can and should do more to ensure an adequate supply of primary care physicians throughout the country and not just in urban areas.

Many private safety-net hospitals are teaching hospitals.

Learn more about what the GAO found and what it recommended in its new report Physician Workforce: Locations and Types of Graduate Training Were Largely Unchanged, and Federal Efforts May Not Be Sufficient to Meet Needs, which can be found here.

GAO Looks at Supplemental Medicaid Payments

Following up its own 2012 report that identified more than 500 hospitals receiving supplemental Medicaid payments that resulted in Medicaid payment surpluses, the U.S. Government Accountability Office has taken a broader look at supplemental payments state Medicaid programs make to hospitals and how those payments are used.

gaoIn a limited study of hospitals in four states, GAO found that some hospitals used supplemental payments for purposes other than serving Medicaid patients and the uninsured – purposes such as ordinary operations, capital purchases, a poison control center, even a helicopter. GAO also found that hospitals were more likely to receive such payments if local funding was used to draw down federal Medicaid matching funds. In some places, hospitals with local governments willing to finance the payments were more likely to receive them than hospitals located in places without such local support.

The GAO recommended that the Centers for Medicare & Medicaid Services take stronger steps to ensure that supplemental Medicaid payments are linked to the provision of Medicaid services and that CMS not permit states to make those payments contingent on local financing.

Learn more about why the GAO looked at supplemental Medicaid payments, what it learned, and what it recommended in the report Federal Guidance Needed to Address Concerns About Distribution of Supplemental Payments.

 

GAO Suggests Changes in Federal Medicaid Funding Formula

The U.S. Government Accountability Office has recommended changes in how the federal government matches state Medicaid funding for its share of overall Medicaid spending.

In testimony submitted to the House Energy and Commerce Committee’s Health Subcommittee, GAO reminded Congress that in the past

…GAO has examined multiple concerns regarding how the FMAP [federal medical assistance formula] allocates funds among states, including during times of economic downturn, and has suggested improvements.

gaoIn particular, the GAO is concerned about how the FMAP formula’s use of per capita income in targeting federal Medicaid matching funds may not accurate reflect economic conditions at the state level, especially during economic downturns, and fail to respond to states’ individual needs during those downturns.

In response to these concerns, the GAO suggested

…that Congress could consider an FMAP formula that targets variable state Medicaid needs and provides automatic, timely, and temporary assistance in response to national economic downturns.

For a closer look at what the GAO investigated, what it concluded, and what it recommended to Congress, go here to see the GAO report Medicaid: Changes to Funding Formula Could Improve Allocation of Funds to States.

GAO: More Information Needed About Supplemental Medicaid Payments

More data is needed about the supplemental Medicaid payments states make to hospitals and how those payments are financed, according to a new report from the U.S. Government Accountability Office (GAO).

According to the GAO, states are increasingly funding non-disproportionate share gao(Medicaid DSH) supplemental Medicaid payments to hospitals with funds from local governments and providers that are then matched by the federal government. In some states those supplemental payments, with the help of federal Medicaid matching funds, result in hospitals receiving reimbursement from Medicaid that exceeds the cost of the care they provide to their Medicaid patients.

In response to this concern, the GAO has urged the Centers for Medicare & Medicaid Services (CMS) to collect more and better data about how states finance their Medicaid programs and to do more to ensure that accuracy of that data. For its part, CMS maintains that its current efforts are adequate.

Learn more about this issue from the GAO report Improving Transparency and Accountability of Supplemental Payments and State Financing Methods, which can be found here.

GAO Looks at Behavioral Health Options

gaoAccess to behavioral health services can be a challenge for low-income adults, so the U.S. Government Accountability Office (GAO) recently looked into those challenges.

In a new report, the GAO examined how many low-income adults have behavioral health problems, where they can go to receive the care they need – including whether there are differences in those options depending on whether the state in which the reside has expanded its Medicaid program – how Medicaid expansion states are providing coverage for behavioral health for newly eligible beneficiaries, and how obtaining Medicaid coverage affects the ability of such individuals to get the care they seek.

Access to behavioral health care can be an especially major challenge in the low-income communities typically served by the nation’s private safety-net hospitals.

Read about the GAO’s findings in the report Options for Low-Income Adults to Receive Treatment in Selected States, which you can find here.

5% of Medicaid Recipients Account for 50% of Costs

Just five percent of all Medicaid recipients are responsible for nearly half of the program’s expenditures.

gaoOr so says a new report by the U.S. Government Accountability Office (GAO).

Conversely, the 50 percent of Medicaid’s least costly recipients account for only eight percent of the program’s costs.

Disabled Medicaid recipients, while fewer than 10 percent of the overall total, represent nearly two-thirds of the highest-cost group.

These figures reflect spending from 2009 through 2011.

The greatest Medicaid expenditures were invested in seven types of care: for patients with asthma, diabetes, HIV/AIDS, mental health conditions, substance abuse, and delivery or childbirth along with those residing in long-term-care facilities.

To learn more about the GAO’s findings, see a summary of the report Medicaid: A Small Share of Enrollees Consistently Accounted for a Large Share of Expenditures and find a link to the complete report here on the GAO web site.