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Federal Health Policy Update for Thursday, August 26

The following is the latest health policy news from the federal government as of 2:30 p.m. on Thursday, August 26.  Some of the language used below is taken directly from government documents.

NASH Advocacy

  • NASH has written to the chairs and ranking members of the congressional committees of jurisdiction over health care to ask them to prevent the anticipated January 1, 2022 tripling of the current Medicare sequester from two percent to six percent of all provider Medicare payments and to consider the challenges that community safety-net hospitals have long faced, and that they now continue to face to an unprecedented degree, when looking for budget savings to offset new federal spending during upcoming federal budget deliberations.  See NASH’s letter here.

Provider Relief Fund

The White House

Centers for Medicare & Medicaid Services

COVID-19

  • Health care providers can now receive additional payments from Medicare for administering vaccines to multiple residents in one home setting or a communal home setting.  Previously, CMS increased Medicare payments for vaccines administered in the home, and now, under this new policy, vaccine providers can receive the increased payment up to five times when fewer than ten Medicare beneficiaries receive the vaccine on the same day in the same home or communal setting.  Learn more from this CMS announcement.
  • CMS has written to Medicare Advantage organizations and Medicare-Medicaid health plans to inform them that in light of the recent surge of the COVID-19 delta variant and increased hospitalizations across the country, it strongly encourages those organizations to waive or relax plan prior authorization requirements and utilization management processes to facilitate the movement of patients from general acute-care hospitals to post-acute care and other clinically-appropriate settings, including skilled nursing facilities, long-term-care hospitals, inpatient rehabilitation facilities, and home health agencies.  The ability of hospitals to transfer patients to appropriate levels of care without unnecessary delays or administrative burdens, CMS writes, is critical to ensuring that hospitals have open acute-care beds to treat patients requiring emergency care.  See the CMS message here.
  • CMS has updated its Medicare provider enrollment relief FAQ.  Find it here.

Department of Health and Human Services

Health Policy News

  • Along with the Department of the Treasury and Department of Labor, HHS is vested with responsibility for implementing the 2020 law that requires health care payers to make available to the public machine-readable files for in-network rates and out-of-network allowed amounts and billed charges for plan years.  That information was to be available publicly by January 1, 2022, but now, the departments have delayed implementation of this requirement for six months.  Learn more from this HHS FAQ.
  • HHS’s Office of the Assistant Secretary for Preparedness and Response will award a single grant of $3 million to establish a new Regional Disaster Health Response System site.  It would be part of a tiered system that builds upon and unifies existing assets within states and across regions to support a more coherent, comprehensive, and capable health care disaster response system able to respond health security threats.  Entities eligible for grants include hospitals, local health care facilities, political subdivisions, states, emergency medical services organizations, and emergency management organizations.  Learn more about the funding opportunity here and here and about the Regional Disaster Health Response System here.  Applications are due September 20.
  • HHS’s Agency for Healthcare Research and Quality has published a statistical brief on diabetes-related inpatient stays in 2018.

Food and Drug Administration

COVID-19

  • The FDA has granted its first full (non-emergency use authorization only) approval of a COVID-19 vaccine.  The vaccine that has been known as the Pfizer-BioNTech COVID-19 Vaccine and will now be marketed as Comirnaty (koe-mir’-na-tee), for the prevention of COVID-19 disease in individuals 16 years of age and older.  The vaccine also continues to be available under emergency use authorization for individuals 12 through 15 years of age and for the administration of a third dose in certain immunocompromised individuals.  Learn more from this FDA news release.
  • The FDA has posted updated information about COVID-19 booster shots, including when they will be available, who should get them, and when people should get them.  Find that information here.

Centers for Disease Control and Prevention

COVID-19

U.S. Citizenship and Immigration Services

  • Under provisions of the Immigration and Nationality Act, the Department of Homeland Security’s U.S. Citizenship and Immigration Services administers the public charge ground of inadmissibility as it pertains to applicants for admission to the U.S. and adjustment of status.  The agency has published an advance notice of proposed rulemaking to seek broad public feedback on the public charge ground of inadmissibility to the U.S. that will inform its development of a future regulatory proposal.  Find the Federal Register notice here.  Comments are due by October 22.

National Institutes of Health

  • A study funded by the NIH has found that drinking alcohol and smoking tobacco cigarettes throughout the first trimester of pregnancy is associated with nearly three times the risk of late stillbirth compared to women who neither drink nor smoke during pregnancy or quit both before the end of the first trimester.  Learn more from this NIH news release.

Medicare Payment Advisory Commission (MedPAC)

  • MedPAC has submitted formal comments to CMS in response to CMS’s proposed home health prospective payment system regulation for 2022.  See MedPAC’s comment letter here.

Congressional Research Service

  • The Congressional Research Service has updated its report Finding Medicare Fee-For-Service (FFS) Payment System Rules:  Schedules and Resources.  Find it here.

 

2019 Change in Public Charge Rule to Disappear

Shortly after taking office the Biden administration stopped enforcing 2019 changes in the so-called public charge rule and now the Supreme Court has agreed to a Justice Department request to dismiss an upcoming case challenging that rule.

The public charge rule, as updated in 2019, calls for all legal immigrants enrolled in Medicaid and certain other safety-net programs to be designated public charges and denied access to permanent U.S. residency and green card status.  Hospitals – including private safety-net hospitals and the National Association of Safety-Net Hospitals – feared that the revised rule would have a chilling effect on the willingness of some legal citizens and legal non-citizens to seek out government health care programs for which they legally qualify.  This, they feared, could lead to many low-income legal citizens and non-citizens choosing not to seek the care to which they are entitled by law and ignoring serious illnesses and injuries until they become a crisis.  This could lead to continuing health problems for such individuals and a potential surge of uncompensated care for the safety-net hospitals to which such individuals turn when their medical conditions absolutely require medical attention – a surge that could jeopardize jobs at those hospitals and access to care in the generally low-income communities safety-net hospitals serve.

Between this action by the Justice Department and the Supreme Court agreement not to hear the case, it appears that the next step will be for the administration, which has already directed its agencies to review such regulations, either to revise or rescind the 2019 changes in the public charge rule.

NASH expressed its opposition to the 2019 changes in the public charge rule on several occasions, including in this letter to the Department of Homeland Security when the changes were proposed and in this 2019 position statement.

Learn more about the public charge rule and recent actions affecting it in the article “Supreme Court agrees to dismiss challenge to Trump public charge rule,” from the online publication The Hill.

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.

Off-Again, On-Again Public Charge Rule is Off Again

A federal rule that would have limited immigration to the U.S. for people who might at some point become dependent on public aid programs has been put on hold again by a federal judge.

Implementation of the rule, delayed by several courts and then authorized by the U.S. Supreme Court until the merits of challenges could be heard, was delayed again by a federal court, which said the rule contained “numerous unexplained flaws” that made it “arbitrary and capricious.”

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.  A recent study published in the journal Health Affairs found that the parents of a projected 260,000 children have disenrolled their children from Medicaid or the Children’s Health Insurance Program (CHIP) because of their fear of the rule’s implications for their families.

NASH has conveyed its opposition to the public charge rule on a number of occasions, including in this 2019 position statement.

Learn more about the rule and this latest court decision in the New York Times article “Trump’s ‘Public Charge’ Immigration Rule Is Vacated by Federal Judge

Public Charge Rule Takes Effect

The “public charge rule” that the administration introduced in 2019, only to have it challenged in the courts, is now being enforced by the U.S. Citizenship and Immigration Services after a federal court lifted an injunction on its implementation.

The rule authorizes USCIS 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.”

NASH opposed the public charge rule when it was proposed in 2018, expressing concern that many immigrants – including those who are eligible for Medicaid and for whom applying for Medicaid benefits would not jeopardize their immigration status – would choose not to apply for Medicaid and would instead turn to private safety-net hospitals and others like them for care when they are sick or injured, thereby increasing the uncompensated care burden for hospitals that already serve large numbers of uninsured, under-insured, and Medicaid patients.  See NASH’s letter expressing this and other views here and go here for a NASH statement about the public charge rule.

Learn more about the USCIS’s intentions for implementing the public charge rule here and learn more about the latest developments on this issue in the article “Trump administration reimposes ‘public charge’ rule following court victory” in the online publication The Hill.

Supreme Court Paves Way for Public Charge Regulation

The revised public charge regulation that will make it more difficult for some immigrants to come to the U.S. will be implemented after the Supreme Court lifted preliminary injunctions issued by lower courts that delayed the regulation’s implementation.

Under revisions of the public charge regulation introduced last year, individuals seeking entry into the U.S. and green cards who do not appear to be financially independent or have employment commitments can be denied entry if they will be dependent on means-tested public aid programs such as Medicaid or food stamps or even if they, or members of their family, appear likely to become dependent on such aid in the near future.

A number of judges throughout the country blocked the administration’s implementation of revisions of the public charge rule.  The Supreme Court’s action only lifts those injunction; it does not address the constitutionality of the regulation, leaving that matter to continue to be addressed by lower courts for now.

The challenge posed to health care providers by the updated public charge regulation is as much a matter of perception as reality:  individuals already legally in the U.S. who are not subject to the regulation have withdrawn from Medicaid out of fear of deportation while others who also are in the country legally and qualify for Medicaid are choosing not to apply for benefits for the same reason.  This, in turn, may leave some providers with more uncompensated care instead of Medicaid reimbursement for the care they provide to some of their patients.

The National Alliance of Safety-Net Hospitals has conveyed its opposition to the public charge regulation to both Congress and the administration.  In a message to Congress, NASH wrote that “The new public charge regulation threatens the health of families and communities and threatens the ability of private safety-net hospitals to serve those families and those communities.”  In response to the proposed changes in the regulation, NASH wrote in a formal comment letter on behalf of private safety-net hospitals that it

…believes the proposed regulation could have a chilling effect on the willingness of many legal citizens and legal non-citizens to seek out government health care programs for which they legally qualify. This could lead to millions of low-income legal citizens and legal non-citizens choosing not to seek the care to which they are entitled by law and ignoring serious illnesses and injuries until they become a crisis. When such individuals have no choice but to turn to hospital emergency departments in search of care – something hospital emergency departments are required by law to provide regardless of a patient’s ability to pay – this could overwhelm those facilities and would do so to the detriment of other patients while also producing a surge of uncompensated care, especially for private safety-net hospitals. That, in turn, could jeopardize the jobs of thousands who work in those hospitals and the economies of the communities in which those hospitals are located. It could also jeopardize access to care for residents of these same communities – including ordinary people who receive their health care coverage from private insurers and Medicare.

See NASH’s entire comment letter here.

Learn more about the Supreme Court’s decision and how it affects implementation of the public charge regulation in the New York Times article “Supreme Court Allows Trump’s Wealth Test for Green Cards.”

 

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.

NASH Seeks Medicaid Exemption From New Public Charge Regulation

Congress should exempt Medicaid enrollment from the criteria in a new federal regulation that defines “public charge” or even overturn that regulation entirely, the National Alliance of Safety-Net Hospitals has declared in a new position statement.

The new statement, developed to coincide with NASH Advocacy Day in Washington, D.C. last week, notes that the fear of being designated a public charge will discourage many immigrants, including those to whom the new regulation does not even apply, from obtaining the medical care they need.  As a result, as many as 13 million legal immigrants are expected to disenroll from Medicaid out of fear of being labeled a public charge or choose not to enroll in the program even though they are entitled to Medicaid benefits.  Those found to be public charges risk losing green card status or even deportation.

Such individuals, NASH believes, will inevitably turn to private safety-net hospitals and others for care when they are sick or injured, placing great financial stress on these hospitals and potentially jeopardizing their ability to serve their communities.  For this reason, NASH has urged Congress to remove Medicaid participation from the criteria defining a public charge or to overturn the new regulation completely.

Learn more in the new NASH position paper “Challenges Posed by the New Public Charge Regulation.”

 

New Public Charge Rule Could Affect Immigrants, Providers

Legal immigrants may become reluctant to seek government-sponsored health care and providers may find themselves delivering more uncompensated care in the wake of the adoption of a new federal “public charge” regulation that seeks to define more narrowly the kinds of individuals who should be granted entry to the U.S. in the future.

The new Department of Homeland Security regulation, while focused on applicants for entry into the U.S., could have the unintended effect of discouraging legal immigrants from enrolling in Medicaid, CHIP, and other government programs and even lead them to disenroll from such programs out of a mistaken concern that participating in such programs could jeopardize their status as legal immigrants.  The Kaiser Family Foundation, in fact, estimates that two to three million people will leave Medicaid and CHIP because of the new regulation.

More than a quarter of a million interested parties responded to the proposed regulation, which was published last October, and since its release last week a wide variety of groups, ranging from the American Hospital Association and America’s Essential Hospitals to the American Council of Pediatrics, have noted the new regulation’s potential impact with alarm.  Hospitals, in particular, are concerned that if people disenroll from Medicaid and CHIP, they will end up providing more uncompensated care to patients who previously had health insurance through those two public programs.

This could be especially challenging for private safety-net hospitals because many are located in communities with large numbers of low-income legal immigrants.

Learn more about the new public charge regulation and health care providers’ reaction to it in the Fierce Healthcare article “Healthcare industry groups warn final ‘public charge’ rule could impact immigrant health, drive up costs.”

“Public Charge” Proposal Raises Potential Issues for Safety-Net Hospitals

A proposal by the Department of Homeland Security could make it more difficult for some immigrants to stay in the U.S. permanently by scrutinizing more closely whether they might become a “public charge” if they remain in the country and rejecting those who appear likely to do so.

By “public charge” the draft Homeland Security regulation refers to people who might depend or come to depend heavily on government assistance if they remain in the country.

If implemented, such a regulation might discourage immigrants from enrolling in government health care programs, which could endanger their health and make it more difficult for urban safety-net hospitals to serve their communities, many of which have large numbers of immigrants.  The regulation also might encourage some people to drop out of government programs that provide services they need.

NASH is concerned about the potential impact of this regulation on private safety-net hospitals and intends to submit formal comments about the proposal.  Comments are due by mid-December.

To learn more about the proposed regulation, see this Washington Post article or go here to see proposed regulation itself.