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Healthsperien Summary: CMS Releases CY 2023 Medicare Physician Fee Schedule Proposed Rule
The Centers for Medicare & Medicaid Services (CMS) recently released the Calendar Year (CY) 2023 Medicare Physician Fee Schedule proposed rule that outlines the Agency’s policy proposals for Medicare payments under the physician fee schedule. Significant policies addressed in this rule include changes to the Medicare Shared Savings Program, behavioral health integration, evaluation and management visits, telehealth services, updates to the Medicare Economic Index, and a new provision for accessing audiology services.
Healthsperien has provided a detailed summary of the proposed rule, including relevant background information and areas where CMS is seeking comments, which can be accessed here.
Summer 2022 Client Update
Healthsperien is pleased to share a Summer 2022 client update as the team continues to grow and provide strategic guidance on health policy issues, solutions, stakeholder partnerships, and innovative approaches to best serve the needs of clients. Healthsperien is excited to share exciting updates including new additions to our talented team of professionals, our website refresh, Healthsperien in the news, recent and upcoming events, and an introduction to our summer interns and our partner organizations. The update can be found here.
Altarum Hosts Upcoming Webinar on Supporting States to Build Better Programs for Dually Eligible Individuals
On July 28th from 3-4pm ET, experts from Altarum, the Center for Health Care Strategies, CMS, Arnold Ventures, and the state of Virginia will review CMS’s recent CY 2023 Medicare Advantage and Part D Rule and discuss how it provides states with new tools to coordinate and integrate care for dually eligible beneficiaries with Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs). The webinar will spotlight the state of Virginia’s journey using innovative program approaches to advancing this important work. Interested stakeholders can register at the link here.
Analysis Finds Permanent ARP Extension Would Cost $250 Billion Over 10 Years, $34 Billion Over 2 Years
In a new analysis completed for GOP lawmakers, the Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT) estimate that permanently extending the ACA subsidies enhanced under the American Rescue Plan Act (ARP) would cost $250 billion over 10 years. That figure is about $30 billion more than previous estimates. However, the 2-year extension is expected to cost less than previous estimates at $34 billion. As a result of increases and decreases among different types of coverage, the CBO and JCT expect that 2.2 million fewer individuals would be uninsured if the subsidies became permanent.
ARP enhanced existing scaled ACA subsidies, which limited premium contributions for families up to 400% of the federal poverty level (FPL), including wiping premiums to $0 for families below 150% of the FPL.
Democrats are hoping to pass temporary extensions using a partisan reconciliation package. The full analysis and comments can be found here.
Administration Action
- The Substance Abuse and Mental Health Services Administration (SAMHSA) released a 988 Partner Toolkit with the goal of facilitating collaborative efforts among stakeholders and aligned 988 communication planning. The toolkit includes key takeaways, relevant statistics, and fact sheets along with presentation decks and other resources.
- The Department of Health and Human Services Office of the Inspector General (HHS OIG) published their audit of nursing home safety and emergency preparedness. The audit found that residents, visitors, and staff were at increased risk of injury or death during a fire or other emergency due to several factors, including inadequate managerial oversight, staff turnover, inadequate oversight by State survey agencies, and a lack of mandatory standardized life safety training programs. Opportunities for CMS to expand on its life safety requirements in nursing homes include proposed regulations to install carbon monoxide detectors, improving support to State survey agencies, standardizing nursing home training, and more frequently surveying high-risk facilities.
Litigation
- A judge in Tennessee temporarily prohibited two federal agencies from enforcing directives issued by the Biden Administration that extend protections for LGBTQ people in schools and workplaces. U.S. District Judge Charles Atchley Jr. ruled in an order for the 20 state attorneys general who sued last August, claiming the Biden administration directives infringed on states’ rights. The directives followed a 2020 U.S. Supreme Court case that, under a provision called Title VII, protects gay, lesbian, and transgender people from discrimination in the workplace.
Congressional Action
- A bipartisan group of 181 House members sent a letter to HHS, urging the agency to stop drug manufacturers from restricting discounts to hospitals in the 340B program. The lawmakers asked HHS to take all available enforcement actions, including the implementation of severe civil monetary penalties. There have been 14 lawsuits against the government this month, as drug companies work to avoid potential monetary penalties from the Health Resources & Services Administration (HRSA) for imposing such restrictions. To date, HRSA has sent out violation letters to nine drug manufacturers and referred seven companies to either the OIG or the Department of Justice.
- The House passed a six-bill funding package in a 220–207 party-line vote. The package contains six funding bills that will be added to the final 12-bill appropriations package. It includes the Agriculture, Rural Development, Food and Drug Administration (FDA), and Related Agencies bill (HR 8239), which gives the FDA $3.6 billion in discretionary funding for FY 2023, marking a $341 million increase over FY 2022. The legislation increases funding for drug and device activities by $64 million and includes an increase of $77 million for food inspections and food outbreaks. Senate appropriators have not yet introduced FY 2023 funding legislation for the FDA and HHS.
Marketplace
- Amazon and One Medical have entered into a definitive merger agreement for Amazon to acquire One Medical for $3.9 billion. One Medical has over 100 locations nationwide and prides itself on convenience, offering in-house lab tests, and same or next-day appointments. In addition to accepting insurance, it also has a membership program, which starts at $199 per year. The deal still requires approval from One Medical’s shareholders and regulators. Several months ago, Amazon announced plans to grow its network of brick-and-mortar clinics following the expansion of its virtual care services through Amazon Care.
Medicaid
- The Center for Medicaid and CHIP Services (CMCS) Director Daniel Tsai made a statement during a Georgetown Center for Children and Families conference keynote saying that beneficiary advocates’ concerns about expiring Medicaid coverage are not unique to the end of the Public Health Emergency (PHE), and instead are a signal that the overarching Medicaid system needs improvement. Tsai highlighted the benefits of adopting continuous Medicaid eligibility for at least 12 months and conducting ex parte renewals and suggested several reforms.
- First Focus on Children, FamiliesUSA, and UnidosUS collaboratively published a reporton the looming equity crisis facing children’s Medicaid coverage at the expiration of the COVID-19 PHE. The report found that the country will see its largest-ever drop in children’s Medicaid coverage if states do not expand eligibility, and Black and Latino children will experience coverage losses at twice the rate of White children. The authors strongly urge policy action to prevent coverage losses that would disproportionately affect families of color and exacerbate inequities within the health system.
- The Centers for Medicare & Medicaid Services (CMS) released a letter outlining a new set of measures to assess the quality of Medicaid-funded Home and Community Based Services (HCBS). CMS cross-references the measures to the 1915(c) waiver service plan and health and welfare sub assurances and the policy areas of access, rebalancing, and community integration. CMS strongly encourages but does not require states to incorporate the measures into their quality reporting requirements for their HCBS programs. However, CMS notes that they will be incorporating the measure set into the reporting requirements for specific authorities and programs in the future.
- The Centers for Medicare & Medicaid Services (CMS) awarded a total of $49 million to 36 grantees in 20 states to connect more children, parents, and families to health care coverage. These awards support President Biden’s Executive Order on Strengthening Medicaid and the Affordable Care Act and reflect Secretary Becerra’s priority to expand access to affordable, quality healthcare. The program will offer enrollment and renewal assistance to expectant parents, as well as children and their families. Grantees will receive up to $1.5 million over the course over three years to advance Medicaid and Children’s Health Insurance Program (CHIP) enrollment.
Research
- The Urban Institute, in partnership with the American Benefits Council and Deloitte, released a research report focused on disparate health outcomes as a result of inconsistent and incomplete race and ethnicity (R/E) data. Health plans could use data to improve health equity by modifying payment arrangements with providers to include health equity incentives and analyzing algorithms and other similar technologies for implicit biases. Health plans can address the barriers to R/E data collection by enhancing community engagement, reducing legal uncertainty, updating, and standardizing self-reported R/E data collection practices, and prioritizing organizational resources. The full text of the report can be found here.
Event Coverage
- The Hill hosted a comprehensive discussion on advancing access, the pursuit of health equity, and resetting the care paradigm across the United States. The summit also covered technology and care development, and the United States’ preparedness for the next health emergency. Speakers from the event included Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), Chiquita Brooks-LaSure, Administrator of the Centers for Medicare and Medicaid Services (CMS), and Dr. Ashish Jha, White House Coronavirus Response Coordinator. Click here to watch the discussions and here to view Healthsperien’s detailed analysis of the event.