Weekly Roundup: November 10, 2022

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Healthsperien Releases Initial Assessment of the 2022 Mid-Term Elections
On Tuesday this week polls for congressional and state and local elections around the country closed, with the outcomes for congressional control still unclear as we await results in several tight Senate races and congressional districts.  Mid-term elections (referring to an off year from Presidential elections) historically have led to reduced seats in Congress for the President’s party, particularly in the U.S. House, often with a switch in party control; influencing that dynamic are multiple factors, including the direction of the economy and other factors. Healthsperien has released an initial assessment of the midterm results, which outlines the implications of the elections on health policy for the rest of the year, in the 118th Congress and the Biden health agenda. The analysis can be found here.
Healthsperien Summary: CMS Releases CY 2023 Medicare Physician Fee Schedule Final Rule
Last week, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2023 Medicare Physician Fee Schedule final rule that outlines the Agency’s payment policies and rates for Medicare Part B services. In addition to finalizing the CY 2023 conversion factor (CF) at $33.06, representing a nearly 4.5% decrease from the $34.61 CF for 2022, a number of significant policies addressed in the rule include:
  • Changes to the Medicare Shared Savings Program,
  • Coding updates, including a new code for behavioral health integration,
  • Telehealth services,
  • Updates to the Medicare Economic Index, and
  • A new provision for accessing audiology services without a physician’s order
Healthsperien has provided a detailed summary of the final rule, which can be accessed here.
Senate Finance Committee Releases Discussion Draft on Integration Between Mental and Physical Health Care
Today, the Senate Finance Committee released (full text, summary of provisions) a discussion draft aimed at improving care integration of mental and physical health care services and expanding access to crisis care and follow up services. The discussion draft includes policies to:
  • Increase payment rates to help providers integrate behavioral health and primary care.
  • Create a standardized payment in Medicare for mobile crisis response team services, including a screening and assessment of the Medicare beneficiary’s mental health or substance use disorder crisis, services to support de-escalation of the individual’s mental health or substance use disorder crisis, and referrals for health and social services.
  • Direct CMS to inform states of best practices and recommendations for building a crisis care continuum financed by Medicaid and CHIP and provide funding for technical assistance and planning grants for states.
  • Require CMS to provide best practices to health care providers on integrating behavioral health care into the primary care setting and encourage CMS to consider models that include behavioral health integration.
  • Establish CMS technical assistance for providers seeking to integrate behavioral health and primary care.
  • Require CMS to issue guidance outlining flexibilities and best practices for partnering between states, Medicaid managed care organizations, and community-based organizations to address health related social needs.
This discussion draft is the fourth legislative draft the Finance Committee has released thus far. The first, released in May, focused on telehealth policies. The second, released in June, focused on youth mental health. The third, released in September, focused on expanding the mental health care workforce. The Committee has indicated that other discussion drafts may be released.
CMS Office of Minority Health Releases Blog on Health Equity Data Collection
The Centers for Medicare and Medicaid Services (CMS) Office of Minority Health released a blog post titled “The Path Forward: Improving Data to Advance Health Equity Solutions,” which outlines, for the first time, a plan to address health equity data challenges across CMS programs and identify next steps for CMS to improve data collection. In the blog, CMS outlines a number of ongoing and future planned efforts to improve collection of health equity data. CMS also outlines several priorities for the future of health equity data collection, including:
  • Collecting new health equity elements across CMS programs to fill existing gaps,
  • Aligning health equity data to acceptable standards across all elements,
  • Gradually implementing health equity scores,
  • Leveraging and aligning with the USCDI as applicable and appropriate,
  • Equipping the industry with new tools and capabilities aligned to health equity goals, and
  • Providing access to disaggregated data insights that the public can use to drive action.
Congressional Action
  • Top Republicans in line to chair important healthcare committees have stated (subscription required) that they intend to focus on how the Centers for Medicare and Medicaid Services (CMS) implements the drug pricing provisions included in the Inflation Reduction Act, but are not expected to attempt repealing the law. Control of the House and Senate have yet to be called, but Republicans may win the House by a small margin.
  • The Medicare Payment Advisory Commission (MedPAC) held its November public meeting to discuss a number of issues related to Medicare payment policy, including differences in quality measure results across Medicare populations, how to support Medicare safety-net hospitals, and standardizing Medicare Advantage plans’ non-Medicare supplemental benefits. Click here to access Healthsperien’s comprehensive summary.
  • HHS released a proposed rule modifying standards for electronic retail pharmacy transactions and a subrogation standard under HIPAA, which currently outlines requirements for how state Medicaid agencies seek reimbursement for pharmacy claims from a corresponding health plan. The rule seeks to improve interoperability, improve patient care, and provide better data for drug utilization monitoring.
  • The Medicaid and CHIP Advisory Commission (MACPAC) released a comment letter on a CMS proposed rule aiming to streamline Medicaid and CHIP eligibility, enrollment, and renewal processes. In their letter, MACPAC expresses broad support for the rule while also considering administrative burdens on states due to the impending redetermination process after the end of the COVID-19 Public Health Emergency (PHE).
  • MACPAC released another letter outlining ways the agency could advance health equity and assess the effects of PHE waivers and flexibilities. Some of MACPAC’s recommendations included collecting race and ethnicity data as well as setting benchmarks for different populations, such as people of color and incarcerated individual, which would address existing data gaps and access issues among Medicaid beneficiaries.
  • The U.S. Supreme Court heard oral arguments in Health & Hospital Corporation of Marion County (HHC) v. Talevski. The lawsuit raises the issue of whether Medicaid beneficiaries can seek recourse on state compliance with federal Medicaid rules, specifically the Federal Nursing Home Reform Act (FNHRA), which establishes minimum standards for nursing facilities to participate in Medicaid. If the Court decides individuals do not have the right to sue, the decision would overturn five decades of judicial precedent.
  • The CMS Innovation Center released a one-year report on the implementation of its refreshed strategic vision and objectives—originally announced in fall 2021. The one-year report outlines actions taken by CMS and CMMI to work toward better care for beneficiaries, through greater accountability for high-quality, person-centered care, more coordinated care, advancing health equity, increased access to care, and promoting transparency.
  • Through its subsidiary Evernorth Health Services, Cigna launched the Evernorth Vitality Index, billed as a “next generation” measure of patient health. The new measure uses eight elements of a patient’s health—physical, spiritual, emotional, environmental, social, occupational, financial, and intellectual—to better gauge a patient’s overall mental and physical health. Cigna plans to use this data to identify and address challenges to patient health to improve long term health and well-being—including improved work and life engagement.
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