Health Care Checkup
July 2, 2021
THE BIG PICTURE
Both the House and Senate are out next week, as negotiations continue over the final details of the bipartisan infrastructure deal that was announced last week. When Congress returns after the July 4 break, we expect to learn additional details about when and how that legislation will move forward. We also expect to learn more about a broader reconciliation bill that will likely invest trillions of dollars in human infrastructure. This week also saw the unveiling of a number of important regulations impacting the health care industry. In the next few weeks, we are likely to see several additional proposed Medicare regulations.

The Department of Health and Human Services issued an interim final rule (IFR), “Requirements Related to Surprise Billing; Part I,” aimed at protecting consumers from surprise medical billing and balance billing. Specifically, the IFR would ban surprise billing for emergency services, high out-of-network cost-sharing for emergency and non-emergency services, out-of-network charges for ancillary care at an in-network facility, and out-of-network charges without advance notice.
 
The Centers for Medicare and Medicaid Services (CMS), issued a proposed rule that would increase the calendar year (CY) 2022 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) base rate from $253.13 to $255.55. This change would result in an increased payment rate of 1.3% for hospital-based ESRD facilities and 1.2% for freestanding facilities.
 
CMS also issued a proposed rule that seeks to expand value-based payments for home health services. The Home Health Prospective Payment System (HH PPS) proposed rule would expand the CMS Innovation Center’s (CMMI) Home Health Value-Based Purchasing (HHVBP) Model from nine states to the entire country effective January 1, 2022.
 
House Republican Leader Kevin McCarthy announced the formation of the Healthy Future Task Force, which will be led by Ways and Means Health Subcommittee Leader Devin Nunes (R-CA) and Energy and Commerce Health Subcommittee Leader Brett Guthrie (R-KY). The Task Force is comprised of 17 House Republicans who will work to craft legislative health proposals. The agenda will focus on a myriad of health issues, including increasing care choices, investing in new cures and therapies, and lowering the cost of health services.
 
Nine hospital organizations sent a letter to Senate Majority Leader Chuck Schumer (D-NY) and Minority Leader Mitch McConnell (R-KY), expressing concern over the funding mechanisms proposed last week for the Bipartisan Infrastructure Framework. Specifically, the organizations expressed opposition to the “use of an extension of mandatory sequestration, as well as unspent COVID-19 provider relief funds, as financing sources for any infrastructure package.”
 
CMS named Daniel Tsai as Deputy Administrator and Director of the Center for Medicaid and CHIP Services. Tsai most recently served as the Medicaid Director for the state of Massachusetts and the Assistant Secretary for MassHealth. During his time at MassHealth, he led the program to shift to value-based care. At CMS, Tsai hopes to combat health disparities and promote health equity among children, pregnant people, parents, seniors, and individuals with disabilities. He is expected to start in the position on July 6, 2021.
What to Expect Next Week: Early July is a typical time for CMS to release proposed Medicare regulations. We will continue to monitor these updates. Next week, both Congressional chambers will be in recess for the July 4 holiday, so the Hill is expected to be quiet.
DEEP DIVE
HHS Announces Surprise Billing Interim Final Rule
 
The Department of Health and Human Services issued an interim final rule (IFR), “Requirements Related to Surprise Billing; Part I,” aimed at protecting consumers from surprise medical billing and balance billing. Specifically, the IFR would ban surprise billing for emergency services, high out-of-network cost-sharing for emergency and non-emergency services, out-of-network charges for ancillary care at an in-network facility, and out-of-network charges without advance notice. The IFR marks the first step toward implementing the No Surprises Act, which passed in December 2020 as part of appropriations legislation P.L. 116-260. Fact sheets can be found here and here.
 
CMS Proposes Updates to End-Stage Renal Disease Prospective Payment System
 
On Thursday, the Centers for Medicare and Medicaid Services (CMS), issued a proposed rule that would increase the calendar year (CY) 2022 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) base rate from $253.13 to $255.55. This change would result in an increased payment rate of 1.3% for hospital-based ESRD facilities and 1.2% for freestanding facilities. CMS also proposes to extend the data reporting timeline for facilities under the ESRD Quality Incentive Program (QIP) until September 1, 2021. Additionally, the agency hopes to promote health equity among Medicare beneficiaries who battle ESRD and will seek stakeholder comment on whether to begin incorporating demographic data into its quality metrics. A fact sheet on the proposed rule can be found here.
 
HHS Says 190,000 Oklahomans to be Eligible for Health Coverage Due to the State’s Medicaid Expansion
 
HHS announced that approximately 190,000 adults in Oklahoma are now eligible for health coverage, due to the state’s recent Medicaid expansion. On June 1, 2021, Oklahoma began accepting applications, and to date, over 120,000 residents have been approved to receive coverage. On July 1, full Medicaid coverage will begin for these individuals. CMS Administrator Chiquita Brooks-LaSure said, “Oklahoma is now a model for other states looking to expand health coverage to those who need it most.”
 
CMS Proposes Rule to Increase Access to Health Coverage for 2022

On Monday, CMS announced a proposed rule to build on the Affordable Care Act (ACA). The proposal would lengthen the annual open enrollment period for 2022 by an additional 30 days, create a new special enrollment period for eligible low-income consumers, and expand the duties of Federally-facilitated Exchange Navigators to offer additional help to consumers enrolling in plans. The proposal also seeks to streamline issuer billing by repealing requirements that could result in costly changes to issuer billing systems. CMS Administrator Chiquita Brooks-LaSure said, “These latest steps aim to better fund outreach efforts and eliminate barriers to coverage. We’re making high-quality, low-cost coverage more accessible than ever.” The fact sheet on the proposed rule can be found here.

CMS Issues Proposed Rule Aimed at Expanding Value-Based Payments for Home Health Care

On Monday, CMS issued a proposed rule that seeks to expand value-based payments for home health services. The Home Health Prospective Payment System (HH PPS) proposed rule would expand the CMS Innovation Center’s (CMMI) Home Health Value-Based Purchasing (HHVBP) Model from nine states to the entire country effective January 1, 2022. The HHVBP Model, which began on January 1, 2016, randomly selected nine states to determine whether payment incentives associated with better care would improve the quality and delivery of home health care services to Medicare beneficiaries. Results from the Model’s performance from 2016-2018 showed an average 4.6% improvement in home health agencies’ (HHAs) quality scores and an average annual savings of $141 million to Medicare. On January 8, 2021, CMS announced that the HHVBP Model met the statutory requirements for expansion. The HH PPS proposes to expand these successes nationwide. A fact sheet on the proposed rule can be found here.

Hospital Organizations Write Letter in Opposition to Infrastructure Pay-Fors
 
This week, nine hospital organizations sent a letter to Senate Majority Leader Chuck Schumer (D-NY) and Minority Leader Mitch McConnell (R-KY), expressing concern over the funding mechanisms proposed last week for the Bipartisan Infrastructure Framework. Specifically, the organizations expressed opposition to the “use of an extension of mandatory sequestration, as well as unspent COVID-19 provider relief funds, as financing sources for any infrastructure package.” Health care providers are still awaiting additional funds from the Provider Relief Fund and from the $8.5 billion that the American Rescue Plan recently allocated to rural health care providers. The hospital organizations underscored the need for health providers to receive those funds during their ongoing fight against COVID-19 and requested that “none of [the] COVID-19 health care relief funds be used for the purpose of funding an infrastructure package.”
 
House Republican Leader Kevin McCarthy Announces the Formation of the Healthy Future Task Force
 
On Tuesday, House Republican Leader Kevin McCarthy announced the formation of the Healthy Future Task Force, which will be led by Ways and Means Health Subcommittee Leader Devin Nunes (R-CA) and Energy and Commerce Health Subcommittee Leader Brett Guthrie (R-KY). The Task Force is comprised of 17 House Republicans, who will work to craft legislative health proposals. The agenda will focus on a myriad of health issues, including increasing care choices, investing in new cures and therapies, and lowering the cost of health services. Additional information on the Task Force can be found here.
 
HHS Announces Awardees of $250 Million to Improve Health Literacy
 
On Monday, HHS announced that the Office of Minority Health (OMH) awarded $250 million in grants among 73 local governments. The funds were given out as part of a two-year initiative to identify and implement best practices for enhancing health literacy to increase COVID-19 vaccination rates and promote better public health practices among underserved communities. The initiative is expected to begin on July 1, 2021, and it aims to “tackle health disparities surrounding COVID-19 vaccination, testing, and treatment.” Promotion of health literacy, which is “a person's ability to find, understand and use information and services to help them make health-related decisions for themselves and others,” is part of the broader Healthy People 2030 framework.
 
CMS Names Director of Center for Medicaid and CHIP Services
 
CMS named Daniel Tsai as Deputy Administrator and Director of the Center for Medicaid and CHIP Services. Tsai most recently served as the Medicaid Director for the state of Massachusetts and the Assistant Secretary for MassHealth. During his time at MassHealth, he led the program to shift to value-based care. At CMS, Tsai hopes to combat health disparities and promote health equity among children, pregnant people, parents, seniors, and individuals with disabilities. He is expected to start in the position on July 6, 2021.
SENATE HEARINGS AND EXECUTIVE SESSIONS
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HOUSE HEARINGS AND EXECUTIVE SESSIONS
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ADMINISTRATION ANNOUNCEMENTS
Centers for Medicare & Medicaid Services
 
Food and Drug Administration
 
Guidance Documents from the Centers for Disease Control and Prevention

National Institutes of Health
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