The Centers for Medicare and Medicaid Services (CMS) issued updates to the Master List of Items Potentially Subject to Face-To-Face Encounter and Written Order Prior to Delivery and/or Prior Authorization Requirements (Master List) and the Required Face-to-Face Encounter and Written Order Prior to Delivery List and the Required Prior Authorization List Background. The Master List is a library of Durable… (Slifer, May 10, 2024) #Coverage Decisions, #Medical Devices

Today the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS) Innovation Center, announced the Increasing Organ Transplant Access (IOTA) Model (press release/ fact sheet/full proposal).  The IOTA Model aims to increase access to life-saving kidney transplants for patients living with kidney disease and reduce Medicare expenditures by transplanting more patients and… (Lewis, May 8, 2024) <span style="font-size:90%;

The Senate Budget Committee convened a hearing to examine ways to alleviate administrative burdens in health care. Democrats used the hearing to criticize prior authorization and emphasize the need for standardization across different insurance companies. Chairman Sheldon Whitehouse (D-RI) also took the opportunity to highlight his discussion draft with Sen. Bill Cassidy (R-LA) that includes provisions for hybrid payments for… (Marceno, May 8, 2024) #Costs, #Delivery Reform, #Insurance Coverage, #Insurance Reform

As the deadline to reauthorize Farm Bill Programs by the end of the fiscal year approaches, policymakers in the committees of jurisdiction have begun to discuss legislative proposals. In addition to agricultural programs, the Farm Bill authorizes several important federal nutrition programs including the Supplemental Nutrition Assistance Program (SNAP). The 2018 Farm Bill expired on September 30, 2023 but the programs… (McClurg, May 8, 2024) #Nutrition

The House Ways & Means Committee is convening a markup Wednesday May 8th at 10:30am to discuss legislative proposals aimed at temporarily extending certain pandemic-era flexibilities, including those related to telehealth (through 2026) and the Acute Hospital Care at Home initiative (through 2029). The cost of making telehealth flexibilities permanent is the primary factor driving consideration of a more modest… (Testa, May 7, 2024) #Hospitals, #Pharmacy Benefit Managers, #Rural Health, #Skilled Nursing Facilities, #Telehealth

Today, the Medicare Trustees released their latest report on the status of the Hospital Insurance (HI) and Supplemental Medicare Insurance (SMI) trust funds (fact sheet; press release). The Trustees release this report annually to provide an update on the projected financial status of the Medicare program. The report includes its finding from the last several years that Medicare faces long-term… (Testa, May 6, 2024) #Budget, #Costs, #Drug Pricing, #Hospitals, #Long-Term Care, #Medicare Advantage, #Medicare Part D, #Physicians, #Post-Acute Care, #Program Integrity

The Congressional Research Service (CRS) released a Legal Sidebar analyzing the implications of the Department of Health and Human Services’ (HHS) finalization of a new rule under Section 1557 of the Patient Protection and Affordable Care Act (ACA) (Impact Health summary of the final rule). The final rule applies antidiscrimination requirements to any health program or activity that receives federal… (Colocho, May 6, 2024) #Health Equity, #Women’s Health

The Departments of Health and Human Services, Labor, and Treasury (the Departments) released Frequently Asked Questions (FAQs) Part 67 to extend the qualifying payment amount (QPA) enforcement discretion under the No Surprises Act until November 1, 2024. Background. In August 2023, the U.S. District Court of the Eastern District of Texas issued an opinion and order in the Texas Medical Association… (Slifer, May 3, 2024) #Hospitals, #Insurance Reform, #Physicians

The Centers for Medicare and Medicaid Services (CMS) released a final rule to revise the definition of “lawfully present” in order to expand eligibility for health insurance coverage through the Exchange and Basic Health Program to recipients of the Deferred Action for Childhood Arrivals (DACA) program (press release; fact sheet). What it is. Under current federal regulations, DACA recipients are… (Marceno, May 3, 2024) #Health Equity, #Health Insurance Exchanges, #Insurance Coverage, #Qualified Health Plans

The Senate Finance Committee and the House Energy and Commerce (E&C) Oversight and Investigations Subcommittee held hearings focused on the cyberattack that targeted Change Healthcare, a subsidiary of UnitedHealth Group (UHG), leading to widespread disruptions in the health care sector (Senate hearing available here, House hearing available here). UnitedHealth Group CEO Andrew Witty testified before both Committees, facing bipartisan scrutiny… (Colocho, May 2, 2024) #Health Information Technology, #Hospitals, #Physicians, #Privacy, #Transparency