- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2026 Rates; Requirements for Quality Programs; and Other Policy Changes; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly; Correction
- CMS: Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026
- CMS: Medicare Program; FY 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
- Public Inspection: CMS: Medicare Program: Fiscal Year 2026 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements
- Public Inspection: CMS: Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program for Federal Fiscal Year 2026
- CMS: Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments; and Appeal Rights for Certain Changes in Patient Status; Corrections and Correcting Amendment
- CMS: Request for Information; Health Technology Ecosystem
- CMS: Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments; and Appeal Rights for Certain Changes in Patient Status; Corrections and Correcting Amendment
- VA: Staff Sergeant Fox Suicide Prevention Grant Program Funding Opportunity
- State: 60-Day Notice of Proposed Information Collection: J-1 Visa Waiver Recommendation Application
- HHS: Request for Information (RFI): Ensuring Lawful Regulation and Unleashing Innovation To Make American Healthy Again
- Public Inspection: CMS: Request for Information: Health Technology Ecosystem
Price of Prescription Drugs Rises
The Congressional Budget Office (CBO) reported on January 25, 2022, that the average net price of brand-name prescription drugs in Medicaid increased 48.3% between 2009 and 2018. Overall average net prescription prices in Medicaid, including brand and generic drugs, declined from $63 to $48.
Racial and Ethnic Disparities in COVID-19 Treatment
A new CDC report documents lower use of monoclonal antibody treatment among certain racial and ethnic minority patients with positive COVID-19 results, relative to white and non-Hispanic patients. Racial and ethnic differences were smaller for inpatient administration of remdesivir and dexamethasone.
HRSA Launches Health Center COVID-19 N95 Mask Program
The Health Resources and Services Administration (HRSA) Bureau of Primary Health Care (BPHC) launched a new initiative on January 17, 2022, with an initial group of 100-200 health centers nationwide invited to participate, with the expectation that it will grow incrementally. Program Information is available on HRSA Health Center COVID-19 N95 Mask Program | Bureau of Primary Health Care. Like the home COVID-19 testing kit initiative, FQHCs will be able to distribute N95 masks provided through the program to community partners, patients and the communities they serve.
HealthChoices 2022 Transition
During this week’s Medical Assistance Advisory Committee meetings, the PA Department of Human Services announced its goal of fully transitioning to the new HealthChoices contracts and managed care organization (MCO) assignments on July 1, 2022. The DHS Office of Medical Assistance Programs (OMAP) is developing a Communications Workgroup to assist in development of communications to consumers and providers about the transition. The workgroup will be compiled of representatives of MCOs, Maximus, consumers and providers. DHS said that those MCOs transitioning have committed to ensuring a smooth transition. OMAP is also developing a timeline graphic with key milestones, which will be coming out soon. Materials to support the transition will be on the Maximus website in mid-April. Mailings to consumers will be released late April, with a deadline of mid- to late-May to make their MCO selection. DHS anticipates 450,000 consumers will have a new MCO selection or assignment.
COVID-19 Updates and Advisories
The Pennsylvania Department of Health issued the following updates and advisories in correlation to the continuing COVID-19 pandemic:
622 – 1/25/22 – UPDATE: Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19
- 621 – 1/25/22 – UPDATE: Work Restrictions for Healthcare Personnel with Exposure to COVID-19
- 620 – 1/15/22 – ADV – Advisory: Therapeutics to Prevent and Treat COVID-19
Click here to access all the 2022 health alerts, advisories and updates.
Pharmacy Benefit Manager Fees Regulated
On December 14, 2021, the Centers for Medicare and Medicaid Services (CMS) unexpectedly issued a letter to U.S. Senator Ron Widen (D-OR) indicating that CMS plans to use its “administrative authority to issue proposed rulemaking” addressing price concessions and direct and indirect remuneration (DIR) fees that pharmacy benefit managers (PBMs) have increasingly charged to specialty and retail pharmacy providers in Medicare and other pharmacy benefit programs in recent years. The proposed regulation was issued on January 12.
Water Assistance Program Applications Available
The Low-Income Household Water Assistance Program (LIHWAP) is a temporary emergency program to help low-income families pay overdue water bills. LIHWAP is a grant. Recipients do not have to repay it. LIHWAP crisis grants may be available if an individual and/or household has an emergency and are in jeopardy of losing their water service. Eligible recipients can receive one crisis grant for their drinking water service and one crisis grant for their wastewater service, up to $2,500 each. Click here for more information about the program or how to apply.
Preventive Care Guidelines Mean Improved Coverage
The U.S. Department of Human Services, through the Health Resources and Services Administration (HRSA), has updated comprehensive preventive care and screening guidelines for women and for infants, children and adolescents. Under the Affordable Care Act, certain group health plans and insurance issuers must provide coverage with no out-of-pocket cost for preventive health services within these HRSA-supported comprehensive guidelines. Among a number of updates, for the first time the guidelines will require such group health plans and insurance plans to provide coverage without a co-pay or deductible for double electric breast pumps. Read more.
Health Center Volunteer Health Professional Program
The Senate HELP Committee released a discussion draft of the Prepare for and Respond to Existing Viruses, Emerging New Threats, and Pandemics Act (PREVENT Pandemics Act). This legislation focuses on strengthening the nation’s public health and medical preparedness and response systems in the wake of the COVID-19 pandemic. In particular, the bill includes language that removes the current statutory expiration date for the Health Center Volunteer Health Professionals Program. Currently, more than 100 health centers utilize more than 500 volunteer providers through the program. NACHC has pushed for an extension given the ongoing workforce shortages that many health centers are facing. A section-by-section summary and full text are available. The Senate HELP Committee is accepting comments on the draft through February 4, 2022, and could move to mark up the legislation after reviewing stakeholder feedback.
Build Back Better Act and Appropriations Continue
President Biden expressed support last week for breaking up the Build Back Better Act into smaller pieces of legislation. However, this strategy is problematic since the bill was designed to be passed using reconciliation, which can only be used a limited number of times per year and avoids a filibuster in the Senate by requiring only 51 votes. Republicans have resisted negotiating an omnibus FY22 with the BBB Act unresolved, and House and Senate appropriators have struggled to overcome issues in determining top-level funding numbers and including policy riders, like the Hyde Amendment. Another continuing resolution (CR) after the current one ends on February 18, 2022, is possible as House and Senate appropriators work to strike a deal. Congress is also considering including additional supplemental COVID-19 relief funding as well as telehealth flexibility extensions in an omnibus appropriations bill.