Appropriators negotiate subcommittee allocations while clock ticks to March deadlines
The status of federal discretionary funding for FY24, which began on October 1, remains in limbo as key negotiations seem to grind to a near halt. Facing a possible government shutdown, Congress passed a continuing resolution to fund the government through the beginning of March, with different bills split between March 1 and March 8 expiration dates. At this point, both Chambers need to agree on how to allocate funding across the 12 appropriations bills, but top appropriators have yet to finalize these totals. Without these totals, the Appropriations Subcommittees cannot write their bills as they do not know how much budget authority they must work with. Adding to these challenges is the fraught conversations around an appropriation supplemental for foreign aid and border security, which may affect overall FY24 allocations. The FY25 appropriations cycle will kick off with the release of the President’s Budget Request following the State of the Union, and may force Congress to debate both years concurrently.
Senate Finance Committee releases a bipartisan plan on generic drug shortages
Senate Finance Committee Chair Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) released a white paper on legislation to prevent and mitigate shortages of critical generic drugs used by patients and providers in the United States. Ideas outlined in the white paper include Medicare Part A and B payment reforms, new incentives for drug supply chain stakeholders to prevent shortages, new pilots in Medicare Part D to bolster incentives for pharmacies, and reforms to the rebate program in Medicaid Drug Rebate Program. This white paper will inform the drafting of legislation.
New York City will erase medical debt for 500,000 residents
New York City announced that the city would invest $18 million in a partnership with RIP Medical Debt to forgive approximately $2 billion in unpaid medical bills held by as many as 500,000 residents. In deciding which debts to buy, the group looks for patients whose unpaid medical bills are at least 5 percent of their annual household income or patients in households with an income under four times the federal poverty line — which is $31,200 for a family of four. New Yorkers do not need to apply to be included in the program. RIP Medical Debt said that those chosen to have their debts erased would receive a letter in the mail. This debt relief will cost the city approximately 0.018 percent of its annual operating budget.
Senate Aging Committee asking assisted living facility companies for more information on cost
The Senate Aging Committee is investigating concerns about workforce shortages and expensive and inadequate care in assisted living facilities by sending letters to Atria Senior Living, Brookdale Senior Living, and Sunrise Senior Living. These letters are part of an effort including holding a hearing on long term care options for older adults.
New CMS guidance helps states address Medicaid enrollees’ needs
The Centers for Medicare and Medicaid Services released guidance on an innovative opportunity for states to address health-related social needs for people with Medicaid coverage through the use of “in lieu of services and settings” in Medicaid managed care. This option will help states offer alternative benefits that take aim at a range of unmet health-related social needs, such as housing instability and food insecurity, to help enrollees maintain their coverage and to improve their health outcomes.
One bad phone call may cost Elevance Health $190 million in Medicare Advantage bonuses
Elevance says Centers for Medicare and Medicaid Services (CMS) penalized the insurer for a single call on March 23, 2023, placed through the federal 711 text telephone system, that the company’s call center never actually received. Elevance’s rating dropped sharply in October and will be visible to consumers for the 2024 plan year. The company is arguing that regulators are using flawed methods to determine these ratings, which then determine the flow of billions of federal dollars to insurers operating private Medicare Advantage plans. Specifically, too much weight is given to a single “secret shopper” call intended to test insurers’ customer service. While the lawsuit revolves around $190 million in bonus payments, the company has said the ultimate impact of the lower rating will mean a $500 million reduction in revenue for 2025.
GAO reported on the progress of the Grant Reporting Efficiency and Agreements Transparency Act
The Government Accountability Office (GAO) released a report on the status of implementation of the Grant Reporting Efficiency and Agreements Transparency Act (GREAT Act) by the Office of Management and Budget (OMB) and the Department of Health and Human Services (HHS). They found that OMB and HHS have made partial progress in meeting deadlines for establishing government-wide data standards and identifying 540 grant data elements. In 2022, federal aid to tribal, state, local, and territorial governments—primarily through grants—totaled roughly $1.2 trillion. Tracking federal grants spending can be difficult because data are sometimes not consistent government-wide. The GREAT Act seeks to strengthen management and oversight of federal grants through the establishment of governmentwide data standards.
HHS released healthcare cybersecurity performance goals
HHS has released sector-specific cybersecurity performance goals (CPGs) to help the sector prioritize key security actions and reduce risk. The voluntary CPGs consist of “essential” and “enhanced” goals, establishing minimum security practices as well as advanced strategies to guide organizations of all security maturity levels. The essential goals help healthcare organizations address common vulnerabilities and establish baseline security protocols to minimize risk. For organizations that have already met the essential goals, the enhanced goals provide an opportunity to level-up security maturity. Each goal is mapped to a specific desired outcome that aligns with HICP practices and NIST standards.
Most rural hospitals no longer offer maternity care
A new report by the Center for Healthcare Quality and Payment Reform has dire news for maternal health, as it finds that 55 percent of rural hospitals no longer offer maternal care. In ten states, more than two-thirds of rural hospitals have stopped delivering babies. If the closest hospital does not offer labor and delivery services, pregnant women may have to travel up to 40 minutes or more to find one that does.
CMS announced a new Innovation in Behavioral Health Model
On January 18, 2024, the Centers for Medicare & Medicaid Services (CMS) announced the Innovation in Behavioral Health (IBH) Model. IBH is focused on improving quality of care and behavioral and physical health outcomes for Medicaid and Medicare populations with moderate to severe mental health conditions and substance use disorder (SUD). Medicare and Medicaid populations experience disproportionately high rates of mental health conditions and/or substance use disorders (SUD), and as a result are more likely to experience poor health outcomes and experiences, like frequent visits to the emergency department and hospitalizations, or premature death. The IBH Model seeks to bridge the gap between behavioral and physical health; practice participants under the IBH Model will screen and assess patients for select health conditions, as well as mental health conditions and/or SUD, in community-based behavioral health practices. IBH is a state-based model, led by state Medicaid Agencies, with a goal of aligning payment between Medicaid and Medicare for integrated services.
What I am reading
Policymakers are searching for solutions to the mental health crisis that has been roiling our youth for decades, and new research published by Dr. Golberstain et al in the Journal of Human Resources provides some answers. This Robert Wood Johnson Foundation supported work studied a program that brought independent mental health therapists into middle and high schools in Hennepin County, Minnesota. The research found that schools with these programs had a reduction of 15 percent in suicide attempts by students.
The rise in new weight-loss drugs like Ozempic and Wegovy has opened up new questions about how our society will approach weight. Washington Post opinion writer Kate Cohen asked if as injectable weight loss drugs become more affordable, will this lead to medical weight loss feeling obligatory for middle- and upper-class Americans in the same way that orthodontics may be given to children to make teeth that look “right”.
It seems like there are new AI tools being developed every day. I was interested in reading about a tool developed by Children's National Hospital and researchers in Uganda to diagnose rheumatic heart disease, which is a largely preventable disease caused by repeated bouts of rheumatic fever. The tool, combined with a lightweight echocardiogram machine costing between $2,000-5,000, can interpret images in seconds and classify them as either “normal” or as “consider rheumatic heart disease” with 90 percent accuracy. If both the US and Ugandan regulators approve of the device, nurses in rural Uganda could be provided with a robe about the size of a computer mouse — to generate images of the heart — and a tablet outfitted with the AI component. Cases flagged as possible rheumatic heart disease would be followed up with an examination by a cardiologist. Rheumatic heart disease kills about 400,000 people annually worldwide, making this intervention a game changer for millions.
As we all fight back against the waves of medical misinformation plaguing patients and providers, I was interested in reading an article in AAMC News asking if spreading medical misinformation is a physician’s free speech right. When speaking to the broader public, including on social media, doctors have more legal protections than when they are giving medical advice to a specific patient, experts say. However, providers can be held accountable for injury that speech causes a patient. This accountability is due in large part to the fact that physicians — like lawyers and many other professionals — must obtain a state license to practice their chosen profession.