THIS WEEK’S DOSE

• Senate Finance Health Subcommittee Holds Roundtable on Substance Use Disorder Care. Panelists and members discussed how to improve treatment in federal health programs.
• House Energy & Commerce Health Subcommittee Holds Legislative Hearing on Telehealth. The hearing focused on 15 bills that would extend expiring Medicare telehealth flexibilities.
• Senate Finance Committee Holds Hearing on Bolstering Chronic Care Through Medicare Physician Payment. Senators discussed physician payment methods and how to improve chronic illness treatment.
• FDA Commissioner Testifies at House Oversight and Accountability Committee Hearing. Commissioner Dr. Robert Califf fielded questions about FDA’s authorities, policies, and priorities.
• CMS Releases IPPS Proposed Rule. The Centers for Medicare & Medicaid Services (CMS) Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) proposed rule would update Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs for FY 2025.

CONGRESS

Senate Finance Health Subcommittee Hosts Roundtable on Substance Use Disorder Care. The panel discussion focused on improving treatment of substance use disorder in federal health programs. Panelists shared their expertise and recommendations for improving the continuum of care, discussed the interdisciplinary teams used in providing such care, and outlined challenges and solutions for treating youth substance use disorder. Senators discussed the potential for different models of care that could be applied to addiction treatment. Regarding proposed methadone flexibilities, members spoke about the challenge of increasing access and preventing diversion.

House Energy & Commerce Health Subcommittee Holds Legislative Hearing on Telehealth. The legislative hearing focused on 15 bills designed to extend flexibilities that Congress first implemented to increase patient access to telehealth services during the COVID-19 public health emergency and has extended since then, and which are set to expire on December 31, 2024. There was bipartisan agreement that telehealth has improved access to care for Americans, especially for rural and underserved populations, and that pandemic flexibilities should be extended. Witnesses urged members to enable CMS to collect data on telehealth utilization and health outcomes. Both members and witnesses raised concerns about telehealth increasing healthcare costs and suggested evaluating potential long-term impacts, while also highlighting the importance of patient autonomy when deciding between virtual or in-person care. Members also focused on the need for Congress to pay for any extension of the policy. There was broad support for H.R. 4189, the CONNECT for Health Act of 2023, and H.R. 7623, the Telehealth Modernization Act of 2024. Summaries of each bill can be found in the subcommittee’s hearing memo.

Senate Finance Committee Holds Hearing on Bolstering Chronic Care Through Medicare Physician Payment. At the hearing, advocates and professionals discussed updating traditional Medicare for the next generation by focusing on managing and treating chronic illness, and revising payment methods for physicians and other clinicians providing healthcare services. Members and witnesses raised concerns about underinvestment in physician payments and prohibitive administrative burden acting as barriers for rural facilities’ participation in value-based care models. There was bipartisan agreement that physicians should be paid more under traditional Medicare to account for inflation and increased overhead costs. Members and witnesses also discussed lessons learned from Medicare Advantage care coordination of chronic disease management.

FDA Commissioner Testifies at House Oversight and Accountability Committee Hearing. US Food and Drug Administration (FDA) Commissioner Dr. Robert Califf testified at the hearing, fielding a long series of questions about FDA’s authorities, policies, and priorities. Members on both sides of the aisle expressed concern over drug shortages and highlighted the need for effective solutions to mitigate these shortages and increase access to affordable and essential treatments. Some Democratic members applauded the FDA’s role in protecting access to reproductive care, while some Republican members expressed concern over the use and regulation of COVID-19 vaccines, treatments, and misinformation. There was also bipartisan concern over the increasing number of foreign illicit vape products that are available for consumer access. In response, Dr. Califf highlighted the FDA is aware of the backlog that has previously existed in the premarket tobacco product applications review process but noted FDA’s significant improvements in the review process.

ADMINISTRATION

CMS Releases IPPS Proposed Rule. CMS proposed an increase of 2.6% in operating payment rates for general acute care hospitals paid under the IPPS that successfully participate in the Hospital Inpatient Quality Reporting Program and are meaningful electronic health record users.

CMS also proposed to test a mandatory episode-based payment model called the Transforming Episode Accountability Model (TEAM). This five-year model would begin 2026 and would require acute care hospitals in specific geographic regions to be accountable for the cost of care for Medicare beneficiaries during and after certain surgical procedures. Selected hospitals would also be required to refer patients to primary care services to support optimal long-term health outcomes. In the rule, CMS lays out a proposed methodology for randomly selecting specific geographic areas across the country that will be included, but the methodology needs to be finalized before geographic areas are selected.

To help mitigate future drug shortages, CMS also proposed to establish a separate payment to support small independent hospitals in establishing and maintaining a buffer stock of essential medicines.

CMS issued several requests for information (RFIs), including two RFIs aimed at improving maternal health.

The CMS factsheet on the proposed rule can be found here, and a factsheet on TEAM can be found here. We are currently reviewing the rule and will publish a more detailed summary on our website.

QUICK HITS

• MedPAC Hosts April 2024 Meeting. At its two-day April meeting, the Medicare Payment Advisory Commission (MedPAC) discussed telehealth policy, payments for certain conditions in inpatient rehabilitation facilities, the physician fee schedule, Medicare Advantage enrollee data, generic drug pricing under part D, and Medicare Part B payment rates and 340B ceiling prices.
• MACPAC Hosts April 2024 Meeting. At its two-day April meeting, the Medicaid and CHIP Payment and Access Commission (MACPAC) discussed Medicaid demographic data collection, Medicaid and CHIP financing, state Medicaid agency contracts, home- and community-based services (HCBS), hospital supplemental payment analyses and Medicaid unwinding.
• HRSA Announces Funding Opportunity for Health Centers to Support Transitions in Care for People Leaving Incarceration. The Health Resources and Services Administration (HRSA) announced the availability of $51 million for the first-ever funding opportunity for HRSA-funded health centers to implement innovative approaches to support transitions in care for people leaving incarceration. Applications are due in Grants.gov on June 10, 2024, and in HRSA Electronic Handbooks on July 2, 2024.
• GAO Releases Report on Health Centers. The US Government and Accountability Office (GAO) found that in 2022, almost 1,400 health centers provided primary and preventive health services to more than 30 million people, regardless of their ability to pay. Health centers’ total revenue rose from about $28.7 billion in 2018 to $42.9 billion in 2022 – an increase of more than $14 billion. The largest single source of revenue was Medicaid, accounting for more than one-third of total revenue each year. The second largest revenue source each year was grants, including those provided by HRSA.
• CMS Releases Resources to Promote Quality Improvement Efforts Within Medicaid-Funded HCBS. The three resources included the 2024 HCBS Quality Measure Set (QMS), an informational bulletin on HCBS QMS reporting requirements for Money Follows the Person grant recipients, and the 2024 Long-Term Services and Supports Quality Measures Technical Specifications and Resource Manual.

NEXT WEEK’S DIAGNOSIS

Congress is in session next week, with healthcare activity expected at the committee level, including House Energy & Commerce hearings on healthcare cybersecurity, improper healthcare payments, data privacy (spanning sectors beyond healthcare) and the president’s healthcare budget, featuring Health and Human Services Secretary Becerra. Because of scheduling changes, our team will publish next week’s Check-Up early, on Wednesday, April 17.