Health Policy Report (10/31)

Capitol Hill Update

Both chambers of Congress will return to Washington after the November 8 midterm elections. The next votes in the House and Senate are scheduled to occur during the week of November 14.

HHS Outlines Organizational Changes To CMMI

On Tuesday, the Department of Health and Human Services (HHS) published a notice in the Federal Register to reflect proposed changes being made within the Center for Medicare and Medicaid Innovation (CMMI) (TRP analysis) Section 1115A of the Social Security Act (SSA) established the CMMI within the Centers for Medicare and Medicaid Services (CMS) to test payment techniques and service delivery models. In 2021, CMMI introduced its Strategic Vision, which outlines a 10-year strategy for providing VBC to improve the health care system for all patients. This proposed reorganization aims to streamline and centralize several of the organizational responsibilities within the CMMI to provide value-based care (VBC) more effectively and efficiently as a part of its Strategic Vision. HHS suggests that these changes will unify operations, enhance continuity, and dedicate more resources and time toward certain activities across the Center.

Senate Finance Releases Discussion Draft on Integration, Coordinated Care Related to Mental Health

On Friday, staff on the Senate Finance Committee released a discussion draft (TRP analysis) of the mental health integration of care provisions to be included as a part of the Committee’s broader legislative effort to improve mental health care for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) beneficiaries. Policy proposals within the discussion draft pertain to:

• Increasing payments to certain providers for the integration of behavioral health;
• Providing payments for mobile crisis response intervention services in Medicare;
• Providing clarity on the eligibility for participation of peer support specialists in furnishing behavioral health integration services in Medicare;
• Providing payment for crisis stabilization services under the Medicare program;
• Integrating behavioral health care for treatment of mental health and substance use disorder (SUD) services in primary care through the Centers for Medicare and Medicaid Innovation (CMMI);
• Making the Medicaid state option to provide qualifying community-based mobile crisis intervention services permanent; and
• Requiring the Department of Health and Human Services (HHS) to improve integration of behavioral health services under Medicare, Medicaid, and CHIP.

At this time, it is unclear whether the Committee intends to hold a markup on these provisions and introduce them as a single package prior to the end of this Congressional session. Alternatively, some of these provisions could be included in a larger end-of-year package.

Lawmakers Bolster Stakeholders’ Press To Extend 5 Percent APM Bonus

Reps. Darin LaHood (R-IL), Peter Welch (D-VT), Suzan DelBene (D-WA), Michael Burgess (R-TX), Brad Wenstrup (R-OH), and Earl Blumenauer (D-OR) are working to gain support to extend the five percent pay bump for alternative payment model participants (APM) for another six years. The Medicare Access and CHIP Reauthorization Act’s (MACRA) provided a five percent payment boost for providers in ACOs, which is set to expire after the 2022 performance period (associated with the 2024 payment year), at which point providers will only receive a 0.75 percent payment increase. Last month, more than 800 provider groups and accountable care organizations (ACO) urged lawmakers to continue the enhanced payment.

Additionally, Reps. Ami Bera (D-CA) and Larry Bucshon (R-IN) — along with a bipartisan group of House lawmakers — requested stakeholder feedback on how to improve MACRA without dramatically increasing Medicare spending. Specifically, stakeholders were asked for creative legislative or regulatory solutions to the program’s pay instability, and feedback is due at the end of the day today. Notably, the Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure expressed the agency’s support for extending those payments last month. However, she also noted that Congress faces competing health care priorities.

ASPR Awards $21 Million to Hospitals for Emergency Preparedness

Last week, the Department of Health and Human Services (HHS) Administration for Strategic Preparedness and Response (ASPR) announced that it will award a total of $21 million in grants to 13 health care facilities in an effort to improve preparedness and response to emerging special pathogens. The grants are designed to strengthen regional health care systems by integrating their existing emergency response strategies at the regional, state, local, and jurisdiction levels. Assistant Secretary for ASPR, Dawn O’Connell, noted how recent health emergencies such as Ebola, COVID-19, and Monkeypox underscore the need for strengthening health care systems’ infectious disease response capabilities. A portion of the funding will go towards designating three new hospitals as Regional Emerging Special Pathogen Treatment Centers (RESPCTs): Washington Hospital Center in Washington, D.C.; the University of North Carolina at Chapel Hill in Chapel Hill, North Carolina; and Spectrum Health System in Grand Rapids, Michigan. Ten existing RESPCT facilities will also receive awards as a part of the effort to enhance and improve public health preparedness.

States Brace for Increase in Medicaid Costs as PHE Unwinding Nears

On October 26, the Centers for Medicare and Medicaid Services (CMS) held another webinar in its series pertaining to Medicaid unwinding. Once the COVID-19 public health emergency (PHE) is terminated, states will redetermine eligibility for Medicaid and Children’s Health Insurance Plan (CHIP) beneficiaries. Factoring in the Department of Health and Human Services (HHS) commitment to alerting states 60 days ahead of terminating the PHE, states will know if the PHE is being extended again by mid-November. A portion of this anticipation is due to the impending costs that states will face as they resume normal coverage operations.

A new report from the Kaiser Family Foundation estimates that if the PHE ends in fiscal year (FY) 2023, enrollment will decline by 0.4 percent, while spending growth would slow from the FY 2022 rate of 12.5 percent to 4.2 percent. However, states are concerned that rising inflation, supply chain issues, and the termination of the enhanced Federal Medical Assistance Percentage (FMAP). Many states intend to alter their eligibility policies by extending postpartum coverage or providing improved continuous enrollment for children.