DCMedical News: Tuesday, January 3, 2023
DCMedical News is published every day both the House and the Senate are scheduled to be in session. The 118th Congress will convene today, January 3, 2023.
THE BIG STORY Tuesday, January 3, 2023
118th Congress Convenes, Plans to Elect House Speaker, Assesses the Final Work of the 117th
The 118th Congress will convene today. The House plans to elect a new Speaker. Both houses will adopt rules for the coming two-year 118th session. The House will meet on January 4, 5, 9, 10, 11 and 12, the Senate not again until the 23rd, and both Houses at the same time not until the 24th, when DCMN will resume publication.
What Hath the 117th Left?
The $1.7 trillion mega-bill passed by the last Congress, among its last acts, contained a miscellany of important health field programs and policies. For hospitals, the legislation (4,155-page bill here, Labor-HHS appropriations list here, Republican leadership summary of the bill here, Democratic leadership summary of the bill here) will postpone a 4% across-the-board Medicare payment cut that was to take effect in 2023. The 2% payment sequester will remain in place. Also, the Medicare-Dependent Hospital and low-volume hospital programs will continue to be funded through 2025.
Physicians will have a reduction of 2%, not the 4.48% which had been otherwise proposed. Said Becker’s, “The legislation curbs a scheduled cut of nearly 4.5 percent to the Medicare physician fee schedule that was set to take effect in 2023, narrowing the cut to 2 percentage points in the year ahead with a scheduled cut of 3.25 percentage points in 2024.” The bill provides a 3.5% bonus for participating in an advanced APM in 2023, a reduction of 1.5% from 2022.
HFMA reports that “The bill extends the Medicaid Money Follows the Person program and protections from spousal impoverishment for people receiving home- and community-based services (HCBS) through September 30, 2027. These policies help make it possible for more people with disabilities to live at home instead of in nursing facilities as they age. The bill includes provisions that will phase out Medicaid continuous coverage requirements. In short, states can begin redetermining Medicaid eligibility and terminating coverage for people no longer eligible starting April 1, 2023, when the enhanced federal matching rate to states will begin decreasing and phase out completely on December 31,2023.”
In addition, “The proposal includes a two-year extension of public health emergency (PHE) waivers for telehealth and for hospital-at-home programs.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
U.S. Hospitals: Sick, In Recovery or Financially Healthy?
The Wall Street Journal reports (here) that U.S. hospitals and health systems, primarily larger hospitals and for-profit chains, were doing better than might be thought based on hospital industry lobbying and the continuing operating losses shown on KaufmanHall “flash” reports.
While COVID kept patients away from hospitals for much of 2020, “Hospitals also were major financial beneficiaries of the pandemic, receiving more than $170 billion in subsidies to defray their operating losses. A study looking at the finances of more than 2,000 hospitals concluded that financial losses from Covid-19 were largely offset by government relief in 2020, keeping profit margins largely intact. What is more, says Dr. Ge Bai, a professor who conducted the study with two other academics, profit rose significantly in 2021 as government aid persisted even as non-Covid activity rebounded. ‘Contrary to the public perception, the industry benefited from the pandemic,’ says Dr. Bai, a professor of health policy at the Johns Hopkins Bloomberg School of Public Health.”
The National Health Melting Down
The United Kingdom’s National Health Service is grappling with nurses striking (here), ambulance workers striking (here) and generally overwhelmed facilities (here).
The Financial Times reports that “nurses walk out for the second time within a week and their union leaders warned industrial action over pay could last six months . . . Rishi Sunak is contending with a wave of strikes as unions in the public sector and beyond respond to the cost of living crisis with demands for higher pay for their members. The industrial action by NHS workers poses the biggest challenge to the prime minister, with opinion polls suggesting the public is largely supportive of their strike action. Some Tory MPs believe that more money should be provided.”
The FT also reports that “Health chiefs have warned they cannot guarantee patient safety during ambulance workers’ strike action today, as prime minister Rishi Sunak refused to reopen this year’s NHS pay deal . . . The government is deploying 600 military personnel to drive ambulances during the strike organised by the Unison, Unite and GMB unions. The NHS Confederation and NHS Providers, which represent health organisations across the UK, warned in a letter to the prime minister of ‘deep worry among NHS leaders about the level of harm and risk that could occur to patients tomorrow and beyond’.”
MEDICARE, MEDICAID AND COMMERCIAL HEALTH INSURANCE
Medicaid Beneficiaries May Sue When Benefits are Reduced
A report in the American Health Lawyers Association weekly news says “Three Medicaid beneficiaries in Arkansas can move forward with their due process claims against various state health officials for allegedly providing insufficient notice and appeals of the reduction or termination of their home health benefits,” (Elder v. Gillespie, Opinion here).
“Under federal and state Medicaid regulations, ADHS [Arkansas Department of Human Services] must notify beneficiaries of a reduction or termination of benefits at least ten days before the date that the adverse action takes effect. If the beneficiary timely appeals, then ADHS may not reduce or terminate their benefits until after the outcome of a hearing . . . According to plaintiffs, ADHS also improperly reduced or terminated their benefits before the outcome of their hearing. ADHS restored the benefits only after plaintiffs’ sued or their attorneys contacted the agency.”
“Defendants argued that the alleged violations were not ongoing since the state had restored plaintiffs’ benefits, but the appeals court noted that the alleged harm remained likely to recur because . . . benefits are reassessed annually, and the state had no plans to change how it operated the program.”
Proposed Rules May Rein In Medicare Advantage (MA) Abuses
New proposed rules from CMS (here, “fact sheet” here, press release here) will constrain false claims in MA advertising, and may also curb the misuse of “prior authorization” limitation on care.
Coverage of the proposal in The New York Times (here) notes “The rules would also address the health plans’ use of techniques that require the company to approve certain care before it would be covered. Patients and their doctors complained to Medicare that the private plans were misusing prior authorization processes to deny needed care. The inspector general’s report estimated that tens of thousands of individuals had been denied necessary medical care that should be covered under the program.”
“The new proposal would require plans to disclose the medical basis for denials and rely more heavily on specialists familiar with a patient’s care to be involved in the decision-making. Medicare has also established tighter time limits for answers on authorizations; patients now often wait up to 14 days. The new rules would also require authorization to cover the full length of a treatment so patients don’t have to continually request identical approvals.”
PUBLICATION SCHEDULE FOR DCMEDICAL NEWS
January 24, 25, 26, 27, 30, 31
February 1, 2, 6, 7, 8, 9, 27, 28
March 1, 7, 8, 9, 10, 22, 23, 24, 27, 28, 29, 30
Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org