Proposed Rules and Rates for FY 2024 Released by CMS
DCMedical News is published every day both the House and the Senate are scheduled to be in session.
The Centers for Medicare and Medicaid services has released six key rules, proposed rules or notices, reports below and also in tomorrow’s edition.
The proposed inpatient prospective payment rule (here) will be published in the May 5 Federal Register, and weighs in with 1,525 pages of proposals concerning revision to acute care hospital operating and capital-related costs, changes to “Medicare graduate medical education (GME) for teaching hospitals; update [to] the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs); and other policy-related changes.” The “other policy-related changes” include “Quality Programs and Medicare Promoting Interoperability Program Requirements for Eligible Hospitals and Critical Access Hospitals; Rural Emergency Hospital and Physician-Owned Hospital Requirements; and Provider and Supplier Disclosure of Ownership.” Comments on the proposed rule are due June 9.
On March 31 CMS released the 2024 Medicare Advantage and Part D rate notice (CMS “Fact Sheet” here) that projects plans will receive a 3.32% overall increase next year, compared to the 1.03% increase CMS had proposed in its advance notice. “The agency will also phase in several factors that contribute to its overall rates for the program, including a hotly contested risk adjustment model, after some stakeholders asked for more time to consider the model,” said InsideCMS. The agency was widely regarded to have backed off from more direct controversy with the MA plans, notwithstanding the findings of multiple OIG reports of gaming, cheating and corruption in the “risk adjustment” MA calculations (Medicare delays crackdown, The New York Times, here; Biden administration goes easy, STAT+ here).
A Brookings-USC study (here) shows how MA plans are overpaying their own subsidiaries to fulfill the 85% medical loss ratio requirement, and to increase overall firm profit from the plans and provider corporations under the same control. “Vertical integration may weaken regulations aimed at reducing the potential for overpayment of MA plans. One important such regulation is the rule governing MA plans’ Medical Loss Ratio (MLR), the ratio of plan spending on health care claims to its premium revenues. The Affordable Care Act required MA plans to maintain an MLR of at least 85% in an effort to improve alignment of costs and payments. If a plan repeatedly uses less than 85% of premium revenues for health expenses (as opposed to administrative costs or profits), then it could be subject to sanctions. However, plan spending directed to related businesses (such as physician groups and PBMs owned by the parent company) is treated as a cost and counted as claims spending when calculating the MLR, even if some of that spending represents profits for the parent company.”
CMS’ proposed inpatient psychiatric facilities (IPF) pay rule released April 4 would increase Medicare payments by 1.9% in 2024, makes changes in quality requirements, and continue the ever-broadening list of reporting, posting and quality related requirements in these as well as in the inpatient rehabilitation facilities (IRF, proposed rule here in the Federal Register of April 7), now including food insecurity.
InsideCMS reports that “One measure to be implemented in 2026 would have IPFs attest to their efforts to address health equity through data collection and leadership engagement. Another measure would assess the percentage of patients who are screened for five specific markers: food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety. The Screening for Social Drivers of Health measure would begin with voluntary reporting in 2024 and require reporting in 2027. The third measure has the same timeline and would show how many patients screened positive for each of the five social determinants of health markers.”
DOCTORS, NURSES, AND OTHER HEALTH PROFESSIONALS
The Deaths of Children: Bullets, Drugs, Cars
A Viewpoint article in JAMA (here) reports that “Although life expectancy in industrialized countries has lengthened over the past century, increases in US life expectancy ceased after 2010, a trend attributed to rising mortality rates among individuals aged 25 to 64 years. Although midlife mortality rates increased over the past decade, mortality rates among children and older adults continued to decrease. The COVID-19 pandemic altered this trend and resulted in a sharp increase in mortality among older adults, an unsurprising outcome. However, pediatric mortality rates also increased, and COVID-19 contributed little to this surge. This increase in all-cause pediatric mortality has ominous implications. A nation that begins losing its most cherished population—its children—faces a crisis like no other.”
“Firearms play a central role in this crisis. They are the leading cause of death among youths aged 1 to 19 years and accounted for nearly half (47.8%) of the increase in all-cause mortality in 2020 . . . Bullets, drugs, and automobiles are now causing a youth death toll sufficient to elevate all-cause mortality rates.”
The New York Times reports (here) that it is not deaths of despair, but deaths of children, driving mortality rates up. “One in 25 American 5-year-olds now won’t live to see 40, a death rate about four times as high as in other wealthy nations.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Hospice Care Worse in For-Profit Hospices
A report in JAMA Internal Medicine (here) on “Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey data from 653 208 caregiver respondents, reflecting care received from 3107 hospices between April 2017 and March 2019,” found that “caregivers of patients receiving hospice care reported substantially worse care experiences in for-profit than in not-for-profit hospices; however, there was variation in reported experiences among both types of hospices.”
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
Medicaid “Unwinding” Proceeds Apace
The New York Times reports (here) that “The federal government has estimated that about 15 million people will lose coverage in the coming months, including nearly seven million people who are expected to be dropped from the rolls even though they are still eligible. Nearly half of those who lose coverage will be Black or Hispanic.”
“Medicaid and the Children’s Health Insurance Program have ballooned to cover roughly 90 million people, or more than one in four Americans — up from about 70 million people at the start of the pandemic. The guaranteed coverage amounted to an extraordinary reprieve for patients, preserving insurance for millions of vulnerable Americans and sparing them the hassles of regular eligibility checks.”
Five states (AZ, AR, Idaho, NH And SD) began dropping Medicaid enrollees April 1, the first day in three years states can drop enrollees who have income too high or who did not respond to forms for renewal of eligibility.
The Wall Street Journal reports on the eligibility changes and the impact on hospitals and insurers, here.
Prior Authorization May Lesson for “Gold Card” Doctors, Hospitals
UnitedHealthCare announced that it would “eliminate, starting next year, many prior-authorization requirements for so-called gold-card doctors and hospitals whose requests it nearly always approves. And it aims to automate and speed up prior authorization, though that will likely take a few years.” This Wall Street Journal report (here) characterized prior authorization as “dreaded medical paperwork,” rather than its recognized role as a “supply side” barrier and impediment to health services.
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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