Proposed Rules and Rates for FY 2024 Released by CMS, Pt. 2
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The Centers for Medicare and Medicaid services has released six key rules, proposed rules or notices, reports below continued from Monday’s edition.
“Payment Notice”
On Monday CMS issued a final rule concerning the 2024 marketplace plans, with special emphasis on behavioral health (press release here, “fact sheet” here). The press release notes “The 2024 Notice of Benefit and Payment Parameters Final Rule (final 2024 Payment Notice) finalizes standards for issuers and Marketplaces, as well as requirements for agents, brokers, web-brokers, and Assisters that help consumers with enrollment through Marketplaces that use the federal platform.” A key provision is an “option to implement a new SEP [Special Enrollment Period] for people losing Medicaid or CHIP coverage, allowing consumers to select a plan for Marketplace coverage 60 days before, or 90 days after, losing Medicaid or CHIP coverage.”.
Skilled Nursing
On April 4 CMS “proposed a 3.7% increase to nursing homes’ Medicare pay rates for fiscal 2024, but did not release proposals for its highly anticipated minimum staffing levels, which President Joe Biden directed the agency to release within a year of his 2022 State of the Union speech,” according to a report from InsideCMS. “Legislators and nursing home stakeholders have been anxiously awaiting updates from CMS on the proposed minimum staffing requirement after the agency blew past its promised deadline to complete the standard, and some expected the staffing minimums would be included as part of the agency’s annual proposed pay rule for skilled nursing facilities.”
Skimpy Plans, Network Adequacy
Finally, the 2024 health insurance “exchange” rules propose to limit the number of skimpy (unqualified) plans insurers can offer, to minimize enrollee confusion and to mitigate against inadequate coverage, and also propose steps to increase “network adequacy” requirements (see also story below). “In comments on the draft rule, key insurance lobbies and GOP lawmakers had urged CMS to refrain from making policy changes that could cause consumer confusion and strip plan choices at a time when millions of people that are losing their Medicaid coverage could be enrolling in the marketplaces . . . But patient advocates, including the Leukemia & Lymphoma Society, strongly backed the CMS proposals.”
DOCTORS, NURSES, AND OTHER HEALTH PROFESSIONALS
Residents Avoiding States with Abortion Limitations
A study from the AAMC (here) shows that U.S. medical school graduates seeking residency positions are avoiding those States which have enacted post-Dobbs limitations on abortion. “While the number of unique medical school graduates, referred to as “U.S. MD seniors,” who applied to programs in all states declined in 2022-2023 from the previous application cycle, states with complete bans saw greater decreases in the number of U.S. MD senior applicants across specialties than states with gestational limits or no restrictions.”
Also, “While states with more severe restrictions are often less populous than other states, U.S. MD applicants may be selectively reducing their likelihood of applying to states with more state-imposed restrictions on health care regardless of the number of available residency programs.”
Telehealth Encounters the Site-of-Service Differential (Hospital Facility Fees); Moves to Certification
Kaiser Health News (here) profiles patients whose telehealth encounters included the unwelcome addition of hospital facility fees (“States Step in as Telehealth and Clinic Patients Get Blindsided by Hospital Fees”).
“Millions of Americans are similarly blindsided by hospital bills for doctor appointments that didn’t require setting foot inside a hospital. Hospitals argue that facility fees are needed to pay for staff and overhead expenses, particularly when hospitals don’t employ their own physicians. But consumer advocates say there’s no reason hospitals should charge more than independent clinics for the same services.” Eight states have limited such facility fees.
The American College of Physicians proposes (here, from the Annals of Internal Medicine) qualifications for physicians to practice telehealth. “Quality standards are fledgling in the telemedicine environment. The same general principles for quality measurement that are applied to in-person care should apply to telemedicine care to ensure that patients receive consistent quality care with no effect on clinical outcomes. Performance measures should be evaluated and modifications made to include telemedicine care.”
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
Poverty is Bad for Your Health, But How Bad? Answer: Poverty is A Major Risk Factor for Death in the U.S.
A Research Letter in JAMA Internal Medicine (here) notes that “The US perennially has a far higher poverty rate than peer rich democracies. This high poverty rate in the US presents an enormous challenge to population health given that considerable research demonstrates that being in poverty is bad for one’s health.”
Overall, the report found that “survival of individuals in poverty mainly begins to diverge from survival of individuals not in poverty at approximately 40 years of age. The gap in survival between those in poverty and those not in poverty increases until a peak near 70 years when it begins to converge.”
With regard to major causes of death, “Current poverty was associated with greater mortality than major causes, such as accidents, lower respiratory diseases, and stroke. In 2019, current poverty was also associated with greater mortality than many far more visible causes—10 times as many deaths as homicide, 4.7 times as many deaths as firearms, 3.9 times as many deaths as suicide, and 2.6 times as many deaths as drug overdose.”
“Cumulative poverty was associated with approximately 60% greater mortality than current poverty. Hence, cumulative poverty was associated with greater mortality than even obesity and dementia. Heart disease, cancer, and smoking were the only causes or risks with greater mortality than cumulative poverty.”
Network Adequacy
The GAO publishes (report here, summary here) a comprehensive report on the adequacy of clinician and hospital networks associated with public and private health plans. The review covered actions by 44 states and CMS. The latter reported to GAO that “In CMS’s annual compliance review for plan year 2020, CMS found that all seven QHP [Qualified Health Plan] issuers selected for the review had at least one issue with provider directories, such as information for a provider’s specialty or status of accepting new patients.”
“As part of its review of provider data, CMS consistently identified differences between provider network data submitted by QHP issuers and secret shopper review results for plan years 2017 through 2021. For example, CMS confirmed that no more than 47 percent of the selected providers listed in the provider data files for QHPs contain accurate, up-to-date, and complete contact, location, specialty, and accessibility information, during these 5 years.”
NPR (here) profiles inappropriately small and inadequate networks, in “The big squeeze: ACA health insurance has lots of customers, small networks.”
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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