In this Policy Round-Up:
- ICYMI: FEMA Seeking Feedback From Stakeholders About the Definition of “Private Nonprofit Facility" (Comments due Sept. 3)
- Input Needed
- CMS Medicare Physician Payment Proposed Rule (Comments due Sept. 9)
- CMS Medicare Home Health Proposed Rule (Comments due Aug. 26)
- Expanding Access to Medical Diagnostic Equipment (MDE)
- Department of Justice Finalizes ADA Title II Rule
- U.S. Access Board Finalizes Rule Setting Low Transfer Height for Certain MDE
- CMS Announces New, Lower Prices for First Ten Drugs Selected for Medicare Price Negotiation
- State Medicaid IT Expenditures To Improve Mental Health/Substance Use Disorder (SUD) Treatment May Qualify for Enhanced Federal Matching Funds
- HRSA Invests Over $200 Million To Help Improve Care for Older Adults
- New AHRQ Grants Expand Long COVID Care Network
- CMS Medicare Guidance
- Helping People With Medicare Part D Coverage Manage Prescription Drug Costs
- FAQs for Pharmacies on Potential PrEP National Coverage Determination
ICYMI: FEMA Seeking Feedback From Stakeholders About the Definition of “Private Nonprofit Facility"
The Federal Emergency Management Agency (FEMA) is seeking comments until Tuesday, September 3, 2024, on a proposed rule to update FEMA’s Public Assistance regulations. The Public Assistance program provides financial assistance to state, local, tribal, and territorial governments, and some private nonprofit organizations, so communities can quickly respond to and recover from major disasters or emergencies.
To qualify for this funding, an entity must be an eligible “facility.” The disability and aging networks have previously shared informally with both ACL and FEMA barriers they have faced in accessing Public Assistance funding because of the definition of “facility.” As a result of this input, FEMA is looking for comment on “whether its definition of ‘private nonprofit facility’ is sufficiently broad to encompass all private nonprofit organizations providing service to older adults and persons with disabilities that are eligible to receive public assistance under the Stafford Act.”
For more information, check out this ACL announcement.
Input Needed: CMS Medicare Physician Payment Proposed Rule
The Centers for Medicare & Medicaid Services (CMS) is proposing new policies as part of its 2025 Medicare Physician Fee Schedule (PFS) proposed rule to advance health equity and support whole-person care.
The PFS is updated yearly and sets Medicare payment for outpatient physician services. Medicare policy is often made through payment rules such as the PFS. The proposed rule seeks to strengthen primary care and expand access to behavioral health, caregiver training services, and oral health, and maintain telehealth flexibilities that began during the COVID-19 public health emergency.
In addition, the proposed rule requests information on topics including new billing codes established by the 2024 Medicare PFS rule that pay separately for community health integration (CHI), social determinants of health (SDOH) risk assessment, and principal illness navigation (PIN) services when clinicians involve community health workers, care navigators, and peer support specialists to provide medically necessary care.
These codes are used to pay providers for critical services that help people stay well and in the community. As we’ve discussed before, these codes can be used by ACL’s network, in partnership with Medicare Part B billing providers, to get reimbursed for services such as person-centered planning, home and community-based services coordination, peer supports, building self-advocacy skills, and more.
CMS has released fact sheets to help people better understand different parts of the proposed rule:
- Proposed rule
- Quality Payment Program proposed changes
- Proposed Medicare Shared Savings Program changes
- Proposed Medicare Prescription Drug Inflation Rebate Program changes
Comments can be submitted online or by mail until Monday, September 9, 2024, at 5:00 p.m. ET.
Input Needed: CMS Medicare Home Health Proposed Rule
CMS is seeking feedback to help inform current and future policies related to Medicare home health as part of a proposed rule that sets forth routine updates to the Medicare home health payment rates for 2025.
CMS invites public input on proposed changes to the Home Health Quality Reporting Program (HH QRP) requirements that will provide more insight into patients’ social determinants of health.
CMS also seeks feedback on the Expanded Home Health Value-Based Purchasing Model, which aims to improve the quality and efficiency of home health care. Specifically, the proposed rule seeks feedback on the potential inclusion of new performance measures, including one related to family caregiving, and other potential performance measures CMS should consider.
Additionally, CMS proposes to replace current long-term care requirements for reporting COVID-19 related data, which expire on December 31, with streamlined continued data reporting requirements for certain respiratory illnesses, including RSV, the flu, and COVID-19.
For more information on the proposed rule, check out this fact sheet.
Comments can be submitted online or by mail until Monday, August 26, 2024.
Expanding Access to MDE: Department of Justice Finalizes ADA Title II Rule
The U.S. Department of Justice (DOJ) released a final rule that seeks to improve access to medical diagnostic equipment (MDE) for people with disabilities. Examples of MDE include examination tables, dental chairs, and mammography and x-ray equipment. The rule clarifies how public entities, such as hospitals and health care clinics operated by state or local governments, can meet their obligations under the Title II of the Americans with Disabilities Act (ADA).
The technical standards for MDE are based on past standards developed by the Access Board and used in the U.S. Department of Health and Human Services' (HHS’) recent rule implementing Section 504 of the Rehabilitation Act. The HHS Section 504 rule applies to entities that receive federal funding or assistance while the DOJ Title II rule applies to public entities (i.e., state and local governments).
To learn more, read DOJ’s press release, which is also available in Spanish, and this fact sheet.
Expanding Access to MDE: U.S. Access Board Finalizes Rule Setting Low Transfer Height for Certain MDE
The Architectural and Transportation Barriers Compliance Board, better known as the Access Board, issued a final rule setting accessibility standards for low-transfer height of medical diagnostic equipment (MDE) at 17 inches, replacing the current standard of 17-19 inches.
Using MDE often requires people to transfer onto an examination table, chair, or other surface for evaluation. MDE has been, and continues to be, inaccessible to many people who use wheelchairs, which can lead to misdiagnosis and present barriers to basic care and examinations. Setting the low-transfer height at 17 inches will improve access to diagnostic care for people with disabilities by accommodating more wheelchair heights and allowing greater ease of transfer for more patients.
The rule, which we’ve discussed before, does not impose any mandatory requirements on health care providers or medical device manufacturers. Rather, this new rule establishes technical criteria that agencies such as HHS, DOJ, and entities such as health care providers, may rely on when issuing future regulations or adopting policies related to the acquisition and use of accessible MDE.
Read more about the many federal regulations advancing civil rights for people with disabilities.
CMS Announces New, Lower Prices for First Ten Drugs Selected for Medicare Price Negotiation
The Inflation Reduction Act gives CMS authority to negotiate prescription drug prices for some drugs covered by Medicare. Last year, CMS selected ten drugs covered under Medicare Part D for the first cycle of negotiations and has now finalized prices for those drugs. The new prices will go into effect for people with Medicare Part D prescription drug coverage in 2026 for the following drugs:
- Eliquis
- Jardiance
- Xarelto
- Januvia
- Farxiga
- Entresto
- Enbrel
- Imbruvica
- Stelara
- Fiasp, Fiasp FlexTouch, Fiasp PenFill, NovoLog, NovoLog FlexPen, and NovoLog PenFill
More drugs will be selected each year as part of Medicare’s drug price negotiation program. Medicare will select up to 15 additional drugs covered under Part D for negotiation in 2025, up to an additional 15 Part B and D drugs in 2026, and up to 20 drugs every year after that.
For more information, check out this fact sheet from the White House or this fact sheet from CMS.
State Medicaid IT Expenditures To Improve Mental Health/SUD Treatment May Qualify for Enhanced Federal Matching Funds
Health information technology (IT) systems can help improve mental health and/or substance use disorder (SUD) treatment and support services for people with Medicaid.
CMS recently released an informational bulletin highlighting examples of certain state Medicaid expenditures on IT that may qualify for enhanced federal matching rates for administrative costs. This includes the use of health IT to help increase access to mental health and SUD services and improve care coordination by supporting greater integration of mental health and SUD treatment into primary care and other health care settings.
In addition, the bulletin recognizes telehealth as a key technology that can support integration and notes that health IT can be used to support increased availability of telehealth technology, improve access to existing treatment providers, and support community integration, as well as crisis response. It also recognizes the role health IT can play in supporting provider-to-provider consultations and the 988 toll-free hotline and connections to mobile crisis response providers.
HRSA Invests Over $200 Million To Help Improve Care for Older Adults
The Health Resources and Services Administration (HRSA) announced more than $200 million in funding to support 42 programs across the country aimed at improving care for older Americans — including people experiencing Alzheimer’s disease and related dementias — through its Geriatrics Workforce Enhancement Program.
The funding will help train primary care physicians, nurse practitioners, and other health care clinicians to provide age-friendly and dementia-friendly care for older adults. The program also focuses on providing families and other caregivers of older adults with the knowledge and skills to help them best support their loved ones.
Visit HRSA’s website for a full list of grantees.
New AHRQ Grants Expand Long COVID Care Network
The Agency for Healthcare Research and Quality (AHRQ) announced new grant awards to fund three multidisciplinary Long COVID clinics at the University of Southern California, University of California San Francisco, and Johns Hopkins University. The grants provide funding to implement and evaluate models for delivering comprehensive, coordinated, and person-centered care to people with Long COVID and support primary care clinicians in Long COVID management.
These grants expand AHRQ’s existing Long COVID Care Network, which was established in September 2023. The goal of the Long COVID Care Network, which we’ve discussed before, is to expand access to care for people with Long COVID, particularly among underserved, rural, vulnerable, and minority populations that are disproportionately impacted by the condition.
Visit AHRQ’s website to learn more about the grantees.
CMS Medicare Guidance: Helping People With Medicare Part D Coverage Manage Prescription Drug Costs
CMS finalized the second part of its guidance on the Medicare Prescription Payment Plan. Starting in 2025, the plan will give people with Medicare Part D prescription drug coverage the option to pay their out-of-pocket costs in monthly payments spread out over the year. The final guidance updates and finalizes requirements proposed in the draft guidance released in February, which we discussed previously on this blog.
The guidance focuses on education and outreach requirements to ensure that people with Medicare Part D are aware of the Medicare Prescription Payment Plan and includes:
- Outreach and education requirements for Part D plan sponsors, including requirements for member ID card or separate mailings, updates to current Part D materials, and website contents.
- Requirements for Part D plan sponsor communications with prospective and current program participants, particularly around election of the payment plan, as well as voluntary removal, non-payment, and termination.
- Information about how CMS will perform outreach and education activities.
For more information, check out this fact sheet and updated implementation timeline for the Medicare Prescription Payment Plan.
CMS Medicare Guidance: FAQs for Pharmacies on Potential PrEP National Coverage Determination
CMS posted a new FAQ document for pharmacies related to a potential National Coverage Determination (NCD) (which we’ve discussed before) to cover pre-exposure prophylaxis (PrEP) using FDA-approved antiretroviral drugs to prevent HIV infection in high-risk individuals.
According to the CDC, PrEP is highly effective for preventing HIV when taken as prescribed. PrEP is currently covered under Medicare Part D but may have cost-sharing and deductibles. If CMS issues a NCD, both oral and injectable forms of PrEP would be covered under Part B as an “additional preventive service” without requiring payment of coinsurance or a deductible.
CMS released these new FAQs based on public feedback asking for more technical information on submitting future potential Part B claims for PrEP. The FAQs cover topics including pharmacy enrollment and billing and are meant to prepare pharmacies ahead of a final NCD, which is expected to be posted and effective in late September.