This Week’s Dose
Additional coronavirus (COVID-19) reduction negotiations proceed to sputter together with low probability of an settlement earlier than Election Day.
COVID-19 Aid Updates.
Senate Republicans tried to vote this week on a focused, $500 billion COVID-19 reduction invoice. Democrats, nonetheless, blocked the measure from advancing, saying it doesn’t go far sufficient. In the meantime, Treasury Secretary Steven Mnuchin and Home Speaker Nancy Pelosi (D-CA) continued talks of a broader deal; at this juncture, it’s unlikely that the White Home and Home Democrats can attain a compromise earlier than Election Day. Additional motion on COVID-19 reduction will doubtless be pushed to the post-election session, or probably into 2021, relying on how the election outcomes form the legislative surroundings.
CMS Delayed Radiation Oncology Mannequin.
Facilities for Medicare and Medicaid Providers (CMS) Administrator Seema Verma introduced that the company will delay the not too long ago introduced Radiation Oncology Mannequin after the supplier neighborhood pressed for extra implementation time earlier than the scheduled January 1, 2021, begin date. The necessary mannequin seeks to check whether or not making potential episode funds to hospital outpatient departments, freestanding radiation remedy facilities and doctor group practices for radiation remedy episodes of care preserves or enhances the standard of care furnished to Medicare beneficiaries whereas decreasing Medicare program spending by means of enhanced monetary accountability for members. Implementation is now set to start July 1, 2021.
HHS Up to date PRF Reporting Necessities and Expanded Part three Eligibility.
In response to issues raised by stakeholders and Members of Congress, the Division of Well being and Human Providers (HHS) up to date its Supplier Aid Fund (PRF) reporting steering. The up to date steering contains two notable adjustments. First, the brand new steering offers that for Normal Distribution funds, a dad or mum entity can report on and direct use of the Normal Distribution funds supplied that sure standards are met (i.e., the dad or mum has suppliers that had been offering affected person care on or after January 1, 2020, and may attest to the Phrases and Situations). Second, the steering removes the language that outlined misplaced income as a change in yr over yr web working revenue. The steering now compares 2019 affected person care income to 2020 affected person care income. Each adjustments characterize a major shift from the September 19, 2020, reporting steering, which many suppliers could view as an enchancment. In the identical announcement, HHS broadened the listing of eligible suppliers for the Part three Normal Distribution to incorporate suppliers that don’t settle for Medicare or Medicaid. The Part three software portal opened October 5, 2020, and can stay open till November 6, 2020. As a reminder, HHS has mentioned that if authorised, suppliers will obtain a baseline cost of roughly 2% of annual income from affected person care plus an add-on cost that considers adjustments in working revenues and bills from affected person care, together with bills incurred associated to COVID-19.
CMS Authorised Nebraska 1115 Waiver.
The Part 1115 waiver presents enhanced Medicaid advantages to sure enlargement beneficiaries starting April 1, 2021. As background, Nebraska expanded Medicaid for this inhabitants on August 1, 2020, with protection starting October 1, 2020. What is exclusive concerning the Nebraska enlargement is that it contains “Primary” and “Prime” advantages. By way of this newly authorised Medicaid waiver, enlargement beneficiaries below the Prime profit package deal can obtain entry to optometrist providers, eyeglasses, dental, dentures and over-the-counter medicines. To be eligible for the Prime advantages, a beneficiary should full sure wellness actions, like an annual well being go to, and sure “private responsibly measures,” equivalent to work or neighborhood engagement actions. This approval comes on the heels of approval for Georgia’s work requirement and partial Medicaid enlargement 1115 waiver. If there’s a second time period for the Trump Administration, count on the development of Medicaid waivers to proceed.
The Home Methods and Means Oversight Subcommittee held a listening to on maximizing well being protection enrollment.
The Senate Judiciary Committee authorised the US Supreme Court docket nomination of Choose Amy Coney Barrett, advancing consideration to the total Senate, which is predicted to vote on October 26.
Vitality and Commerce Committee Chairman Frank Pallone (D-NJ), Methods and Means Committee Chairman Richard Neal (D-MA) and Senate Finance Committee Rating Member Ron Wyden (D-OR) despatched a letter calling on HHS to launch paperwork associated to the Administration’s proposal to distribute $200 drug low cost playing cards to Medicare beneficiaries. The letter follows reviews that the HHS Normal Counsel raised issues concerning the proposal’s legality.
A bipartisan group of 229 Home members despatched a letter urging Speaker Pelosi and Home Minority Chief Kevin McCarthy (R-CA) to deal with pay cuts to sure specialty suppliers that had been included on this yr’s Medicare Doctor Charge Schedule proposed rule.
CMS launched a report on premiums and participation in HealthCare.gov for plan yr 2021. The report reveals that premiums are down 2% from 2020, and 22 extra well being plans are becoming a member of the market.
CMS printed incessantly requested questions on the Group Well being Entry and Rural Transformation Mannequin.
A federal appeals court docket rejected requests to assessment two earlier selections that upheld Administration insurance policies reducing Medicare reimbursement for 340B lined entities and off-site hospital clinics.