The Center for Affordable Whole Person Care logo. A person icon with its arm raised in power with a 360 degree arrow symbolizing ''whole person care.'' [[link removed]]
Families USA's Center for Affordable Whole Person Care Newsletter
This newsletter will be sent out every other month to bring you the latest news from the front lines of the health care value movement and our work to rein in health care industry abuses and reorient economic incentives to ensure affordable, quality, equitable care and health for all.
We'd love to hear from you! Please reach out if you have any news to share for our next issue.

Families USA’s Center for Affordable Whole Person Care Bi-Monthly Newsletter  

This newsletter will be sent out every other month to bring you the latest news from the front lines of the health care value movement and our work to rein in health care industry abuses and reorient economic incentives to ensure affordable, quality, equitable care and health for all.   

   

We'd love to hear from you! Please reach out if you have any news to share for our next issue.      

    

News from Congress  

Lower Costs, More Transparency Act - House Committees on Energy and Commerce, Ways and Means, and Education and the Workforce

Representatives Cathy McMorris Rodgers (R-WA), Frank Pallone (D-NJ), Jason Smith (R-MO), and Virginia Foxx (R-NC) introduced new bipartisan legislation that would increase health care price transparency and lower overall costs for patients and employers. This legislation builds upon prior efforts in each of three house committees: Energy and Commerce, Ways and Means, and Education and the Workforce. Key provisions of this bill include:

Codifying the Hospital Price Transparency rule by amending the statutory basis to explicitly require disclosure of negotiated rates in dollar amounts. It would also codify the Transparency in Coverage rule.

Applying site-neutral payment policies to off-campus hospital outpatient departments for drug administration services.

Requiring off-campus hospital outpatient departments to obtain a separate national provider identifier and to use that separate identifier when billing Medicare for items and services.

Extending funding for the Community Health Center Fund and National Health Service Corps.



Bipartisan Primary Care and Health Workforce Act - Senate Committee on Health, Education, Labor, and Pensions

Senators Bernie Sanders (I-VT) and Roger Marshall (R-KS) introduced new bipartisan legislation that would address the primary care crisis in America and the major workforce challenges of nurses and primary care physicians. The bill would ban anticompetitive contract terms, requires hospital outpatient departments to bill under separate National Provider Identifiers, and bans hospitals from charging facility fees for telehealth and evaluation & management services. It would also provide more than $26 billion in funding, generated by combatting waste, fraud and abuse in the health care system. This funding would be allocated as follows:

$5.8 billion per year for three years in funding for community health centers.

An additional $3 billion in funding for community health centers to expand offerings in dental and mental health care.

$640 million over the next three years to provide 2,100 scholarships and debt forgiveness to healthcare professionals working in impacted communities.

$1.5 billion over the next five years for the Teaching Health Center Graduate Medical Education program to create more than 700 new primary care residency slots.

$1.2 billion in grants to community colleges and state universities for two-year registered nursing programs.

The bill passed committee by a 14-7 vote and will advance to the Senate floor. Families USA submitted a Statement for the Record in support of this bill.



Hearing on Reduced Care for Patients: Fallout From Flawed Implementation of Surprise Medical Billing Protections – House Committee on Ways and Means

The House committee on Ways and Means held a hearing to learn about the challenges of implementing of the No Surprises Act (NSA) law from providers, Independent Dispute Resolution (IDR) entities, consumer health advocates, and insurers. The administration is currently considering new rulemaking under the IDR process in response to recent legal challenges. Representatives on this Committee were concerned about stagnation in the IDR process and recurrent challenges from providers, insurers, and consumers throughout the process. Families USA submitted a Statement for the Record to advocate for lawmakers to remain steadfast in their support for strong consumer protections under the No Surprises Act.



The Latest from the Biden Administration 

States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model – Centers for Medicare and Medicaid Innovation (CMMI)

The Centers for Medicare and Medicaid Services (CMS) announced States Advancing All-Payer Health Equity Approaches and Development (AHEAD), a new voluntary total cost of care model, scheduled to operate for a total of eleven years through 2034. The model builds off of similar state models such as the Maryland Total Cost of Care Model, the Vermont All-Payer Accountable Care Organization Model, and the Pennsylvania Rural Health Model, includes hospital global budgets and an emphasis on primary care participation. The model will also include adjustments for social risk and stratified data collection to address health inequities. There are openings for eight states to participate and CMS will award up to $12 million per state for operating costs.



Federal Independent Dispute Resolution Process Suspended – Centers for Medicare and Medicaid Services (CMS)

Following a decision in Texas Medical Association et al. v. United States Department of Health and Human Services (also known as the TMA III lawsuit), CMS has suspended all Federal IDR process operations relating to the NSA. The ruling in the TMA III case vacated portions of the NSA regarding the validity of Qualifying Payment Amount calculations within the IDR process. Until further notice, disputing parties can continue to engage in open negotiation, but no decisions will be issued via federal dispute arbitration. The TMA III decision, alongside other ongoing litigation as well as pauses to the IDR process may expose consumers to higher cost-sharing until the administration establishes new rulemaking.

 

Guiding an Improved Dementia Experience (GUIDE) Model – Centers for Medicare and Medicaid Innovation (CMMI)

CMS announced a new alternative payment model for dementia care management, Guiding an Improved Dementia Experience (GUIDE). It will fund comprehensive, person-centered assessments and care plans, care coordination, and 24/7 access to a support line. Goals of the GUIDE model include improving care quality for people living with dementia, enabling them to remain in their homes and communities, and reducing strain on unpaid caregivers. To achieve this, participants will receive a lump-sum infrastructure payment, per-beneficiary-per-month payments for participants to provide care management and care coordination services, and allowances to bill for respite services. CMS also implemented health equity adjustments to the monthly payments and requires annual data reporting to identify ongoing disparities and track progress toward health equity objectives. The model will launch on July 1st, 2024 and operate for a total of eight years.



New CMS Rule Promotes High-Quality Care and Rewards Hospitals that Deliver High-Quality Care to Underserved Populations – Centers for Medicare and Medicaid Services (CMS)

CMS issued the final FY2024 Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System rule. This rule adopts hospital quality measures to foster safety, equity, and reduce preventable harm, recognizes homelessness as an indicator of increased resource utilization in the acute inpatient hospital setting, and finalizes a health equity adjustment in the scoring methodology for the Hospital Value-Based Purchasing Program. Additionally, acute care hospitals who participate in the Hospital Inpatient Quality Reporting Program will receive an increase in operating payment rates of 3.1% as an incentive to report more data on health equity.



Adjustments to ACO REACH – Centers for Medicare and Medicaid Services (CMS)

CMS announced changes to the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model for Performance Year 2024. Notable changes include revisions to payment risk adjustment methodology, which are expected to decrease benchmarks by 0.4%, and revisions to health equity benchmark adjustments to incorporate Low-Income Subsidy Status, and state-based Area Deprivation Index. The changes are intended to increase payments and provide resources for ACOs delivering care to patients in communities impacted by health inequities.



CMS Enforcement Actions on Hospital Price Transparency – Centers for Medicare and Medicaid Services (CMS)

CMS issued new civil monetary penalties to nine hospitals who have failed to meet price transparency requirements. The hospitals are in nine separate states and territories, and penalties range from $56,940 to $979,000 in cost. These enforcement actions serve as a deterrent for other hospitals with poor compliance on federal price transparency regulations.



Medicare Shared Savings Program Saves Medicare More than $1.8 Billion in 2022 – Centers for Medicare and Medicaid Services (CMS)

CMS announced that the Medicare Shared Savings Program (MSSP) saved $1.8 billion for Medicare in 2022, which is the sixth consecutive year with overall savings. Approximately 63% of participating Accountable Care Organizations (ACOs) earned payments for their performance in 2022. These ACOs included more than 550,000 participating clinicians supporting nearly 11 million Medicare beneficiaries. Continued success for MSSP demonstrates potential savings for both providers and consumers in alternative payment models which deliver a care relationship with accountability for quality and total cost of care, unlike care under traditional fee-for-service systems.



State Updates

California Assembly Bill-716: Ground medical transportation – California State Assembly

The California State Assembly and State Senate passed AB-716, which would close the gap in surprise billing coverage to protect consumers from receiving surprise bills for ground ambulance services. The bill is on Governor Newsom’s desk. It will prevent out-of-network surprise bills for both emergency and non-emergency ground ambulance services and protect uninsured Californians from being charged inflated ambulance rates.



Shapiro Administration Takes Action to Address Nursing Shortage, Allows Additional Licensed Nurses To Practice in Pennsylvania – Governor Josh Shapiro, Pennsylvania

Pennsylvania Governor Josh Shapiro’s administration announced that Pennsylvania will allow registered nurses and licensed practical nurses who hold a multistate license to practice in the state. An industry survey in November 2022 from AMN Healthcare revealed vacancy rates of 30% for nurses providing direct care. This action will expand the pool of recruits for health care facilities in the state and alleviate overworked staff, making conditions safer for both patients and providers.



Arizona Plans to Submit Amendment to Active Section 1115 Demonstration; Seeking Permanent Extension of Parents as Paid Caregivers – Arizona Health Care Cost Containment System



Arizona requested an amendment to the State’s active 1115 Waiver Demonstration to allow for the permanent extension of payments to parents who serve as paid caregivers for their children, a program previously allowed under a COVID-19 flexibility. This amendment would combat care worker shortages and establish additional support services for family units and keep care at home for individuals.



California Department of Health Care Services Prepares to Submit Section 1115 Demonstration to Strengthen Behavioral Health Supports – California Department of Health Care Services

California’s Department of Health Care Services plans to submit a Section 1115 Waiver to CMS for $6.98 billion over a five-year period from 2025 to 2029. The goals of the demonstration, referred to as BH-CONNECT, are to strengthen the behavioral health workforce, provide resources to support counties and providers with practice transformation, and incentivize performance and outcome improvements, particularly for children and youth who receive care from multiple services.



Health Care Value in the News    

Hospital Pricing  

Reforming Abusive Billing Practices, One Step At A Time: - Health Affairs

The Health Care Provider Pricing Policy Puzzle: - Health Affairs

The next driver of inflation: health care: - Axios



Hospital Consolidation  

Understanding the Role of the FTC, DOJ, and States in Challenging Anticompetitive Practices Of Hospitals and Other Health Care Providers: - KFF

Understanding Mergers Between Hospitals and Health Systems in Different Markets: - KFF

New merger guidance could stretch timing of health care deals: - Axios



Payment Reform 

It’s Time For A New Season Of Episode-Based Payment - Health Affairs

Paying For Dementia Care That Improves Patient Outcomes, Supports Caregivers, And Saves Money - Health Affairs

Making Equity Primary In The Making Care Primary Model: - Health Affairs

 

Surprise Billing  

Doctors say insurers are ignoring orders to pay surprise billing disputes: - Axios 

Surprise Billing: Volume Of Cases Using Independent Dispute Resolution Continues Higher Than Anticipated: - Health Affairs



Price Transparency  

Health Care Price Transparency Legislation: How Can Congress Help Employers And Workers?: - Health Affairs

 

Site Neutral Payments 

Details matter (a lot) in site-neutral payments: - Axios

Facility Fees 101: What is all the Fuss About? - Health Affairs

  

Families USA Resources  

New Reports:  

Congress Should Codify and Strengthen Hospital and Plan Price Transparency Regulations: This fact sheet details areas for improvement of the hospital price transparency rule and increasing compliance. It calls on Congress to codify strengthened versions of both the Hospital Price Transparency and the Transparency in Coverage regulations.



Congress Must Act: Families Across America Should Pay the Same Price for the Same Health Care Services: This fact sheet addresses broken payment incentives in Medicare which have resulted in large hospital corporations buying up doctor’s offices and “rebranding” them as hospital outpatient departments to charge more for care. The fact sheet calls on Congress to enact bipartisan legislation including comprehensive site-neutral payment reform.



Families USA, alongside Colorado Consumer Health Initiative, Consumers for Quality Care, Health Access California, Pennsylvania Health Access Network, Public Citizen, and PIRG, launched a new Consumers for Fair Hospital Pricing coalition. The coalition will be focused on making hospital care higher quality and more affordable through advocacy for issues including ending price gouging by hospitals, fixing market failures to prevent further hospital consolidation, and strengthening price and quality data transparency.



Families USA joined the Leukemia and Lymphoma Society and 14 additional consumer and patient organizations in signing an amicus brief defending the No Surprises Act from litigation in New York – Daniel Haller v. U.S Department of Health and Human Services. Haller is challenging provisions of the No Surprises Act which prohibit providers from balancing billing patients.



Families USA submitted a letter to House and Senate leadership, with sign-on from more than 60 organizations, urging Congress to advance and enact legislation that strengthens and codifies price transparency regulations and promotes site-neutral payment reform.



Consumers First submitted comments to CMS on the CY2024 Outpatient Hospital proposed rule. The comment letter includes recommendations to strengthen and improve the Hospital Price Transparency Rule, to renew efforts to implement comprehensive site neutral payment policy, and to integrate health equity into data collection and hospital quality measures.



Consumers First submitted comments to CMS on the CY2024 Medicare Physician Fee Schedule proposed rule. The comment letter includes recommendations to refine and modify descriptors related to Community Health Integration Services, to support and further extend reimbursement for primary care, and to support increased reimbursement for behavioral health services.



Consumers First’s Steering Committee submitted comments to the FTC and DOJ on Draft Merger Guidelines. The comment letter expands on recommendations to consider proposed mergers’ impact on patient access to high-quality care and health outcomes and to ensure that federal anti-trust laws are fully applied to cross-market mergers.



  

Want to Tweet about these issues? Use our partner toolkit!  

  

Resources from our Partners  



Health Access California

California Consumer Goals & Guiding Principles for the Office of Health Care Affordability  



Public Citizen

Report: Ranking of the Rate of State Medical Boards’ Serious Disciplinary Actions, 2019-2021



Public Interest Research Group

Tell your US Representatives: Lower Costs, More Transparency



United States of Care

Hidden Cost of Care – Discover innovative solutions to lower health care pricing and drive policy change

If you would like to reach out, please contact Mike Persley, Strategic Partnerships Campaign Manager, at [email protected]
Copyright © 2022 Families USA, All rights reserved.
Our mailing address is:
1225 New York Ave NW #800, Washington, DC xxxxxx
If you believe you received this message in error or wish to no longer receive email from us, please unsubscribe: [link removed] .