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
Chair Sanders, Ranking Member Cassidy Seek Information from Health Care Providers on Workforce Shortage -Senate HELP
The Senate’s Committee on Health, Education, Labor, and Pensions (HELP) released a Request for Information (RFI) on the current state, and impact of, the health care workforce shortage. This is following a formal statement on the subject by Chairman Bernie Sanders and a Committee hearing aimed at unveiling the root causes of the crisis. Estimates show that there is a shortage of 120,000 doctors, that we will need 450,000 additional nurses in the next couple years, and that we need 100,000 additional dentists right now. The workforce shortage is impacting health outcomes and contributing to wasteful health care spending. RFI comments were due March 20.
Warner, Blackburn Lead Bipartisan Senators in Pushing to Help Rural Hospitals Deliver Quality Care -Sen. Warner, Sen. Blackburn
Senator Mark Warner (D-VA), Senator Marsha Blackburn (R-TN), and twelve other Senators, have written a letter to CMS Administrator Chiquita Brooks-LaSure in advance of this spring’s proposed Inpatient Prospective Payment System (IPPS) rule. The group is asking for CMS to extend the Low Wage Index Hospital Policy for the next four years. The policy allows certain rural hospitals, in low wage areas, to increase reimbursement in order to recruit and retain quality health care professionals. Without action the Medicare payments in this policy will be reduced in the fall of this year, even as rural hospitals continue to struggle with the ramifications of Covid-19 and the current health care workforce shortage.
Chairs Rodgers, Guthrie Announce Health Subcommittee Hearing on Transparency and Competition -House E&C
House Energy and Commerce Subcommittee to Focus on Lowering Unaffordable Health Care Costs announced a hearing on health care transparency and competition, specifically how these areas can lower health care costs for consumers. The hearing will give members, and experts, the opportunity to discuss these issues and hopefully build bipartisan agreement on how to make health care more accessible and affordable through legislative solutions. Witnesses have not been announced yet and the hearing will take place on March 28 at 1 PM.


The Latest from the Biden Administration

Participants Announced for ACO REACH - CMMI
CMS has announced the 132 Accountable Care Organizations participating in ACO REACH for 2023. ACO REACH is a redesign of the Geographic Direct Contracting Model, intended to better reflect the Administration’s goals of advancing health equity, promoting provider leadership, and protecting beneficiaries. The model’s first performance year began on January 1, 2023 and will run for four years. Outcomes from this first year’s participants will set the baseline for years to come and inform continued model development. Applications for future participation are open now.
Justice Department Withdraws Outdated Enforcement Policy Standards -Department of Justice
The Department of Justice’s (DOJ’s) Antitrust Division has withdrawn three of their antitrust policies for being outdated and overly permissive. The policies range from 1993-2011 and removing them should allow for the DOJ and Federal Trade Commission to put in place antitrust policies that have stricter enforcement and serve in the best interests of transparency. Antitrust policies help protect and promote competition, and are an important element in controlling rising hospital prices and ensuring hospital consolidation doesn’t restrict access to health care. There has yet to be new guidance or policies implemented in their place.
Initial Report on the Independent Dispute Resolution (IDR) Process April 15 – September 30, 2022 - HHS, CMS
An official report on the No Surprises Act (NSA) Independent Dispute Resolution (IDR) Process, representing results from April to September 2022, has been released. In that period, 90,078 disputes were initiated, 3,576 reached a payment determination, 15,895 were determined ineligible. As elements of the NSA and IDR process face lawsuits in states, the Department remains committed to publishing the required information, increasing transparency, and providing this important data to the public and Congress. As well as demonstrating, to disputing parties, the outcomes of effective implementation of the NSA.
President Biden’s State of the Union Address -the White House
During the State of the Union speech, President Biden lifted up recent victories including Medicare drug negotiation in the Inflation Reduction Act and continued successes in enrollment through the Affordable Care Act marketplaces. President Biden indicated that Medicare and Social Security would not be cut in budget negotiations and called attention to preparations for the end of the Public Health Emergency, approaching on May 11.
Medicare and Medicaid Programs; Disclosures of Ownership and Additional Disclosable Parties Information for Skilled Nursing Facilities and Nursing Facilities -CMS
CMS issued a proposed rule requiring disclosure of ownership and management information for Medicare Skilled Nursing Facilities (SNFs) and Medicaid nursing facilities. Provisions from the proposed rule should shed a light on the impacts of private equity on nursing homes and is consistent with the Administration's previous attention on the quality of care in nursing homes. Improving the transparency of ownership and management information aims to empower residents and families to make decisions about the care they receive and give CMS insight into trends affecting care quality and health outcomes. Comments are due April 14.
HHS Releases Initial Guidance for Medicare Prescription Drug Inflation Rebate Program -HHS
HHS and CMS have released initial guidance on implementation of the Medicare Prescription Drug Inflation Rebate Program. For drug companies that raise their prices faster than the rate of inflation, they will now have to pay rebates into the Medicare Trust Fund. CMS is seeking comments on key areas including reductions of certain rebates and assuring the accuracy of the rebate payments. The next key date in the implementation of the Inflation Reduction Act is April 1, at which time beneficiaries with Medicare and Medicare Advantage may start seeing lower coinsurance for Part B drugs that have price increases higher than inflation.
MedPAC March 2023 Meeting -Medicare Payment Advisory Commission
In their March meeting, MedPAC continued to support pay alignment for certain outpatient services. Because of site of service payment differentials, there are services that can be safely provided in either a hospital outpatient department (HOPD), independent physician office, or ambulatory surgical center (ASC) but are incentivized through the higher payment to be delivered HOPDs. The Chair presented 66 Ambulatory Payment Classifications (APCs) for payment alignment. The Commission will discuss and review these before making an official recommendation to Congress. This is a continuation of work that MedPAC began in 2014 and could have an impact on advancing site neutral payment policies.
The President’s Fiscal Year 2024 Budget -The White House, Office of Management and Budget
President Biden released his proposed budget which will go into Congressional hearings for amendment and approval. Toplines for health care related provisions include making permanent the premium cuts expanded through premium tax credits and the Inflation Reduction Act, reducing prescription drug costs, improving and expanding Medicaid home and community-based services, investments in maternal health and health equity, coverage expansion for mental and behavioral health services, and support for the nursing workforce and other health care professionals. Biden made clear that the budget protects and strengthens Medicare. The proposed budget is a clear demonstration of the administrations priorities to push for better affordability, access, and quality for consumers.
CMS Approves First-in-Nation Justice-Involved Reentry Section 1115 Demonstration - CMS/CalAIM
CMS approved California’s request to amend their California Advancing and Innovating Medi-Cal (CalAIM) 1115 waiver, allowing them to provide Medicaid services for youth and young adults in prisons, jails, and correctional facilities for up to 90 days prior to release. CA hopes that this will help to stabilize justice-involved enrollees’ physical and behavioral health and establish a re-entry plan. CA will directly evaluate if this program helps to improve coverage and continuity of coverage, and reduce morbidity and mortality for beneficiaries. The program is approved through December 2026.
2024 Medicare Advantage and Part D Advance Notice - CMS
CMS released their CY 2024 Medicare Advantage (MA) and Part C and Part D Payment Policies advance notice, prior to the final rate announcement set for April. The advance notice rule includes proposed changes to MA plan payments, including a 2.09% effective growth rate increase, and technical updates to the MA risk adjustment model. CMS is seeking comment on MA quality measurement as it works to align quality measures across programs. The notice also includes cost-sharing updates to the Part D program as part of implementation of the Inflation Reduction Act. The updates are intended to ensure both programs can continue to meet patient’s health needs. The deadline for comments was March 3 and the final Rate Announcement will be published no later than April 3.


State Updates
Senate Bill 83 - PA Senate
The Pennsylvania (PA) legislature is considering a bill - Senate bill 83 – that would codify hospital price transparency regulations into state code. The bill would also create strict guidelines for hospital acquisition applications and approval, as overseen by the PA Dept. of Health and would require the Department to conduct a study on the impact of health system acquisitions. This bill points toward a national trend of cracking down on anti-competitive behavior as well as using state authority to enforce federal price transparency rules.
Indiana Bill Would Fine Hospitals That Exceed Price Cap -Indiana General Assembly
Indiana House Bill 1004 would allow the Indiana Department of Insurance to take corrective action or establish a penalty for non-profit hospitals that exceed percentages of a national mean price. It also would establish a health care cost oversight board. If enacted, this bill could help to reign in and control hospital price increases. The bill has past House and is currently in the Senate.
Governor Lamont Announces 2023 Legislative Proposal: Cancel Medical Debt for Connecticut Residents -Connecticut, Governor Ned Lamont
The Governor of Connecticut (CT) announced plans for legislation canceling medical debt for residents. The legislation would allow the state to invest $20 million of federal Covid-19 relief funds to buy medical debt from residents and negotiate with hospitals and hospital systems directly to erase the balances. There are several campaigns in communities and states across the country- including programs in Texas, Michigan, Toledo, and Chicago- using the nonprofit RIP Medical Debt to do this same process. Alleviating medical debt would significantly impact the financial security and emotional health of CT residents.
Texas Court Sides With Providers a Second Time in Litigation Related to No Surprises Act IDR Process -Mannat
A Texas Federal District Court has again sided with the Texas Medical Assocation (TMA) and other providers in a case against regulations in the No Surprises Act (NSA). The court decided that the regulations in question lean towards the Independent Dispute Resolution (IDR) process in a way that is unfairly balanced against providers, specifically around the way that arbitrators must evaluate key information in the IDR process. The Departments of Health and Human Services, Labor, and the Treasury have asked arbitrators to hold all payment determinations and recall any made after the February decision. This is another road block in effectively implementing the federal rule that passed in 2020 and became effective in 2022.
Limits on Hospital Facility Fees -Colorado General Assembly
The Colorado General Assembly is considering a bill that would put limits on the use of hospital facility fees. The bill would prohibit a health care provider affiliated with, or owned by, a hospital or hospital system from charging facility fees for outpatient services at an off-campus location or through telehealth, as well as certain outpatient, diagnostic, or imaging services that can be performed safely in a non-hospital setting. Facility fees drive up cost for patients and contribute to a pattern of pushing services into higher cost hospital outpatient settings.



Health Care Value in the News
Hospital Pricing
A Road Map for Action: Recommendations of the Health Affairs Council on Health Care Spending and Value - Health Affairs
Consolidated systems charge more for marginally better care, study finds -Healthcare Dive
Healthcare Mergers and Acquisitions Regain Momentum -Revcycle Intelligence, Kaufman Hall

Payment Reform
The Case for ACOs: Why Payment Reform Remains Necessary – Health Affairs
ACO Benchmarks Based on Area Deprivation Index Mask Inequities - Health Affairs
Blues to press Congress to expand site-neutral payment reforms to more outpatient clinics - Fierce Healthcare
Surprise Billing
Is the No Surprises Act Working? 99% of the Time, Yes. -Stop Surprise Billing Now
No Surprises Act -the Georgetown Litigation Tracker
Judge hands providers another win by striking down surprise billing arbitration process -Fierce Healthcare

Price Transparency
Ongoing Challenges with Hospital Price Transparency -KFF
Hospital Price Transparency: Progress And Commitment To Achieving Its Potential -Health Affairs
New analysis: CMS vastly overestimates hospital price transparency efforts -STAT

Site Neutral
Hospital outpatient billing draws bipartisan heat -Axios

Quality
The Health of US Primary Care: A Baseline Scorecard Tracking Support for High-Quality Primary Care -Milbank Memorial Fund, The Physicians Foundation


Families USA Resources
Recent Events
Families USA hosted a webinar for partners to discuss the underlying financial incentives that drive inequities in our health care system and how true payment reform has the potential to ensure affordable, quality care and economic stability for families. A recording can be found here.

New Reports
What is Costs to Have a Baby in America: A State-by-State Analysis: This paper examines the high cost of childbirth in America to understand the scale of unaffordable labor and delivery hospital care and highlights the impact that irrational hospital prices have on the financial security of our nation’s families.


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


Resources from our Partners
American Academy of Family Physicians (AAFP)
• From Volume to Value: Progress, Rationale, and Guiding Principles
National Academy for State Health Policy (NASHP)
• NASHP Model Prohibiting Anticompetitive Contract Terms — Application to Employer Plans
Consumers for Quality Care
• Nonprofit Hospital Scorecards
Center for American Progress
• Empowering State Attorneys General To Fight Health Care Consolidation
National Patient Safety Board Advocacy Coalition
• How Would a National Patient Safety Board Benefit Patients and Families?

For more information, please contact Mike Persely, Strategic Partnerships Campaign Manager, at MPersley@familiesusa


Families USA
1225 New York Ave NW
Suite 800
Washington, DC xxxxxx
United States
If you believe you received this message in error or wish to no longer receive email from us, please unsubscribe: [link removed] .