RISE summarizes health care headlines that you may have missed during the holidays.
Medicaid redeterminations, telehealth flexibilities included in bipartisan omnibus bill
President Biden has signed the Consolidated Appropriations Act of 2023 into law. The $1.7 trillion bipartisan legislation will fund the government through September 30, provides additional funding to the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), National Institutes of Health, and the Centers for Disease Control and Prevention, and makes changes to the several health policies. For example, the law provides Medicaid agencies with the rules for winding down the Medicaid continuous enrollment requirement that was part of the COVID-19 relief package in March 2020 and begin Medicaid redeterminations for millions of Americans. States will be able to reevaluate Medicaid eligibility as of April 1. The law also provides 12 months of continuous coverage for children under the Medicaid and the Children’s Health Insurance Program. The legislation always extends Medicare telehealth provisions that were put in place during the COVID-19 public health emergency for two years and provides funding for mental health, substance use disorder, and crisis response services.
HHS proposes rule to adopt standards for health care attachments
CMS, on behalf of HHS, has issued a proposed rule, “Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification to Referral Certification and Authorization Transaction Standard that would adopt standards for “health care attachments” transactions, such as medical charts, x-rays, and provider notes that document physician referrals, and office or telemedicine visits. These modifications to the Health Insurance Portability and Accountability Act of 1996 transactions would support both health care claims and prior authorization transactions, standards for electronic signatures to be used in conjunction with health care attachments transactions, and a modification to the standard for the referral certification and authorization transaction. CMS estimates that if finalized, the proposed rule would save approximately $454 million annually in administrative costs and is a part of HHS’ and CMS’ ongoing efforts to significantly reduce paperwork burdens and empower health care providers to focus on direct patient care and streamline the care experience for patients and providers. Click here to read the full proposal. Public comments will be accepted through March 21.
HealthCare.gov enrollment outpaces previous years–so far
Affordable Care Act (ACA) marketplace enrollment continues to outpace previous years, with nearly 11.5 million people selecting coverage as of December 15, a key milestone marking the deadline for coverage starting January 1, 2023. About 1.8 million more people have signed up for health insurance, or an 18 percent increase, from this time last year, according to CMS. “Unprecedented investments lead to unprecedented results. Under President Biden’s leadership, we have strengthened the Affordable Care Act Marketplace with continued record affordability, robust competition, and historic outreach efforts–and today’s enrollment numbers reflect that,” said HHS Secretary Xavier Becerra in the announcement. The HealthCare.gov Marketplace Open Enrollment remains open until January 15.
HHS proposes changes to increase access to care and prevent discrimination
HHS Office for Civil Rights (OCR) has issued a proposed rule that aims to restore the longstanding process for the handling of conscience complaints and provide additional safeguards to protect against conscience and religious discrimination. In 2019, under the Trump administration, OCR issued a regulation that provided broad definitions, created new compliance regulations, and created a new enforcement mechanism for statutes related to the conscience rights of certain federally funded health care entities and providers. Three federal district courts determined the final rule was unlawful. Due to these court decisions, and consistent with the Administration’s commitment to safeguard the rights of federal conscience and religious nondiscrimination while protecting access to care, this notice of proposed rulemaking proposes to partially rescind the Department’s 2019 rule while reinforcing other processes previously in place for the handling of conscience and religious freedom complaints.
OIG audit: Cigna received nearly $6M in overpayments for 2016 and 2017
A recent Office of Inspector General (OIG) audit that examined Cigna-HealthSpring of Tennessee, Inc. (Cigna) submissions of claims with high-risk diagnosis codes has determined the medical records didn’t support the diagnosis codes. OIG sampled 279 claims that included high-risk diagnosis codes for which Cigna received higher payments for 2016 through 2017. For 195 of the 279 sampled enrollee-years, the medical records that Cigna provided did not support the diagnosis codes and resulted in $509,194 in overpayments. Based on the sample records, OIG estimates that Cigna received at least $5.9 million in overpayments for 2016 and 2017. OIG recommends that Cigna refund Medicare for the overpayments and identify similar instances of noncompliance that occurred before and after the audit period. Cigna didn’t concur with the recommendations or OIG’s audit methodology.