RISE summarizes recent headlines that impact Medicare, Medicare Advantage, and Medicaid.

Fed to provide $1B for community health center construction and renovation projects 

The U.S. Department of Health & Human Services (HHS) will provide $1 billion via the American Rescue Plan for community health centers across the country to fund major construction and renovations projects. Community health centers that receive funding will be able to use the money for COVID-19 related capital needs and to construct new facilities, renovate and expand existing facilities, and purchase new equipment, HHS said in the announcement. All of the nation’s 1,400 health centers funded by Health Resources and Services Administration will be eligible for the funding to expand their capacity to provide primary and preventive health care services to medically underserved populations and communities, which are often disproportionately affected by COVID-19. Applications for the funding are due by June 25. Visit the ARP-Capital technical assistance webpage for award submission guidance, technical assistance information, and other resources. 

CMS proposes to withdraw requirement that hospitals post negotiated MA rates

Although hospital industry officials are still reviewing the Centers for Medicare & Medicaid Services (CMS) entire proposed fiscal 2022 Hospital Inpatient Prospective Payment System rule, they are pleased with one planned change: the agency wants to repeal the requirement established in the 2021 final rule that hospitals and health systems disclose privately negotiated contract terms with payers on the Medicare cost report. In a fact sheet, CMS said the proposal to repeal the collection of market-based rate information on the Medicare cost report and the market-based MS-DRG relative weight methodology will avoid imposing additional unnecessary burden on hospitals.

We have long said that privately negotiated rates take into account any number of unique circumstances between a private payer and a hospital and their disclosure will not further CMS's goal of paying market rates that reflect the cost of delivering care. We once again urge the agency to focus on transparency efforts that help patients access their specific financial information based on their coverage and care,” Tom Nickels, executive vice president, American Hospital Association, said in a statement. Beth Feldpush, DrPH, senior vice president of policy and advocacy, America’s Essential Hospitals, said  the group is also pleased, noting “we believe this policy exceeded the agency’s statutory authority.”

AHIP survey: Health insurers commit multiple resources to improve COVID-19 vaccine rates

A new survey conducted in March by America’s Health Insurance Plans (AHIP) finds health insurance providers are taking a multifaceted approach to improve vaccine uptake. AHIP received 42 responses from plans representing 110 million Americans enrolled in commercial, Medicare, and Medicaid plans. The survey, which was conducted in advance of vaccine availability being opened to all adults, examined how health insurance providers are engaging to ensure wide-spread vaccine acceptance and uptake and equitable access to vaccines. AHIP said the results also reveal the importance of public-private partnerships for vaccine delivery, vaccination coordination, and education on the safety and efficacy of vaccines.

“Throughout the COVID-19 crisis, health insurance providers have worked hard to ensure that costs are not a barrier to testing and treatment. We are now seeing that commitment extended through their work for equitable vaccine access, particularly among those most vulnerable to the worst effects of the virus, and continued vaccine uptake,” said Matt Eyles, president and CEO of AHIP.

The survey found:

  • Nearly all insurance providers have trained their care and disease managers (98 percent), as well as their customer service representatives (96 percent) to answer questions on local vaccine availability, rules, and locations.
  • A strong majority (77 percent) have provided transportation for members to get a vaccine when needed.
  • Top actions to ensure equitable vaccine uptake include education, awareness, and outreach campaigns (90 percent), covering the cost of vaccine administration at no cost to members (88 percent), working with state and local government leaders to ensure equity in vaccine strategies (85 percent), addressing members’ vaccine hesitancy (83 percent), and engaging with community leaders in communities of color (77 percent).
  • A strong majority (73 percent) have partnered with other stakeholders to optimize allocation and distribution of vaccines. Those stakeholders most frequently include state and local governments, community health centers, pharmacies, and hospitals and health systems.
  • Phone calls are proving most effective for engaging seniors age 65 and older, with 79 percent of health insurance providers pointing to phone calls as most effective for spreading the word. Other effective tactics include community partnerships (48 percent), social media posts (42 percent) and email (33 percent).