RISE summarizes the latest health care news from the Centers for Medicare & Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and the Commonwealth Fund.
CMS 2022 inpatient final rule increases payments to treat COVID-19, repeals MA rate disclosure requirement
CMS this week issued the
Hospital Inpatient Prospective Payment System (IPPS)/ Long Term Care Hospital (LTCH) Prospective Payment System final rule, which authorizes additional payments for diagnostics and therapies to treat COVID-19 during the current public health emergency (PHE), and beyond. The rule takes effect Oct. 1 and revises payment policies, as well as policies under certain quality and value-based purchasing programs for hospitals, to lessen the adverse impacts of the pandemic. CMS said in an announcement that some of the changes will provide incentives for the meaningful use of certified electronic health record (EHR) technology that will help public health officials monitor for future unplanned events.
The final rule repeals a requirement that hospitals report their median payer-specific negotiated charges with Medicare Advantage (MA) plans. CMS said in a fact sheet that had hospitals been required to comply with the requirement, it would have led to 64,000 hours of administrative burden. The decision was lauded by the American Hospital Association (AHA), which opposed the plan to have hospitals and health systems disclose privately negotiated contract terms with payers on the Medicare cost report. The policy was meant to better align fee-for-service Medicare payments with market rates, but the AHA said privately negotiated rates are not an appropriate benchmark for fee-for-service Medicare payments.
“How Medicare pays for hospital care and evaluates quality, are integral pieces of achieving and addressing gaps in health equity and strengthening our health care system for a more sustainable future. CMS is moving forward to incorporate what we have learned from the COVID-19 pandemic in order to improve quality and increase transparency so that patients are positioned to make informed decisions about their care,” said CMS Administrator Chiquita Brooks-LaSure in the announcement. “With this final rule, we are further improving how we measure and evaluate data while investing in quality care for people that rely on Medicare for coverage.”
For more information, click here for the CMS fact sheet on the final rule and here for the unpublished final rule. The final rule is scheduled to be published in the Federal Register on August 13.
Monthly premium for standard Medicare Part D coverage will increase in 2022
CMS also announced that the average basic monthly premium for standard Medicare Part D coverage is projected to be approximately $33 in 2022. The agency releases the projected average basic monthly premium annually—calculated based on plan bids submitted to CMS—to help beneficiaries understand overall premium trends before open enrollment when they can select from plan options for the upcoming benefit year.
The average 2022 basic Part D premium is projected to increase nearly 5 percent from 31.47 in 2021. The projected average basic premium is calculated based on plans’ expectations of per capita drug spending in the coming year. CMS anticipates releasing the final 2022 premium and cost-sharing information for 2022 Medicare Advantage and Part D plans in mid- to late-September 2021.
CMS is also releasing information on the Part D national average monthly bid amount to help Part D plan sponsors finalize their premiums and prepare for Medicare open enrollment. Medicare open enrollment for coverage beginning January 1, 2022 will run from October 15 to December 7, 2021. Click here for more information on the Part D national average monthly bid amount, the Part D regional low-income premium subsidy amounts, the Medicare Advantage employer group waiver plan regional payment rates, and the Medicare Advantage regional preferred provider organization benchmarks.
CDC extends eviction order in areas of substantial and high transmission of COVID-19
Dr. Rochelle Walensky, director of the CDC, this week signed an order that evictions of tenants for failure to make rent or housing payments could be detrimental to public health control measures to slow the spread of the virus that causes COVID-19. The order will expire on October 3 and applies in U.S. counties experiencing substantial and high levels of community transmission levels of the virus. The eviction moratorium allows additional time for rent relief to reach renters and to further increase vaccination rates. In the context of a pandemic, eviction moratoria—like quarantine, isolation, and social distancing—can be an effective public health measure to prevent the spread of communicable disease. Eviction moratoria facilitate self-isolation and self-quarantine by people who become ill or who are at risk of transmitting COVID-19 by keeping people out of congregate settings and in their own homes.
US once again lands at the bottom of health care rankings
Despite spending more of its gross domestic product on health care, the United States trails far behind other high-income countries on measures of health care affordability, administrative efficiency, equity, and outcomes, according to a new report released by the Commonwealth Fund. The country ranks last on access to care, administrative efficiency, equity, and health care outcomes but second on measures of care process. The United States has been at the bottom of the list in all seven studies the Commonwealth Fund has conducted since 2004, CNN reports. The study examines 71 performance measures from international studies conducted in each country and administrative data from the Organisation for Economic Co-operation and Development and the World Health Organization. The top-performing countries overall are Norway, the Netherlands, and Australia. These top performers provide universal coverage, remove cost barriers, invest in primary care systems to ensure high-value services are equitably available in all communities to all people, reduce administrative burdens that divert time, efforts, and spending from health improvement efforts, and invest in social services, especially for children and working-age adults.