RISE summarizes recent regulatory news, including announcements and proposals from the U.S. Department of Health and Human Services, the Centers for Medicare & Medicaid Services, and the Centers for Disease Control and Prevention.

CMS releases action plan to advance health equity and address systemic inequities

As part of its efforts to make health equity the first pillar of its strategic vision, the Centers for Medicare & Medicaid Services (CMS) on Wednesday released an action plan to advance health equity and make high-quality, affordable health care available to all people, regardless of their background. Health equity will be “embedded within the DNA of CMS and serve as the lens through which we view all of our work. Our vision is clear and our goal is straightforward—we will not stop until every person has a fair and just opportunity to attain their optimal health,” CMS Administrator Chiquita Brooks-LaSure said in an announcement.

As a part of its plan, CMS laid out the significant role health equity will play in the work of all CMS Centers and Offices, including the Center for Medicare (CM), the Center for Medicaid & CHIP (CMCS), Center for Consumer Information and Insurance Oversight (CCIIO), the Center for Medicare and Medicaid Innovation (CMMI), and the Center for Clinical Standards and Quality (CCSQ). This work includes working with and sharing best practices across states, health care facilities, providers, insurance companies, pharmaceutical companies, people with lived experience, researchers, and other key stakeholders to drive commitments to advance health equity. The centers and offices will work to:

  • Close gaps in health care access, quality, and outcomes for underserved populations.
  • Promote culturally and linguistically appropriate services to ensure understandable and respectful care and services that are responsive to preferred languages, health literacy, and other diverse communication needs.
  • Build on outreach efforts to enroll eligible people across Medicare, Medicaid/CHIP, and the marketplace.
  • Expand and standardize the collection and use of data, including on race, ethnicity, preferred language, sexual orientation, gender identity, disability, income, geography, and other factors across CMS programs.
  • Evaluate policies to determine how CMS can support safety net providers caring for underserved communities and ensure care is accessible to those who need it.
  • Ensure engagement with and accountability to the communities served by CMS in policy development and the implementation of CMS programs.
  • Incorporate screening for and promote broader access to health-related social needs, including greater adoption of related quality measures, coordination with community-based organizations, and collection of social needs data in standardized formats across CMS programs and activities.
  • Ensure CMS programs serve as a model and catalyst to advance health equity throughout the health care system, including with states, providers, plans, and other stakeholders.
  • Promote the highest quality outcomes and safest care for all people through use of the framework under the CMS National Quality Strategy.

In addition, CMS will encourage health care leaders to make commitments to advance health equity, such as designing, implementing, and operationalizing initiatives that support health; eliminating avoidable differences in health outcomes experienced by people who are disadvantaged or underserved; and providing the care and support people, particularly those with Medicare, Medicaid, or Marketplace coverage, need to thrive.

2023 proposed inpatient, long-term hospital rule aims to advance health equity, maternal health

CMS this week issued a proposed rule for inpatient and long-term hospitals that intends to advance health equity and improve maternal health outcomes. In addition to annual policies that promote Medicare payment accuracy and hospital stability, CMS said in an announcement that the FY 2023 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) rule includes measures that will encourage hospitals to build health equity into their core function to improve care for people and communities who are disadvantaged and/or underserved by the health care system. The rule includes three health equity-focused measures in hospital quality programs, seeks stakeholder input related to documenting social determinants of health in inpatient claims data, and proposes a “Birthing-Friendly” hospital designation.

“This rule, which funds a substantial portion of Medicare programs, is crucial to the foundation of CMS’ vision, ensuring access for all people with Medicare and maintaining incentives for our hospital partners to operate efficiently,” Brooks-LaSure said in the announcement. “This year—through a health equity lens—we are also re-envisioning the next chapter of health care quality and patient safety.”

To address health care disparities in hospital inpatient care, CMS has proposed three health equity-focused measures for adoption in the Hospital Inpatient Quality Reporting (IQR) Program. The first measure assesses a hospital’s commitment to establishing a culture of equity and delivering more equitable health care by capturing concrete activities across five key domains, including strategic planning, data collection, data analysis, quality improvement, and leadership engagement. The second and third measures capture screening and identification of patient-level, health-related social needs—such as food insecurity, housing instability, transportation needs, utility difficulties, and interpersonal safety. By screening for and identifying such unmet needs, hospitals will be in a better position to serve patients holistically by addressing and monitoring what are often key contributors to poor physical and mental health outcomes.

CMS is also seeking input on how to optimally measure health care quality disparities, including what to prioritize in data collection and reporting as well as approaches to consider in driving provider accountability across hospital quality programs.

The agency also wants to create a new hospital designation to identify “birthing friendly hospitals” and additional quality measure reporting to drive improvements in maternal health outcomes and maternal health equity.

To learn more, click here for a fact sheet on the proposed rule and here for a fact sheet on the maternal health and health equity measures.

DOJ won’t fight judge’s decision on mask mandate unless CDC shows requirement is necessary again

Although the Department of Justice (DOJ) and the Centers for Disease Control and Prevention (CDC) disagree with a district court judge’s decision to strike down the federal transportation mask mandate, it said in a statement this week that it will appeal it only if the CDC determines the order is remains necessary for public health. The CDC had extended the mandate, which requires face coverings on planes, trains, and in transit hubs, to May 3 to allow more time to study the latest subvariant, which is now responsible for most of the COVID-19 cases in the United States. But U.S. District Judge Kathryn Kimball Mizelle ruled on Monday the CDC exceeded its authority. In a statement, DOJ spokesman Anthony Coley said the department “continues to believe the order requiring masking in the transportation corridor is a valid exercise of the authority Congress has given CDC to protect the public health” and it will continue to work to preserve it. If the CDC decides that a mandatory order remains necessary for the public’s health, Coley said the DOJ will appeal Mizelle’s decision. UPDATE: The CDC said late Wednesday that it had asked the Department of Justice to appeal the decision to the 11th U.S. Circuit Court of Appeals.

Meanwhile, CDC launches a forecasting and outbreak analytics center for infectious diseases

While some health experts worry that the District Court judge’s decision on the transportation mask mandate would undermine the CDC’s ability to control future outbreaks that endanger the public’s health, the CDC has announced it has launched the Center for Forecasting and Outbreak Analytics (CFA). The forecasting center would enhance the government’s ability to use data, models, and analytics to enable timely, effective decision-making in response to public health threats for CDC and its public health partners. CFA will also develop a program to provide insights about infectious disease events to the public to inform individual decision-making–the equivalent of the National Weather Service but for infectious diseases.

Feds release data for the first time on ownership of hospitals and nursing homes enrolled in Medicare

CMS on Wednesday released data publicly, for the first time, on mergers, acquisitions, consolidations, and changes of ownership from 2016-2022 for hospitals and nursing homes enrolled in Medicare. The information can be used as a tool for researchers, state and federal enforcement agencies, and the public to better understand the impacts of consolidation on health care prices and quality of care. The Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation (ASPE) has also released a related report—an analysis of the new CMS data examining trends in changes of ownership over the past six years. The data and analysis aim to promote competition and advance the Biden administration’s goal of improving transparency around nursing facility ownership and enhancing nursing home safety and quality.

Among the findings:

  • Changes of ownership have been much more common in nursing homes than hospitals over the past six years.
  • Ownership varies by state. Nineteen percent of hospitals (14 out of 73) in South Carolina were sold during this period, while most states had fewer than four percent of hospitals change ownership.
  • Sixty-two percent of skilled nursing facilities that were purchased have a single organizational owner, seven percent have multiple organizations owners, while 18 percent have only individual owners and approximately 13 percent have both types of owners.