Stay ahead of the latest regulatory shifts and healthcare breaking news with Headlines from the Hill.
In this month’s edition you will find:
Cost of Healthcare: Three bills proposed.
Three health bills were discussed during the House Education and the Workforce markup on September 11. The bills discussed include:
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- Congressional Review Act resolution to stop the Biden-Harris rule limiting access to Association Health Plans (AHPs) (H.J. Res. 181)
- Healthy Competition for Better Care Act (H.R. 3120)
- Transparent Telehealth Bills Act of 2024 (H.R. 9457)
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All bills were favorably reported to the House as amended for future consideration.
One of note, the Transparent Telehealth Bills Act of 2024, passed unanimously out of committee. The bill would require private health insurance plans to cover certain services provided via telehealth and would prevent healthcare facilities from charging consumers a separate facility fee. The facility fees for telehealth would only be permitted when there is no professional fee available to the billing provider.
Medicare Payment Advisory Commission (MedPAC) considers rural health quality.
MedPAC examined gaps in measurement of quality among rural healthcare providers and the unique challenges policymakers face in addressing those gaps. The foundational discussion and subsequent work are expected to be included in a chapter of MedPAC’s upcoming Report to Congress.
What you need to know:
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- MedPAC wrestled with ways to broaden and improve quality measurement among rural providers and the patients they serve.
- While rural providers who participate in Medicare payment sectors are required to report on quality metrics, including for payment purposes, critical access hospitals (CAH) are exempt and the Commission may consider ways to address that.
- MedPAC noted that low patient volumes complicate quality measurement and that rural providers also could face disproportionate administrative burdens in complying with reporting requirements.
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MedPAC critical access hospitals: Shifting coinsurance to 20% of payment rates and introducing a cap.
MedPAC addressed several key issues around CAHs. The focus was addressing the high coinsurance costs at CAHs, which are currently based on hospital charges rather than Medicare payment rates. Commissioners proposed shifting coinsurance to 20% of payment rates and introducing a cap, similar to standard hospitals. These discussions will potentially lead to formal recommendations to Congress.
Timeline for changes are still under consideration. What you need to know:
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- There are discrepancies in cost-sharing between CAHs and standard hospitals
- There is a challenge of basing coinsurance on charges rather than costs, leading to higher out-of-pocket expenses for beneficiaries.
- Potential policy changes could include capping outpatient coinsurance or shifting it to a percentage of payment rates rather than charges.
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Prior Authorization: State legislatures imposing tighter rules.
While Congress appears stalled with its legislative proposals to streamline prior authorizations, many states have surged ahead and imposed tighter rules on health insurance companies.
According to a National Conference of State Legislatures database, 23 states enacted more than 43 bills related to prior authorization in the last few years, with 18 enacted so far in 2024 alone. In December, the American Medical Association surveyed doctors and found that 94% reported delays caused by precertification requirements and 19% said delays had caused hospitalizations.
CMS Â鶹Éçmadou noticed, and finalized a rule in January that requires speedier reviews of prior authorization requests under Medicare, Medicaid, the Children's Health Insurance Program and the health insurance exchanges, and the agency is considering further steps.
