Health Care Week in Review July 12, 2024

Health Care Week in Review: CMS Issues Calendar Year 2025 Proposed Medicare Payment Rules for Physicians and Hospitals

Below is Alston & Bird’s Health Care Week in Review, which provides a synopsis of the latest news in health care regulations, notices, and guidance; federal legislation and congressional committee action; reports, studies, and analyses; and other health policy news.


Week in Review Highlight of the Week:

This week, CMS issued the calendar year (CY) proposed 2025 Medicare Physician Fee Schedule (PFS) and Hospital Outpatient Prospective Payment System (OPPS) rules.


I. Regulations, Notices & Guidance

Event Notices

July 11-12, 2024: FDA announced a meeting entitled, Evaluating Immunosuppressive Effects of In Utero Exposure to Drug and Biologic Products. This is a hybrid meeting open to the public.

July 25, 2024: FDA announced a meeting of the Oncologic Drugs Advisory Committee. This meeting is open to the public.

August 2, 2024: FDA announced a meeting of the Genetic Metabolic Diseases Advisory Committee. This is a virtual meeting open to the public.

August 6, 2024: FDA announced a workshop entitled, Artificial Intelligence (AI) in Drug & Biological Product Development. This is a hybrid workshop open to the public.

August 22, 2024: The Health Resources and Services Administration (HRSA) announced a meeting of the Advisory Council on Blood Stem Cell Transplantation. This is a virtual meeting open to the public.

August 26-27, 2024: CMS announced a meeting of the Advisory Panel on Hospital Outpatient Payment. This is a virtual meeting open to the public.

August 27, 2024: The Substance Abuse and Mental Health Services Administration (SAMHSA) announced a meeting of the Center for Substance Abuse Prevention National Advisory Council. This is a hybrid meeting open to the public.

August 28, 2024: SAMHSA announced a joint meeting of the SAMHSA National Advisory Council (NAC), the Center for Mental Health Services NAC, the Center for Substance Abuse Prevention NAC, the Center for Substance Abuse Treatment NAC; and the two SAMHSA advisory committees: Advisory Committee for Women’s Services (ACWS) and the Tribal Technical Advisory Committee (TTAC). This is a virtual meeting open to the public.

II. Hearings & Markups

  • On July 11, 2024, the Senate Committee on Aging held a hearing entitled, Health Care Transparency: Lowering Costs and Empowering Patients. Witnesses included: Dr. Chris Whaley, PhD, Associate Director of the Center for Advancing Health Policy through Research, Associate Professor of Health Services, Policy and Practice, Brown University School of Public Health; Chris Deacon, JD, Principal Owner, VerSan Consulting, LLC; Cora Opsahl, MBA, Health Fund Director, 32BJ Health Fund; and, Sophia Tripoli, MPH, Senior Director of Health Policy, Families USA.

III. Reports, Studies, & Analyses

  • On July 2, 2024, the Kaiser Family Foundation (KFF) released an issue brief entitled, In 2024, A Majority of States Offer Medicare Advantage Plans to Their State Retirees, with 13 Offering Medicare Advantage Exclusively. The report found there has been a significant shift towards Medicare Advantage (MA) plans among states offering health benefits to Medicare-age retirees in 2024. Nearly all states and the District of Columbia provide health benefits to their Medicare-age retirees, with only Idaho and Nebraska not offering such benefits. Notably, 13 states now exclusively offer MA plans to their retirees, an increase from eight states in 2016. According to the issue brief, this shift is driven by the potential for cost savings and simplified administration for MA plans. Meanwhile, 21 states and DC offer a combination of MA and supplemental plans that wrap around traditional Medicare, providing retirees with more options. However, the number of states offering only supplemental plans has decreased. This trend reflects the growing preference for MA plans, which typically offer lower premiums and more comprehensive benefits, despite potential tradeoffs such as limited provider networks and the use of utilization management tools.

IV. Other Health Policy News

  • On July 1, 2024, the Biden Administration announced the availability of over $200 million to enhance geriatric care, particularly for those with Alzheimer’s disease and related dementias. This funding, managed by HRSA, will support 42 programs across the nation, focusing on training primary care providers to deliver age-friendly and dementia-friendly care. Additionally, the initiative aims to equip families and caregivers with the necessary skills to support their aging loved ones effectively. In his statement, HHS Secretary Xavier Becerra emphasized the administration's dedication to building a skilled healthcare workforce to meet the growing needs of older adults. This effort is part of a broader Health Workforce Initiative to improve workforce recruitment, retention, and career advancement, aligning with the National Plan to Address Alzheimer’s Disease. The program aims to ensure that primary care providers can identify and address the unique needs of older patients, providing comprehensive support to over six million Americans living with Alzheimer’s and their caregivers. A press release with more information is available here.
  • On July 8, 2024, the Biden Administration announced $27.5 million in funding opportunities to improve women’s behavioral health across the United States, as part of efforts led by SAMHSA. This funding aims to expand access to mental health and substance use services and enhance provider capacities to address these issues, particularly for pregnant and postpartum women. As part of this initiative, nearly $1 million has been awarded to support residential treatment services for this demographic. These investments, funded through the American Rescue Plan (ARP), will support programs like the Community-Based Maternal Behavioral Health Services Program and the Women’s Behavioral Health Technical Assistance Center. These initiatives aim to provide timely, culturally relevant care and strengthen community referral pathways for at-risk women, as well as enhance the capacity of providers to implement evidence-based practices. A press release with more information is available here.
  • On July 10, 2024, CMS released the CY2025 PFS Proposed Rule addressing updates and changes to the Medicare program, aimed at improving healthcare efficiency, accessibility, and quality. In the rule, CMS proposes changes to drug payment policies, notably under the Medicare Prescription Drug Inflation Rebate Program, affecting both Part B and Part D drugs. This includes clarifications on rebate calculations and exclusion criteria for certain drugs, potentially impacting how these medications are priced. The rule also proposes continued reimbursement for telehealth services, via audio-only communication, for any telehealth service furnished to a beneficiary in their home if the distant site physician or practitioner is technically capable of using an interactive telecommunications system but the patient is not capable of, or does not consent to, the use of video technology. Additional key updates involve payment guidelines for dental services linked to specific medical services and changes to the Medicare Shared Savings Program (MSSP) to enhance savings and care coordination. Other provisions include expanded Medicare coverage for opioid use disorder treatments provided by opioid treatment programs, and policy updates for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs). The rule also includes revisions to the Ambulance Fee Schedule and Clinical Laboratory Fee Schedule regulations and expanded coverage for colorectal cancer screening and Hepatitis B vaccines. Comments to the rule are due by September 9, 2024. The text of the proposed rule is available here. A fact sheet is available here.
  • On July 10, 2024, CMS released the CY2025 OPPS Proposed Rule. The 984-page annual proposed rule includes numerous proposals, including to revise the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) payment system for CY 2025. CMS also proposes numerous updates including, but not limited to: (1) modification of the “Four Walls” rule to allow, in part, federal reimbursement for services provided outside a behavioral health clinics and services provided by clinics in rural areas; (2) creation of new Conditions of Participation (CoP) for hospitals and critical access hospitals (CAH) that provide obstetrical (OB) services; and (3) separate payment for any diagnostic radiopharmaceutical with a per day cost greater than $630. Comments to the rule are due by September 9, 2024. The text of the rule is available here. A fact sheet is available here.

View our Health Care Legislative & Public Policy team.

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