Becerra Shoots Down Giving More than 60 Days Notice on Ending COVID-19 Public Health Emergency

Fierce Healthcare / By Robert King
 
Giving more than 60 days notice that the COVID-19 public health emergency will end is going to be difficult, as states and lawmakers have pressed for a longer heads-up, according to Department of Health and Human Services (HHS) Secretary Xavier Becerra.

The secretary spoke with reporters Friday during a press conference that included remarks on the status of unwinding the public health emergency (PHE) and how the agency’s COVID-19 relief efforts will be impacted if Congress doesn’t approve additional funding. 

The healthcare industry and states are waiting to find out when the PHE will end and with it the loss of key flexibilities for telehealth reimbursements and the start of eligibility redeterminations for Medicaid. 

The current PHE is scheduled to expire April 16 and will likely be extended again for 90 days. HHS has promised to give at least a 60-day notice when the PHE will expire for good. 

However, Republicans in Congress, payer groups and states have asked for more advance notice to get ready for the unwinding of the PHE. Several hospital groups have also asked for more notice as they must prepare for the end of the PHE’s requirement that Medicaid programs not disenroll beneficiaries. 

Becerra conceded, though, to reporters that it is “tough to give much more than 60 days” notice. 

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President Signs Omnibus Spending Bill

The Health Group

Last week President Biden signed into law a $1.5 trillion spending package, referred to as an “Omnibus Spending Bill”.  The legislation will fund the government through September 2022.  The Bill also provides significant financial assistance to Ukraine.

For hospices, the Bill includes an extension of the flexibility for hospices to meet the requirement for a face-to-face visit for recertification of eligibility through a virtual visit for 151 days after the end of the COVID-19 PHE.  This face-to-face flexibility was part of the CARES Act in 2020.  The PHE, expected to end this summer, will allow this flexibility to continue for an additional 151 days or until December 2022.

The bill also contains a one-year extension, from FY2030 to FY2031, of the existing formula used in calculating the annual update to the hospice aggregate limitation (“CAP”). 

Unfortunately, the legislation does not include any extensions of the Medicare sequester moratorium. The sequester, suspended during the PHE, is effective April 1, 2022, with a one percent (1%) reduction in Medicare payments.  The sequester will be a two percent (2%) reduction in Medicare payments starting July 1, 2022.  

HOSPICE MEDICARE ADVANTAGE APPLICATIONS RELEASED

CMS has published information needed for Medicare Advantage Organizations (“MAOs”) interested in participating in the Hospice Benefit Component of the VBID Model, including the scope of the benefit, as well as policies relating to the quality, networking, and payment policies.  Additional information is available at Medicare Advantage Value-Based Insurance Design Model | CMS Innovation Center and VBID Model Hospice Benefit Component Overview | CMS Innovation Center.

CMS will be hosting a session on Tuesday, April 5, 2022, to discuss the Medicare Advantage Value-Based Insurance Design (“VBID”) Model and its Hospice Benefit Component.  Information is available at Office Hours: 2023 Medicare Advantage Value-Based Insurance Design Model and its Hospice Benefit Component | CMS Innovation Center. 

Home- and Community-Based Services Are a Safe Bet

McKnight’s Home Care / By Liza Berger

If you like to gamble and know a thing or two about post-acute care, it seems pretty clear where to put your money at this point: home- and community-based services (HCBS).

Two developments in recent days helped make that case. One is a new report from the Kaiser Family Foundation, which found that the realignment of long-term services and supports (LTSS) toward HCBS keeps moving in that direction. In fiscal year 2019, the most recent year in which data are available, HCB LTSS made up 59% of total spending — the highest to date — while institutional LTSS comprised 41% of total spending. The gulf has continued to widen since fiscal year 2013, when HCBS surpassed institutional care in the share of LTSS dollars.

Another, perhaps even more significant indication came from a key source: Jennifer Bowdoin, Ph.D., director of the Division of Community Services Transformation for the Centers for Medicare & Medicaid Services. During a session this week of the legislative and regulatory conference of the National Association for Long Term Services and Supports, she pointed out that there is strong legislative and regulatory momentum toward home- and community-based services. The reasons by now are clear. It is where people want to receive services and it has proven to be less costly than institutional care.

As an example, states are using the funds designated from Section 9817 of the American Rescue Plan to bolster their HCBS. It is estimated they are spending $25 billion on HCBS from the investment. For those that need more of an incentive to grow HCBS, there is a ripe carrot dangling in the form of the Money Follows the Person demonstration program, which offers a higher reimbursement rate and more flexibility to provide additional HCBS services, she pointed out.  

All of this is probably not new to home care providers, who have to be in-the-know on state funding and rules regarding services. But it’s nice to see that when it comes to healthcare policy and payments, there’s no place like home.

Study: Value-Based Care Lowers Hospitalizations, ER Visits in Medicare Advantage

Fierce Healthcare / By Paige Minemyer 
 
Value-based care can drive down acute care episodes such as hospitalizations and emergency room visits among Medicare Advantage beneficiaries, a new study shows.

The research, published in JAMA Network Open and led by analysts at Humana and Harvard, found MA members treated by doctors in advanced value-based care models saw 5.6% fewer hospitalizations and 13.4% fewer emergency department visits compared to those treated in fee-for-service arrangements.

Value-based care models have been adopted in Medicare Advantage more rapidly than in traditional Medicare, Medicaid and commercial insurance.

"This is just more ammunition that value-based care works," said William Shrank, M.D., chief medical officer at Humana and one of the study's authors, in an interview with Fierce Healthcare.

Humana has seen notable success within its own member population through value-based care. In its most recent value-based care report, the insurer found that the members enrolled in its value-based care programs had a 60% lower risk of readmission after 30 days.

A majority (67%) of Humana members are cared for by a provider in a value-based care arrangement, according to the report.

Shrank said that while the insurer has tracked its own internal data for some time, Humana wanted to build the volume of evidence further with data that could be published in a peer-reviewed journal like JAMA. Participating in value-based care is not a simple or easy process for many providers, so having that database may make the pitch a bit easier, he said.

Having a rich collection of data can also be a valuable asset in continuing to iterate on existing models, making them work better for members, Shrank said.

"I hope that we as an industry, as a sector do a better job of evaluating and understanding the impact of value-based care on the member," he said.