US lawmakers recently advanced a broad healthcare bill during a US House Energy & Commerce Health Subcommittee markup. In this Health Policy Breakroom podcast episode, McDermott+Consulting’s Debra Curtis and Rodney Whitlock break down the markup and address extenders, PBMs, site-neutral policies and the timing of this bill.
At a recent open Commission meeting, the Federal Trade Commission (FTC) voted unanimously to issue a Notice of Proposed Rulemaking to amend the Health Breach Notification Rule (HBNR). The FTC’s proposed amendment aims to codify the HBNR’s application to digital health and mobile technologies. However, several aspects of the proposed amendment lack clarity and are likely to cause confusion unless further clarified through the ongoing rulemaking process.
The US Department of Health and Human Services Office of the Inspector General (HHS OIG) recently unveiled a new toolkit that seeks to help analyze telehealth claims for federal healthcare program integrity risks. It is based on methodologies highlighted in OIG’s September 2022 data brief; the data brief identified billing practices by Medicare providers that OIG was concerned posed a high risk to program integrity. OIG intends for the toolkit to be used by public and private parties—including Medicare Advantage plan sponsors, private health plans, State Medicaid Fraud Control Units and other federal healthcare agencies—to assess program integrity risks and identify providers whose billing may warrant further scrutiny.
Members of Congress could call for more transparency about how hospitals use their federal drug discount program savings. According to this Bloomberg Law article, a study found that the Health Resources and Services Administration’s oversight of the 340B program could be improved. McDermott Partner Emily Jane Cook said there is interest in Congress overseeing aspects of hospitals, including the 340B program.
“I wouldn’t be surprised to see a bill being introduced that imposes more explicit oversight requirements,” Cook said.
Reproduced with permission. Published May 15, 2023. Copyright 2023 by Bloomberg Industry Group, Inc. (800-372-1033) http://www.bloombergindustry.com.
Medicare Advantage (MA) plans are facing both regulatory and business risks following the conclusion of the COVID-19 Public Health Emergency (PHE). What are the major MA flexibilities and requirements related to the pandemic, and have they ended along with the PHE?
The Internal Revenue Service (IRS) recently issued a Chief Counsel Advice memorandum to remind sponsors of health and dependent care flexible spending arrangements (FSAs) about their responsibility to adequately substantiate claims in order to receive favorable tax treatment under Section 125 of the Internal Revenue Code (the Code). The IRS emphasizes that the standards for substantiation are stringent, and employers who fail to comply will face significant and undesirable consequences. The memorandum also provides a helpful overview of the relevant laws, illustrated through six examples of claims practices.
For decades, promoters have marketed programs to employers seeking to leverage the favorable tax treatment accorded employer-provided medical benefits. These programs are variously described as “wellness” or “preventive services” arrangements, and they are usually wrapped in or offered with hospital indemnity policies. While varying in their design features and terminology, these programs all hold out the promise of outsized income and/or payroll tax savings. But can these programs deliver on that promise?
In a new article published by the American Staffing Association, McDermott’s Alden J. Bianchi and American Staffing Association Senior Counsel Edward Lenz express their view that any such health program that claims to achieve material payroll tax savings exposes adopting employers to a significant risk of violating federal tax and other laws.
On May 3, 2023, the Centers for Medicare & Medicaid Services (CMS) published the proposed rule Medicaid Program; Ensuring Access to Medicaid Services. The aim of the proposed rule is to enhance transparency in payment rates, establish uniformity in data and monitoring and provide states with fresh avenues to encourage the active involvement of beneficiaries in their Medicaid programs. These efforts are aimed at enhancing access to care. The rule places a special emphasis on home and community-based services (HCBS), encompassing mandates for direct care worker compensation, the development of grievance processes, defining critical incident reporting and implementing HCBS quality reporting measures.
As lawmakers race to put together a debt ceiling deal, Republicans and Democrats are working on healthcare legislation that they believe could have bipartisan support. According to this InsideHealthPolicy article, the potential legislation could include limited site-neutral pay expansions and duals reform.
The Centers for Medicare & Medicaid Services recently unveiled plans to toughen its hospital price transparency enforcement. According to this InsideHealthPolicy article, these proposals include earlier and automatic civil penalties, eliminating warning notices for hospitals that have not attempted to comply with price transparency requirements and giving hospitals no more than 45 days to implement a corrective action plan.
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