Senate Appoints Brooks-LaSure as CMS Administrator; HHS Funds Pediatric Mental Health

May 26, 2021 - HHS is busy dispersing funds for pediatric mental health and COVID-19 testing for uninsured patients while under fire DGME payments. CMS gets a new administrator, delays final ruling after public comments show hesitancy, and reworks MIPS payments. Meanwhile, ONC efforts support health equity in IT.

Chiquita Brooks-LaSure Appointed CMS Administrator

Yesterday, the Senate confirmed Chiquita Brooks-LaSure as the new CMS Administrator, making her the first Black woman to lead the agency. Previously, Brooks-LaSure lead the implementation of the Affordable Care Act at HHS and most recently was the managing director of Manatt Health. In her new role, Brooks-LaSure will be responsible for overseeing the Medicare, Medicaid, and CHIP programs in an—almost—post-pandemic world. READ MORE

CMS Delays Final Ruling to “Define Reasonable and Necessary”

The Medicare Program; Medicare Coverage of Innovative Technology and Definition of ‘Reasonable and Necessary’ rule originally published in January 2021 has a new effective date of December 15. The rule intended to update the definition of ‘reasonable and necessary’ and present guidelines around the Medicare Coverage of Innovative Technology pathway, efforts that provide Medicare beneficiaries access to breakthrough medical technologies linked to the FDA’s Breakthrough Devices Program. But public comments raised concerns about coverage and payment for the innovative medical devices outlined in the rule. READ MORE

ONC Efforts Promote Health Equity

ONC recently announced its health IT demographic EHR certification requirements will work to standardize race and ethnicity data. The certification requires health IT to record race and ethnicity at the same level of detail as CDC’s Race and Ethnicity code technology, which includes over 900 concepts for race and ethnicity for precise self-identifying demographics. Technologies must be able to code multiple races and ethnicities in the EHR. ONC is calling for healthcare professionals to work with IT developers to implement a strategy to record race in a way that best fits the needs of its specific patient population. READ MORE

CMS Reweights MIPS Cost Performance Category

The lack of service utilization data in 2020 led CMS to reweigh the cost performance category of the Merit-Based Incentive Payment System (MIPS) from 15 percent to zero for performance year 2020. The Centers point to the COVID-19 pandemic’s impact on primary care visits as the cause for this change, worrying the skewed data could lead to inaccurate results. Points will be redistributed to other categories impacting reimbursement paid out to eligible clinicians in 2022. READ MORE

HHS Funding Supports Pediatric Mental Health, Uninsured  

HHS announced $14.2 million in American Rescue Plan funding to expand Pediatric Mental Health Care Access (PMHCA) projects. There are currently 21 PMCHA projects across the country, and the HHS announcement now makes these programs eligible for funding to support teleconsultations, training, technical assistance, and care coordination that increase children and adolescent access to mental health care. READ MORE

On May 25, HHS also announced $4.8 billion in supportive funding to the Health Resources and Services Administration’s COVID-19 Uninsured Program. The money will go toward reimbursing healthcare providers testing uninsured individuals for COVID-19. Since May 19, approximately $4 billion has been distributed to providers for this purpose. The program also supports access to COVID-19 treatment and vaccination for uninsured individuals. READ MORE

Congressional Bill Aims to Reduce Financial Burden of Telehealth Care

Last week, senators introduced the Telehealth Expansion Act of 2021. The bill would extend the temporary provision in the CARES Act that allowed first-dollar coverage for virtual care visits. If passed, telehealth visits would be exempt from certain high-deductible health plans, eliminating a large financial barrier to accessing care. Telehealth services covered under the bill would include rehab and therapy, behavioral health, and chronic disease management. The American Telemedicine Association and the Alliance for Connected Care are among several organizations in support of the bill. READ MORE

HHS Ordered to Recalculate Medicare DGME Payments

The US District Court of DC announced HHS unlawfully changed the weighting factors used for Medicare Direct Graduate Medical Education (DGME) payments. A group of five hospital plaintiffs argued their payments were unlawfully reduced and misalign with a Medicare statue—declaring a weighting factor of 1.00 for residents in their initial residency period and 0.5 for fellows. These weights are combined to determine the hospital’s number of full-time equivalents which in turn is used to inform payments. The court is now requiring HHS to recalculate the payments. READ MORE