News Briefs: Biden administration will apply closer scrutiny to healthcare billing practices

The White House in April announced steps to try to lessen the burden of medical debt on patients and families, including holding providers and debt collectors accountable for harmful actions.

Part of the effort is a U.S. Department of Health and Human Services (HHS) initiative to evaluate how providers’ billing practices affect healthcare access and affordability along with the accrual of medical debt.

To make the assessment, HHS will request data from more than 2,000 providers on:

• Medical bill collection practices
• Lawsuits against patients
• Financial assistance
• Financial product offerings
• Third-party contracting or debt-buying practices

According to a Biden administration fact sheet, HHS will “weigh this information in their grantmaking decisions, publish topline data and policy recommendations for the public, and share potential violations with the relevant enforcement agencies of jurisdiction.”

In addition to the scrutiny on providers, the Consumer Financial Protection Bureau will “investigate credit-reporting companies and debt collectors that violate patients’ and families’ rights and [will] hold violators accountable,” the fact sheet states.

Tentative deal to provide pandemic funding won’t replenish the COVID-19 Uninsured Program

The fate of the COVID-19 Uninsured Program appeared to be sealed after a bipartisan agreement was reached to fund pandemic-related supplies but not anything related to provider payments.

Senate Republicans and Democrats agreed March 31 on the contours of a bill that would provide $10 billion for therapeutics and vaccines but would not fund the COVID-19 Uninsured Program. The bill had not passed either chamber when hfm went to press.

Barring last-minute changes to the bill, providers are on the hook for the costs of administering vaccines to patients who have no insurance coverage. The terms and conditions of the federal vaccination program prohibit billing individuals for vaccine-related services.

At the provider’s discretion, uninsured patients can be billed for COVID-19 tests and treatments such as antivirals and monoclonal antibodies now that the federally funded program is out of money.

In some states, uninsured patients automatically become eligible for Medicaid coverage when receiving COVID-19-related testing. The Families First Coronavirus Response Act allowed states to implement that option starting in 2020 and receive federal funding to cover the additional costs.

According to the Kaiser Family Foundation’s tracker, 15 states had incorporated that option, which will cease to be available upon the expiration of the public health emergency.

Healthcare spending projections for the 2020s reflect an expectation of steadying trends

CMS actuaries released healthcare spending projections for the remainder of this decade, estimating that spending increases largely will moderate and return to something close to normal over the next couple of years.

By around 2024, “Economic and demographic factors are anticipated to reemerge as the most influential drivers of health-sector trends,” the actuaries wrote in their report, which was published in Health Affairs and for which data are available on the CMS website.

Total healthcare spending is projected to increase by an average of 5.1% per year through 2030. That’s the same annual growth rate projected for GDP, meaning healthcare spending as a share of GDP would stay essentially flat at 19.6%.

The stability of those numbers is a marked change from 2020, when healthcare spending jumped by 9.7% and — with the overall economy simultaneously contracting — the share of GDP taken up by healthcare spending rose from 17.6% to 19.7%. With healthcare utilization declining, the big driver of the accelerated spending that year was federal funding through the Provider Relief Fund, Paycheck Protection Program and public health programs.

Medicare confirms plans to exclude coverage of new Alzheimer’s drug in most scenarios

CMS issued a final Medicare coverage determination for the Alzheimer’s drug Aduhelm, mostly sticking with the proposed criteria issued in January. The decision restricts coverage in most healthcare encounters in response to widespread concerns about the drug’s safety and effectiveness that arose leading up to the FDA’s accelerated approval in June 2021.

The decision finalizes a proposal to cover Aduhelm, a monoclonal antibody treatment that’s directed against amyloid for the treatment of Alzheimer’s disease, in clinical trials approved by CMS.

In an expansion of the proposed criteria, Aduhelm and future monoclonal antibody treatments designed to reduce amyloid also can be covered in trials that are conducted under an “investigational new drug” application as authorized by the FDA or National Institutes of Health. Such studies would be permissible when drugs are approved on an accelerated basis, as Aduhelm was.

CMS removed proposed restrictions on clinical-trial coverage that would have excluded some key patient populations, such as patients with neurological conditions other than Alzheimer’s disease, and also removed the requirement that all trials be conducted in a hospital-based outpatient center.

CMS issues FY23 proposed payment rules for hospices, IPFs and IRFs

CMS in late March released proposed regulations governing FY23 prospective payments to hospices, inpatient psychiatric facilities (IPFs) and inpatient rehabilitation facilities (IRFs).

In each of the rules, the biggest news arguably is the proposed implementation of a permanent budget-neutral approach to “smoothing” annual changes in the wage index. Specifically, a provider’s wage index could decrease by no more than 5% from the prior year.

The provisions could foreshadow a similar accommodation in the rule for FY23 hospital inpatient payments as CMS seeks to stabilize wage metrics after a tumultuous period brought on by the pandemic. The proposed rule for inpatient payments was expected to be published by late April.

For organizations that meet quality-reporting requirements, the proposed payment increases for FY23 are 2.7% for hospices and IPFs and 2.8% for IRFs. The comment period runs through May 31 for all three rules.