News

Federal Legislation

Bipartisan, Bicameral Health Privacy Bill Proposed

• On April 7, the House Energy and Commerce Chair Cathy Rodgers (R-WA) and Senate Commerce Chair Maria Cantwell (D-WA) released draft federal privacy legislation. The bipartisan legislation sets national standards for data privacy rights and establishes measures to enforce violations of the law, including a private right to action for individuals. Previous attempts at privacy legislation have failed, but the new draft legislation does not overturn existing state laws around the privacy of health information, medical information, medical records, or HIV status and testing. Instead, federal preemption would occur in other privacy areas. In the draft legislation, the Federal Trade Commission is established as the federal privacy enforcer, including enforcement of requirements relating to health information (Inside Health Policy, April 7).

Hearing on the Change Healthcare Cyberattack Coming Up

• The Senate Finance Committee plans to hold a hearing in the next several weeks to discuss “lessons learned” from the Change Healthcare cyberattack that took place in February. The hearing will delve into topics relating to possible legislation or regulations to improve the response system in case of another cyber emergency (Inside Health Policy, April 4).

Federal Regulation/Guidance

CMS Releases Enrollment, Eligibility, and Renewal Processes Final Rule

• CMS released a final rule on April 2, 2024, titled, “Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, Enrollment, and Renewal Processes.” This final rule is intended to reduce barriers to enrollment and improve retention in Medicaid, CHIP, and the Basic Health Program (BHP). The final rule was first proposed in September 2022 and includes several provisions to streamline enrollment and provide for more simplified transitions between these programs in response to President Biden’s Executive Orders from January 2021 and April 2022 (CMS, and CMS, March 27).

CDC Releases Health Alert Informing Public about Recent Avian Flu Infection

• On April 5, the CDC released a health alert to inform the public about the human avian flu infection that occurred in Texas. The alert included background information on the individual who tested positive for the virus and recommendations concerning the virus for clinicians, state health departments, farmers, live-stock owners, and the general public. The CDC has stated that it will work with the FDA, the Department of Agriculture, and state health departments to monitor those actively exposed to animals with the virus. Currently, there is limited knowledge regarding how infectious the virus is and whether available vaccines are effective in protecting individuals against it (Inside Health Policy, April 8).

Notice of Benefit and Payment Parameters for 2025 Final Rule is Published

• CMS released the Notice of Benefit and Payment Parameters for 2025 final rule on April 2, 2024, for Qualified Health Plans. The final rule allows states to provide routine adult dental services as an essential health benefit (EHB) starting January 1, 2027. The final rule also makes changes to certain EHB prescription drug benefit requirements, including requiring Pharmacy and Therapeutics Committees to have at least one patient representative. CMS has also codified current policy that prescription drugs covered by a plan in excess of a state’s benchmark plan are considered EHBs. The final rule also creates network adequacy standards for Marketplace health plans on the federal platform by limiting how far and long a consumer must travel to see certain providers. Special enrollment periods have been extended for consumers with household incomes at or below 150% of the FPL, and the dates of Open Enrollment periods across almost all Marketplaces have been aligned to generally begin on November 1 and end no earlier than January 15. The final rule also provides states flexibility in establishing an effective date of eligibility for enrollment in BHP coverage. Finally, the final rule codifies the reinterpretation of the State Marketplace and State Medicaid and CHIP agencies’ use of the Federal Data Services Hub so that the access and use of data provided by the Verify Current Income (VCI) Hub service is considered a state agency function. State Exchanges and State Medicaid and CHIP agencies will be required to pay to access and use the VCI Hub service starting July 1, 2024 (CMS, April 3; CMS, April 2; CMS, April 2).

CMS Releases Final Rule Greatly Impacting Medicare Advantage

• On April 4, CMS released a final rule that revises the Medicare Advantage (MA) Program, Medicare Part D, Medicare Cost Plan Program, PACE, Health IT Standards and Implementation Specifications. A few key provisions of the final rule include fixed rates for brokers, prohibitions of contracts between MA organizations and third-party marketing companies, a new outpatient behavior health provider category that includes mental health counselors, marriage and family therapist, opioid treatment centers, mental health centers, addiction medicine physicians, nurse practitioners and physician assistants, and limits for out-of-network cost sharing for D-SNP PPOs (CMS, April 4; Fierce Healthcare, April 5).

Federal Studies and Reports

Mayo Clinic Study Finds that Patients in Rural Areas with COVID-19 Had Higher Susceptibility to Hospital Re-Admission and Death

• A recent study by the Mayo Clinic has found that, patients with COVID-19 living in rural areas experienced greater rates of hospital re-admission and loss of life following hospitalization compared with those residing in urban areas, even after the roll out of multiple vaccinations and booster shots. The study results point to gaps in access to high-quality and comprehensive healthcare among the individuals residing in rural areas, specifically in the realms of post-acute, primary, and specialty care (Axios, April 9; Oxford Academic, April 2024).