News

DOJ Creates New Task Force to Focus on Healthcare Monopolies

• The U.S. Department of Justice (DOJ) has established a new task force, the Antitrust Division’s Task Force on Health Care Monopolies and Collusion (HCMC), that will take on healthcare monopolies and collusion and guide the division’s enforcement strategy and policy approach in healthcare. HCMC will facilitate policy advocacy, investigations, and civil and criminal enforcement in healthcare markets. The goal of the task force is to ensure that monopolies and bad actors are being held accountable for violations of the antitrust laws in the healthcare space. HCMC will be led by Katrina Rouse, a longtime antitrust prosecutor who joined the Antitrust Division in 2011. The HCMC has set up a website HealthyCompetition.gov where the public can share information or concerns about the healthcare system (Fierce Healthcare, May 9; Healthcare Finance, May 13).

Biden Administration Looking to Implement Minimum Cybersecurity Standards for Hospitals

• At the Bloomberg Tech Summit on May 9, Anne Neuberger, the deputy national security advisor for cyber and emerging technology, announced that the Biden administration will soon release rules requiring hospitals to meet minimum cybersecurity standards. This announcement comes in the wake of the Change Healthcare cyberattack, which exposed the healthcare data of 100 million individuals. Additionally, the Biden administration will offer free cybersecurity training to approximately 1,400 small, rural hospitals in the coming weeks (Modern Healthcare, May 9).

Federal Legislation

House Ways & Means Committee Advances Bill to Extend Medicare Telehealth and More

• On May 8, the House Ways & Means Committee advanced legislation to continue Medicare telehealth flexibilities through 2026 and the hospital at home demonstration through 2029. The bill also includes the extension of some Medicare programs for rural and low-volume hospitals and add-on payments for emergency ambulance services through September 30, 2025. To cover these costs, the bill relies on pharmacy benefit manager (PBM) reforms for companies working with Medicare Part D plans and extends pay cuts to clinical labs and hospice. Although official estimates from the Congressional Budget Office are not available yet, committee staff preliminary estimates suggest that the PBM reforms will save the federal government up to $700 million. Several other bills were also sent to the House that aim to assist rural hospitals such as boosting ambulance payments, increasing grants, and requiring a set percentage of graduate medical education training slots go to rural hospitals. Despite overall bipartisan support, some lawmakers were concerned about potential increases in premiums or the lack of safeguards for fraud and abuse (Inside Health Policy, May 8; Modern Healthcare, May 8).

Kansas Senator Plans to Reintroduce MA Prior Authorization Bill

• Senator Roger Marshall (R-KS) plans to reintroduce a bipartisan bill aimed at streamlining Medicare Advantage prior authorization. A similar bill previously passed in the House in 2022 but stalled in the Senate due to high costs. Senator Marshall believes that this bill could see success this year, as cost wouldn’t be an issue, due to CMS’ finalization of the prior authorization rule earlier this year. Senator Marshall believes this bill will further aid Medicare patients and help regulate prior authorization within the private sector, especially regarding prescription drug access (Inside Health Policy, May 8).

Federal Regulation and Guidance

CMCS Extends Unwinding Flexibilities through June 2025

• On May 9, CMCS released an Information Bulletin (CIB) announcing the extension of unwinding flexibilities available through 1902(e)(14)(A) Waivers, verification plan addendums, and regulatory timeliness exceptions, through June 30, 2025. This extension comes as states across the country continue to struggle with the unprecedented volume of renewals and associated administrative burdens beyond their control. KFF analyses estimate that 21 million Medicaid enrollees have been disenrolled so far, and that 70% of these disenrollments are due to procedural reasons or administrative error. The CIB notes that once certain provisions within the “Streamlining the Medicaid, Children’s Health Insurance Program, and Basic Health Program Application, Eligibility Determination, and Renewal Processes” rule become effective on June 3, states will no longer need a waiver to update beneficiary contact information from managed care plans and the U.S. Postal Service National Change of Address database and mail forwarding service. Additionally, the CIB also points out that the rule also repealed the requirement that beneficiaries apply for other benefits to qualify for Medicaid (CMS, May 9; Inside Health Policy, May 9).

CMCS Releases Informational Bulletin Encouraging States to Improve Access to Mental Health and Substance Use Disorder Services for Medicaid and Chip Individuals Experiencing Homelessness

• On May 10, the Center for Medicaid and Chip Services (CMCS) released an Informational Bulletin (CIB) detailing and encouraging states to use the various opportunities available to improve access to care and services for people experiencing homelessness, specifically related to mental health and substance use disorder (SUD) services. CMS urges states to expand efforts to provide mental health and SUD treatment and support services to eligible Medicaid and CHIP beneficiaries. The CIB highlights more recent Medicaid and CHIP coverage and payment opportunities including the Certified Community Behavioral Health Clinic (CCBHC) demonstration, various state plan and Section 1115, 1915(b) and 1915(c) waivers, and managed care in-lieu of services and settings. The document also includes references to additional guidance documents and resources for states relating to evidence-based strategies, like the ones listed in the CIB, to improve outcomes for individuals with mental health and SUD challenges, especially for those who are experiencing or at risk of homelessness (CMS, May 10).