News

National Committee for Quality Assurance (NCQA) Updates Healthcare Effectiveness Data and Information Set (HEDIS) Measures for 2025

• Health plans will be required to report on three new measures starting in 2025: rates of documenting mammogram results; following up with patients after abnormal breast cancer assessments; and controlling blood pressure for individuals with hypertension. NCQA also intends to remove four measures, including the pain assessment indicator and antidepressant medication management, and will make changes to current measures. The new measures aim to better support minority populations that are at a higher risk for missing follow-up care after diagnosis or treatment for a health issue. Additionally, among the changes in other measures, NCQA has opted to remove the data source reporting requirement for measures stratified by race and ethnicity for 2025 due to the administrative burden it places on health plans, though plans scored high on this measure in 2024, the first year it was included (Modern Healthcare, August 2).

Former HHS Secretaries Sebelius and Azar Advocate for Medicare Site-Neutral Policies

• Medicare site-neutral payment reforms could fund major policy priorities for either political party according to previous HHS secretaries speaking at an event hosted by the Paragon Health Institute. Previously, the Committee for a Responsible Federal Budget (Committee) estimated that site-neutral payment reforms could reduce Medicare spending by $153 billion and reduce cost sharing and premiums for beneficiaries by $94 billion. Additionally, the Committee stated that these reforms could reduce the federal budget deficit by $117 billion and disincentivize consolidation and facility fee bills. Former HHS Secretaries Sebelius and Azar wrote a joint opinion piece earlier this year in support of site-neutral requirements, though both expressed doubt that Congress would pass stand-alone legislation on the topic for several reasons including strong hospital provider opposition to site-neutral policies (Inside Health Policy, July 30; C-SPAN, July 29).

Health Resources and Services Administration (HRSA) Releases Top 10 Accomplishments for Health Centers

• The HRSA reviewed four years of health center outcomes in August 2024 and developed a top 10 achievements list. Health centers serve patients whether they have insurance or are able to pay for their care. The data found that 90% of patients seen had incomes of less than 200% federal poverty level (FPL). In 2023 alone, community health centers (CHCs) served over 31 million individuals, the highest number ever recorded and an increase of more than 2.2 million people since 2020. In addition to record patient growth, there has been an increase in school-based care, public housing outreach, and prenatal care expansions. These, coupled with increases in community health workers and healthcare training, cancer screening strides, HIV testing breakthroughs, mental health advancement, and clinical quality improvements round out the list of achievements CHCs have seen over the past four years (POLITICO Pro, August 6).

Federal Legislation

Senate Appropriations Bill Focused on SDOH and Rural Health Advances

• On August 1, the Senate Appropriations Committee advanced its FY2025 HHS spending bill on a bipartisan basis. The bill includes a focus on social determinants of health (SDOH) and funding for initiatives to diversify the healthcare workforce. Specifically, the health workforce budget for HRSA would increase from $1.40 billion to $1.41 billion and support programs at HRSA that improve the diversity of the healthcare workforce. The bill also includes $71 million for CDC public health workforce efforts including potential investment in fellowship and training programs for various types of professionals; $12.5 million for firearm injury and mortality prevention research; and a $21 million increase above the FY2024 enacted amount for various rural health initiatives (Inside Health Policy, August 5).

Federal Regulation and Guidance

CMS Releases Skilled Nursing Facility Prospective Payment System (SNF PPS) Final Rule

• On July 31, CMS released its SNF PPS final rule, which includes a 4.2% pay increase for skilled nursing facilities (SNF), amounting to $1.4 billion. Many stakeholders have expressed mixed feelings about the pay hike and their dissatisfaction with the additional civil monetary penalties (CMPs) tied to health and safety violations, arguing that CMPs take away from resources needed to improve support and address root causes that their residents need. The rule also adds four new SDOH reporting requirements to the SNF Quality Reporting Program for FY2027, including living situation, two food related measures and utilities (Inside Health Policy, August 1).

CMS Releases Final Rule on PPS, Finalizes TEAM Model

• On August 1, CMS released for public inspection its final rule, governing Medicare prospective payments for inpatient acute care hospitals and long term care hospitals. Inpatient acute care hospital payments will increase by 2.90% in FY2025, totaling a net $2.90 billion, up from the 2.60% originally proposed. Stakeholders remain critical, believing that the slight increase still does not adequately address rising costs and operational challenges. CMS also finalized the TEAM model, a five-year program aimed at improving care coordination during and after surgeries through bundled payments for five different surgical episodes, despite stakeholder concerns. Long term care hospitals will receive a 3% increase to the standard payment rate with payments expected to increase by $45 million. CMS will also implement a higher than normal increase in outlier thresholds to align with statutory requirements that payments are 8% of the total. Other proposals finalized in the rule are the extension of a 2020 policy to address wage index disparities affecting low-wage hospitals for an additional three years; a separate payment for small, independent hospitals to maintain and support their stock of essential medicines; an additional payment for housing insecurity; and an additional 200 residency positions funded by Medicare, half of which will be specifically for psychiatry or its subspecialties (Inside Health Policy, August 2).