News

Congressional Debates Could Derail Healthcare Spending Agenda

• Congressional lawmakers must pass another round of government funding before the start of the new fiscal year on October 1. House Republicans have released their proposal for a short-term continuing resolution to extend government funding for six months after October 1. This version includes provisions from the SAVE Act related to voting in federal elections. This proposal is unlikely to move forward due to disagreements with the SAVE Act provisions and the timeline for funding with House Democrats as well as the Senate. Many healthcare issues are highly expected to be addressed in an end-of-year package (Modern Healthcare, September 9; Politico Pro, September 10).

AMA Continues to Express its Opposition to MIPS Quality Measures

• In a September 5 letter to CMS regarding the 2025 Medicare physician pay rule, the American Medical Association (AMA) reiterated that the new quality measures are time consuming, costly, and are failing to properly reflect care provided to patients. AMA’s CEO, James Madera, spoke about how participating physicians can have their Medicare payments cut down by upwards of -9% and how the system unfairly punishes small, rural, and independent practices, adding to the existing health inequities. The AMA is urging CMS to retire the voluntary MIPS reporting program that runs until 2027 or instead make it mandatory and focus on the implementation of conditions-based reporting measures. The organization also hopes for Congress to pass the Data-Driven Performance Payment System (DPPS), which would replace MIPS (Inside Health Policy, September 5).

Eligibility Systems Overseen by Deloitte Continue to Cause Delays and Enrollment Issues While Costing States Millions

• In January, the National Law Health Program (NLHP) urged the Federal Trade Commission (FTC) to investigate Deloitte for “ongoing and nationwide errors and unfair and deceptive trade practices.” Since then, it has been found that the Deloitte-operated eligibility systems often experience errors that take years, and hundreds of millions of dollars, to update. Many of the states that Deloitte contracts with also use the systems to assess eligibility for other safety-net programs, including food benefits. Currently, Deloitte has contracts with 25 states to operate eligibility systems. These contracts are worth approximately $6 billion and cover 53 million enrollees. While Deloitte has stated that the allegations are “without merit,” many states, including Georgia and Tennessee, are awaiting fixes to the system while others are turning to the courts for assistance (KFF Health News, September 5).

Federal Regulation and Guidance

CMS Publishes New Templates, Instructional Guides for State Agencies to Confirm Compliance with Recently Finalized Mental Health Parity and Addiction Equity Act Requirements

• On September 9, CMS released an updated set of templates and instructional guides for state agencies to utilize when documenting mental health and substance use disorder (SUD) benefits in managed care programs, Medicaid alternative benefit plans (ABPs), and/or CHIP. The information is expected to regulate, simplify, and improve processes for states. CMS also informally requested comment to consider prior to finalizing these tools and will seek approval from the Office of Information and Regulatory Affairs in accordance with the Paperwork Reduction Act before delivering them for use (Medicaid.gov, September 9).

Final Rule Released for the Mental Health Parity and Addiction Equity Act

• On September 9, the U.S. Departments of Health and Human Services, Labor, and the Treasury released a new final rule implementing the Mental Health Parity and Addiction Equity Act (MHPAEA). The final rule amends certain provisions of the existing MHPAEA regulations and adds new regulations. Insurers must now evaluate and revise their non-quantitative treatment limitations (NQTL), including adequacy of provider networks, reimbursement for out-of-network providers and frequency of prior authorizations, to ensure compliance. The final rule closes a loophole that exempted state and local health plans from MHPAEA, which will extend the law’s protections to approximately 120,000 more individuals. The final rule reflects and addresses thousands of comments received from the public comment period on the proposed rules that were published on August 3, 2023 (Inside Health Policy, Fact Sheet, September 9).