Current Report Articles
Federal Focus

Federal Focus (June 19, 2020) – HHS Finalizes Implementing ACA Discrimination Prohibitions
The U.S. Department of Health and Human Services issued a final rule that implements Section 1557 of the Affordable Care Act prohibiting discrimination. The "final rule makes clear that the substantive protections prohibiting discrimination on the basis of race, color, national origin, disability, age, and sex remain in effect." The final rule also relieves approximately $2.9 billion in regulatory burdens throughout five years.

CMS New Outpatient Prior Authorization Process Begins July 1
The Centers for Medicare & Medicaid Services established a nationwide prior authorization process for certain services performed in hospital outpatient departments. CMS "believes prior authorization for certain hospital OPD services will ensure that Medicare beneficiaries continue to receive medically necessary care – while protecting the Medicare Trust Fund from improper payments." The process will apply to OPD services that are provided on or after July 1. The policy applies to 42 CPT codes that cover the following services:

  • Blephoraplasty
  • Botulinum toxin injections
  • Panniculectomy
  • Rhinoplasty
  • Vein ablation

HRSA Releases New Funding Opportunity to Address NAS in Rural Areas
The Health Resources and Services Administration’s Federal Office of Rural Health Policy released a Notice of Funding Opportunity for the Rural Communities Opioid Response Program-Neonatal Abstinence Syndrome. HRSA will award approximately 30 grants to rural consortia to reduce the incidence and impact of NAS. Successful RCORP-NAS award recipients will receive up to $500,000 throughout a three-year period of performance to conduct a combination of prevention, treatment and recovery activities designed to improve systems of care, family support and social determinants of health. While the focus of RCORP-NAS is primarily opioid use disorder, applicants also may choose to address additional substances of concern or substance use disorders among the target population. The target populations are pregnant women, mothers, and women of childbearing age who have a history of, or who are at risk for, SUD/OUD and their children, families and caregivers who reside in rural areas.

MLN Connects Provider eNews Available
The Centers for Medicare & Medicaid Services issued updates to MLN Connects Provider eNews. eNews includes information about national provider calls, meetings, events, announcements and other MLN educational product updates. The latest issue provides updates and summaries of the following:

  • HHS announces new laboratory data reporting guidance for COVID-19 testing
  • Trump administration encourages reopening of health care facilities
  • Prior authorization process and requirements for certain hospital OPD services: payment-related services

NRHRC Releases the Sustainable Care Coordination Guide and Workbook for Rural Organizations
The National Rural Health Resource Center released a sustainable community and care coordination guide and workbook to provide a framework for rural organizations to actively plan for the sustainability of their already established care coordination programs. The guide takes you through a process of identifying community organizations to increase the effectiveness of coordination, finding potential gaps in your care coordination process and developing partnerships for continued success. They recommend organizations utilizing the guide use the companion workbook to record their work as they move through the guide.

CMS Announces New File Submission Process
The Centers for Medicare & Medicaid Services announced a new and improved file submission process that allows hospitals to submit files directly within Hospital Quality Reporting on the QualityNet Secure Portal. The new process is available for the following programs:

  • Electronic Clinical Quality Measures
  • Inpatient Quality Reporting
  • Outpatient Quality Reporting
  • Hospital Consumer Assessment of Healthcare Providers

Additional details are available.