(Sept. 15, 2023) – CMS Issues Fact Sheet on Process for the First Round of Medicare Drug Price Negotiations
The Centers for Medicare and Medicaid Services issued a Fact Sheet with Information on the process for the first round of negotiations for the Medicare Drug Price Negotiation Program. The fact sheet includes information about how drugs were selected for the first cycle of negotiations, what the process is, more information about the negotiations and a flow chart of the process. The first round of negotiations is anticipated to occur during 2023 and 2024, with resulting negotiated prices effective beginning in 2026. The U.S. Department of Health and Human Services announced in late August the first ten drugs selected for Medicare price negotiation.
CMS Issues Proposed Minimum Staffing Standards for Long-Term Care Facilities
The Centers for Medicare & Medicaid Services released proposed regulations setting minimum staffing requirements within long-term care facilities. The proposed rule would set the staffing ratio for registered nurses at 0.55 hours per resident per day, require an RN onsite 24 hours a day, and 2.45 HPRD for nurses aides. CMS noted the proposed rule would cost approximately $32 million in year one, $246 million in year two, $4 billion in year three and they expect costs to increase by $5.7 billion by year 10. CMS further estimates the total cost throughout 10 years will be $40.6 billion. Of note, CMS states, "LTC facilities would be expected to bear the burden of these costs unless payers increase rates to cover the cost." Comments about the rule are due by Monday, Nov. 6.
CDC Issues Health Advisory for Increased RSV Activity in Southeastern U.S.
The Centers for Disease Control and Prevention issued a health advisory following increased Respiratory Syncytial Virus activity in the Southeastern United States. Historically, regional increases like this have predicted the beginning of RSV season with a spread to the north and west throughout the following three months. The CDC is encouraging providers to prepare to provide new RSV monoclonal antibody products to protect infants, along with the new vaccine for adults ages 60 years and older.
CMS Warns States about Improperly Ending Kid's Medicaid Coverage
The Centers for Medicare & Medicaid Services sent a strongly-worded letter to states directing them to take corrective action to ensure children are not being removed unnecessarily from coverage when other members of the family are ineligible. Children have higher income eligibility standards than adults, so it's likely children will continue to be eligible for coverage even if adults in the family are not. DSS reports its automated system and review processes have been corrected and it complies with the requirements of the CMS letter. Nonetheless, hospitals should be diligent with respect to the state's eligibility determinations for their young patients.
CMS Releases OQR Manual Addendum 16.0b
The Centers for Medicare & Medicaid Services released addendum 16.0b to the Outpatient Quality Reporting Program specifications manual, effective with encounters Jan. 1 – Dec. 31, 2023, unless otherwise specified. Changes are outlined in the associated release notes and include updates to the clinical data file layout and Appendix A, Table 7.01. The addendum is available on QualityNet.
MLN Connects Provider eNews Available
The Centers for Medicare & Medicaid Services issued the following updates to MLN Connects Provider eNews:
Before You Go ...
- September is National Recovery Month, which serves to highlight the gains achieved by those living in recovery, as well as the pathways forward for individuals still battling with an SUD. The tagline, "Every person. Every family. Every community," serves as a reminder that this disease is indiscriminate, and everyone impacted deserves equal access to care and treatment. Visit SAMHSA's Recovery Month Toolkit for ways to get your organization involved.
- A webinar for hospitals participating in the Inpatient Psychiatric Facility Quality Reporting Program is scheduled at 1:00 p.m. Tuesday, Sept. 19. Registration is required for the webinar, Fiscal Year 2024 IPF Prospective Payment System Final Rule and Annual Payment Update Determination.
- 2024 ORYX® requirements for chart-abstracted measures and electronic clinical quality measures for accredited The Joint Commission hospitals will be discussed in a TJC webinar scheduled at 11:00 a.m. Thursday, Oct. 12. Registration is required.
- The Administration for Strategic Preparedness and Response, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services and Office of the National Coordinator for Health Information Technology continue to work on hospital essential elements of information. This effort will gather information to provide recommendations for a standardized lens into the readiness of, stress on and resources available in hospitals before, during and after emergencies. The agencies are co-hosting the second round of listening sessions to review draft EEIs.
- AHA's Community Health Improvement network and its Institute for Diversity and Health Equity request a call for content for the 2024 Accelerating Health Equity Conference. For more information, visit the conference website.