Regulatory Update – 6.24.22

Medicare’s Inpatient Payment Proposal: Stakeholder Letters

Click here to view PHA’s summary of Medicare’s fiscal year 2023 payment proposal (password: PHAMedicare).

Several stakeholder groups submitted comment letters to CMS. Click here to view the American Association of Orthopaedic Surgeons’ comment letter.

Medicare Advantage: OIG Finds Improper Prior Authorization Denials

The Office of Inspector General of the U.S. Department of Health and Human Services (OIG) released a report on April 27, 2022, finding:

  • Thirteen percent of Medicare Advantage Organizations (MAOs) denials of prior authorization requests should have been approved.
  • Eighteen percent of payment requests were improperly denied.

Updated CMS Survey Memos

CMS announced on June 14, 2022, that it is altering the requirement of state surveyors to check staff vaccinations at facilities:

“While State Survey Agencies (SAs) may expand any survey to include vaccination requirement compliance for non-deemed providers and suppliers and those deemed by Accrediting Organizations with CMS-approved programs (AOs) (with authorization from the appropriate CMS location), SAs and AOs will now only be expected to perform compliance reviews of the staff vaccination requirement during initial and recertification surveys and in response to specific complaint allegations that allege non-compliance with the staff vaccination requirement. SAs and AOs are no longer expected to perform these reviews on every survey. This reduction in survey frequency is in keeping with the normal process for oversight of any Medicare requirement, and is supported by the high rates of compliance in initial surveys.”

Audio-Only Telehealth Guidance: Office of Civil Rights

The U.S. Department of Health and Human Services’ Office of Civil Rights (OCR) recently offered guidance on audio-only telehealth as it relates to HIPAA.

The guidance addresses four issues:

  • Does the HIPAA Privacy Rule permit covered health care providers and health plans to use remote communication technologies to provide audio-only telehealth services?
  • Do covered health care providers and health plans have to meet the requirements of the HIPAA Security Rule in order to use remote communication technologies to provide audio-only telehealth services?
  • Do the HIPAA Rules permit a covered health care provider or a health plan to conduct audio-only telehealth using remote communication technologies without a business associate agreement in place with the vendor?
  • Do the HIPAA Rules allow covered health care providers to use remote communication technologies to provide audio-only telehealth if an individual’s health plan does not provide coverage or payment for those services?

AMA & FSMB Look at Flexibility for Interstate Telemedicine Policy

The Federation of State Medical Boards updated its telemedicine policy in April 2022. The American Medical Association included support for some flexibilities related to interstate telemedicine.

MedPAC Members: New Appointments

The Medicare Payment Advisory Commission (MedPAC), which makes recommendations to Congress, announced is membership roster on May 26.

New Members

The following four members were newly appointed; their terms begin in May 2022 and expire in April 2025: 

  • Robert Cherry, MD, MS, Chief Medical and Quality Officer at UCLA Health in Los Angeles, CA.  Dr. Cherry is a trauma and critical care surgeon, and earned his medical degree from Columbia University and a Master in Health Care Management from Harvard University.  
  • Kenny Kan, FSA, CPA, CFA, MAAA, Vice President and Chief Actuary of Horizon Blue Cross Blue Shield in Newark, NJ.  Mr. Kan “recently helped launch a Medicare Advantage plan.”  He holds a Master in Professional Accounting from the University of Texas. 
  • Gregory Poulsen, MBA, Senior Vice President at Intermountain Healthcare in Salt Lake City, UT.  Mr. Poulsen is described as a “key architect” of innovations at Intermountain Healthcare, “including offering a Medicare Advantage plan.”  He earned a Master of Business Administration from Brigham Young University. 
  • Scott Sarran, MD, Chief Medical Officer at MoreCare in Cook County, IL.  Dr. Sarran is a geriatrician, and earned his medical degree from Northwestern University. 

New Member (Expired Term)

The following new member was appointed to serve out the remaining term of Jonathan Perlin, who has resigned.  This term will expire in 2024:  

  • Cheryl Damberg, PhD, Director of the RAND Center of Excellence on Health System Performance, distinguished chair in Health Care Payment Policy, and a principal senior economist at the RAND Corporation in Santa Monica, CA.  Dr. Damberg is an “international expert in pay-for-performance and value-based payment reforms.”  She holds a PhD in Public Policy from the Pardee RAND Graduate School of Public Policy Studies. 

Members Reappointed 

The following two members were re-appointed; their terms expire in April 2025: 

  • Lawrence Casalino, MD, PhD, Professor of Public Health and Population Health Sciences at Weill Cornell Medical College in New York, NY. 
  • Amol Navathe, MD, PhD, Associate Professor, Co-Director of the Healthcare Transformation Institute, and Associate Director of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania’s Perelman School of Medicine in Philadelphia, PA. Dr. Navathe will serve as Vice Chair