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MedPAC Issues Draft Recommendations for 2021

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This week, the Medicare Payment Advisory Commission (MedPAC) issued its draft recommendations for each of the Medicare fee-for-service payment systems, as required by law. These recommendations, directed at Congress and the Department of Health and Human Services Secretary, are for calendar year (CY) and federal fiscal year (FFY) 2021. MedPAC will meet in January to vote on its recommendations.

CHA Issues Summary of Health Plan Price Transparency Proposed Rule; CMS Call December 10

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CHA has issued a summary, prepared by Health Policy Alternatives, on the proposed rule that would establish a number of new price transparency requirements for health plans. These regulations, proposed by the Centers for Medicare & Medicaid Services (CMS) along with the departments of Labor and Treasury, are intended to build on recently finalized price transparency requirements for hospitals and reflect President Trump’s June 24 executive order. Comments on the proposed rule are due Jan. 29.

CHA Issues Summaries of CY 2020 OPPS Final Rules; American Hospital Association and Member Hospitals File Suit

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CHA has released two summaries of Centers for Medicare & Medicaid Services (CMS) policies finalized under the calendar year (CY) 2020 outpatient prospective payment system (OPPS) final rules. The first summary details payment, policy, and  outpatient quality reporting changes finalized for the CY 2020 OPPS under the Nov. 1 final rule, which take effect Jan. 1, 2020. The second summary, prepared by Health Policy Alternatives, Inc. (HPA), details specific price transparency requirements finalized in a separate final rule, issued Nov. 15 and effective Jan. 1, 2021.

New Report Shows Disparities in Access to Behavioral Health Care for Employer-Sponsored Health Plans

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Mental health care services and addiction treatment are increasingly harder to access and afford, a new study finds. By analyzing claims data across 50 states for hundreds of health insurances plans, researchers discovered that the disparity between mental health and physical health care worsened from 2016 to 2017. According to the report, out-of-network usage for behavioral health care is higher than that for medical and surgical providers, and the gap is growing. More highlights are available in a press release.

Symposium Next Week Highlights Positive Changes in Behavioral Health Care

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Nearly 300 people will gather next week to learn more about the positive changes happening in behavioral health care. CHA’s annual Behavioral Health Symposium, to be held Dec. 9-10 in Riverside, will deliver valuable and timely information and provide an opportunity for attendees to network with their peers.

DHCS Issues Implementation Update on Health Homes Program

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The Department of Health Care Services has released an update on implementation of its Health Home Program, which helps manage and coordinate care for Medi-Cal managed care plan members with certain chronic health and/or mental health conditions who have high health care needs or who are experiencing homelessness. The update provides enrollment data, information on core services, and a member success story.

CHA Provides Input on Improving Health in Rural, Underserved Areas

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Last week, CHA responded to a request for information from the House Ways & Means Committee soliciting input for its Rural and Underserved Communities Health Task Force, which is working to develop bipartisan legislation to improve health care outcomes in underserved communities.

CMS Opens Application Period for Direct Contracting Models

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The Centers for Medicare & Medicaid Services (CMS) has opened the application period for two voluntary Direct Contracting Model options: professional and global. Applicants interested in participating in the implementation period must submit applications by Feb. 25; the application tool will be available later this month. In spring 2020, CMS will announce a separate application period for organizations that wish to participate in the first performance year. Organizations that are considering applying must submit a letter of intent by Dec. 10, if they have not already done so.