CHA Regulatory Update – Sept. 1. 2023

Welcome to the September 2023 edition of the CHA Regulatory Update. Monthly updates cover important information on regulatory issues in the health care field, specifically those associated with the federal government, as well as Colorado state agencies involved in health care issues – including the Colorado Behavioral Health Administration (BHA), Colorado Department of Human Services (CDHS), Colorado Department of Public Health and Environment (CDPHE), Colorado Department of Regulatory Affairs (DORA), Colorado Department of Health Care Policy and Financing (HCPF), and the Colorado Department of Labor and Employment (CDLE).

As a reminder, September’s CHA Regulatory Briefing Call is scheduled from 10-11 a.m. on Wednesday, Sept. 6. This month’s deep dive will be a presentation from experts at CDPHE on two new bills affecting hospitals – Senate Bill (SB) 23-020, Timely Certified Death Certificates, and House Bill (HB) 23-1077, Informed Consent to Intimate Patient Examinations. Find out more about these bills in CHA’s issue brief here.

Registration is now open for CHA and Polsinelli’s 2023 Regulatory Compliance Summit. This year’s program will be a hybrid, half-day program and will include sessions on key regulatory issues like the Colorado Option, compliance hot spots, and behavioral health reform. Register for in person attendance here and virtual attendance here. The agenda for the program can be found here.

To join the regulatory update call, please click on this link. This call allows for informal discussion regarding priority regulatory issues. To receive calendar invites for future calls, please contact Marie Cone LeBeaumont, CHA program coordinator, at [email protected].

September’s Regulatory Update includes information on the following issues:

State Updates

AQCC: Regulation 28 Adopted
BHA: Provider Rule Packet Released
BHA: Feedback Requested on New M Forms by Sept. 22
BHA: HB 23-1269 Reporting
CDPHE: Issues Perinatal Health Data Report
CDPHE: Sunsets Standing Orders for COVID-19 Vaccines
CDPHE: Stakeholder Process for HB 23-1218 Announced
CHA: Advocacy Deep Dive at Annual Meeting
CHA: Registration Open for Workplace Violence Education Series
Colorado Life and Health Insurance Protection Association: Offers Guidance on Friday Health Plans
DOI: CHA Submits Comment Letter on Medical Inflation Definition
DOI: PDAB Prioritizes Five Drugs for Affordability Review
HCPF: CHA Secures Indefinite Delay to Portion of Inpatient Hospital Review Program
HCPF: RAC Engagement Opportunities
HCPF: ACC Phase III Public Listening Sessions and Concept Paper
HCPF: Hospital Discounted Care Reporting Due, Clarifies Settings Subject to Hospital Discounted Care Requirements
HCPF: Releases Updated FAQ for Accessing Health First Colorado Behavioral Health Services
HCPF: Updated Data for Colorado’s End to Continuous Coverage Requirement
HCPF: 23 Colorado Hospitals to Receive Rural Provider Access and Affordability Stimulus Grant

Federal Updates

AHA: Details on Proposed IPPS Rule
CDC: Launches Sepsis Program for Hospitals
CDC: Releases Report Showing Significant Rates of Mistreatment During Maternity Care
CHA: Letter Sent to Delegation Advocating Against Site Neutral Payment Policies
CHA: Sen. Bennet Joins Dear Colleague Letter on DSH Cuts After CHA Advocacy
CHA: Sends Letter to Congressional Delegation to Reform Mental Health Step Therapy
CISA: Alert on Rhysida Ransomware Impacting U.S. Hospitals
CMS: Data Report Reveals One in Three Medicaid Patients Disenrolled in April
CMS: Issues Hospital IPPS Final Rule for FY 2024
CMS: Reinstates $50 Fee to Administer New No Surprises Act Payment Disputes
CMS: Releases Inflation Reduction Act First Anniversary Fact Sheet
CMS: Releases Request for Applications for the Making Primary Care Model
CMS: Revises ACO REACH Model for Next Year
Departments: New IDR Administrative Fee FAQs Available
DOL: Sues UnitedHealth Third Party Administrator for Improperly Denying ED Claims
HRSA: Awards $100M to Grow the Nursing Workforce

State Updates

AQCC: Regulation 28 Adopted

On Aug. 15-17, the Air Quality Control Commission held a rulemaking hearing on Regulation 28, which will implement building performance standards for all buildings greater than 50,000 square feet in Colorado. The Colorado Association of Health Care Engineers and Directors testified as part of the Colorado Real Estate Alliance, which CHA is a member of, on the detrimental impact this regulation would have on hospitals. A final version of the regulation will be released in September following a review by the Attorney General. Additional information can be found here.

BHA: Provider Rule Packet Released

The BHA released an updated proposed rule packet with provider rules related to the Behavioral Health Entity license, Safety Net approval, and 27-65 designation on Aug. 18 here. CHA submitted comments on the previous iteration of the proposed rules in June. Going forward, the rule packet will have a first reading at the State Board of Human Services from 8:30 a.m. to 5 p.m. on Friday, Sept. 8 (join here). The second reading is scheduled for Friday, Nov. 3, after which the rules will be finalized for a Jan. 1, 2024, implementation date. Please review this crosswalk that CHA prepared and provide comments to [email protected] by Wednesday, Sept. 6.

BHA: Feedback Requested on New M Forms by Sept. 22

The BHA is requesting feedback from stakeholders on draft M forms to be used starting Jan. 1, 2024. Feedback can be submitted to this survey until Friday, Sept. 22. The draft M forms can be found here. The forms will be finalized on Sunday, Oct. 1, upon which the BHA will offer a series of trainings on these finalized forms to ensure hospitals are prepared to use the new forms. Additional information can be found here.

HB 23-1269 Reporting – First Reporting Period Starts Sept. 1

HB 23-1269 requires hospitals to report to the BHA on the total number of children and youth patients who were boarding or had an extended stay in the previous quarter. The first reporting period will be Sept. 1 through Dec. 31, with reporting due in January 2024 through this Google Form. Additional information can be found in a memo from the BHA here.

CDPHE: Issues Perinatal Health Data Report

On July 31, CDPHE issued its Maternal Mortality Prevention Program legislative report, “Perinatal Health Data: Strengths, Weaknesses, and Opportunities to Improve.” The report makes several recommendations to improve maternal care in Colorado:

Invest in data processing and analysis positions focusing on EHR interoperability
Fund functional EHR adoption for smaller practices or individual maternal health providers
Collaborate and standardize data collection and reporting efforts when appropriate
Fund sustainable data linkage projects
Invest in qualitative data collection and storytelling outside of health care settings

If you have questions, please contact Richard Bottner, CHA vice president of clinical excellence, at [email protected].

CDPHE: Sunsets Standing Orders for COVID-19 Vaccines

After Thursday, Aug. 31, CDPHE will no longer provide signed statewide standing orders for providers for COVID-19 vaccines. Vaccine providers must work with their agency or organization’s medical director or other authorized provider to obtain signed standing orders for vaccines that are given by registered nurses, pharmacists, and other appropriately trained health care personnel in their clinics.

Standing order templates are also available at immunize.org.

If you have any questions, please email the Clinical Resources Unit at [email protected].

CDPHE: Stakeholder Process for HB 23-1218 Announced

HB 23-1218 will require facilities to provide information to patients on services that they don’t provide. CDPHE plans to hold the first stakeholder meeting from 12:30 to 3:30 p.m. on Tuesday, Sept. 26 and will recur every fourth Tuesday of the month until the conclusion of the stakeholder process in spring 2024. Fill out this Google Form to receive information, updates, and meeting dates and topics. CHA’s issue brief on the bill can be found here.

CHA: Advocacy Deep Dive at Annual Meeting

The role of advocacy in shaping the health care landscape is critical, and understanding how your team can use advocacy as a tool is empowering. At the 2023 CHA Annual Meeting – coming up on Oct. 9-10 at the Park Hyatt Beaver Creek Resort – attendees will have the opportunity to explore advocacy from a range of perspectives while learning about current and future trends that will require a strong voice from health care professionals. In addition to gaining insight into Colorado’s upcoming 2024 legislative session, the Annual Meeting will offer an Advocacy Track for those interested in diving deeper into the subject. Sessions will include:

Federal Update: What is Happening in Congress – Learn about the latest developments at the federal level and how pending and passed legislation will affect Colorado hospitals.
Case Study: Elevating the Hospital Voice and Engaging Staff – Explore the value of advocacy that involves the voices of health care workers on the frontline and how grassroots tools can strengthen hospital advocacy efforts.
Regulatory Jeopardy – Discuss the variety of requirements placed on hospitals as guests from HCPF, CDPHE, and the Colorado Behavioral Health Administration face off to answer questions on hospital regulations.

Register now for the Annual Meeting to secure the early bird registration fee of $509 (available until Friday, Sept. 15). Reserve your room for a discounted rate of $256/night (available until Friday, Sept. 15)

If you have any questions, please contact Peggy McCreary, CHA senior education and events coordinator, at [email protected].

CHA: Registration Open for Workplace Violence Education Series

Join CHA this fall for a member education series to help reduce workplace violence incidents and their impact on health care providers. In the three-part Workplace Violence Series, health care security expert Michael Dunning will discuss three key opportunities for hospitals and health care employees to reduce workplace violence:

Escalation awareness | Noon – 1 p.m. on Tuesday, Sept. 12
- Learn to recognize early warning signs of violence, de-escalate confrontations, and implement preventive measures for a safer work environment
Reducing point of care violence |11 a.m. – noon on Tuesday, Oct. 17
- Learn strategies and techniques for minimizing the risk of violence during patient interactions
Self-defense and de-escalation myths | Noon – 1 p.m. on Tuesday, Nov. 14
- Learn evidence-based insights into effective self-defense measures and de-escalation strategies that align with real-world hospital scenarios

To register, sign up here for the three-part series for $250 or just one session for $99.

If you have any questions, please contact Peggy McCreary at [email protected] or 720.330.6034.

CHA: Sends Letter to Congressional Delegation to Reform Mental Health Step Therapy

In late July, CHA signed on to a letter to the Colorado congressional delegation urging them to pass federal legislation reforming step therapy requirements for mental health. The letter notes, “More than 20 states have passed legislation restricting step therapy practices… Unfortunately, there are still no protections at the federal level. Federal policy would help improve access to mental health care for the millions who remain afflicted by [serious mental illnesses], proving monumental in our collective efforts to battle the U.S. mental health epidemic.”

CHA supported HB 23-1130 – Drug Coverage for Serious Mental Illness – to drastically improve timely access to high-quality, personalized mental health care for patients suffering from serious mental illnesses by limiting step therapies. These protections only apply to plans regulated by the Colorado Division of Insurance, so CHA joined a coalition to send a letter to the Colorado congressional delegation asking them to institute the same protections for plans regulated at the federal level.

More information on HB 23-1130 and other behavioral health policies can be found in CHA’s behavioral health issue brief.

Colorado Life and Health Insurance Protection Association: Offers Guidance on Friday Health Plans

An order of liquidation has been entered for Friday Health Plans of Colorado, Inc. As a member of the Colorado Life & Health Insurance Protection Association, Friday Health will have all of its claims paid by the Association consistent with the Friday Health policies up to the statutory limit of $500,000 per covered policyholder.

Valid coverage: Friday Health coverage is valid until midnight on Thursday, Aug. 31, and providers must continue to provide care to Friday policyholders. Beginning Sept. 1, Friday Health policies are no longer valid.
Special enrollment period: A special enrollment period has begun to allow Friday Health insureds to find new health insurance coverage.
Claims payment: The Special Deputy Receiver for Friday Health will be paying claims until Sept. 1. The association will begin paying claims after that. All submitted claims will be transferred automatically to the association for payment. Please DO NOT resubmit claims.
New claim submission: Submit NEW bills/claims in the same manner as sent to Friday Health.

DOI: CHA Submits Comment letter on DOI Medical Inflation Definition

On Aug. 4, CHA submitted a comment letter to the DOI on proposed changes to Regulation 4-2-85 around the definition of medical inflation. In the letter, CHA expressed concerns that the proposed definition will not reflect the current basis of experience of medical care trends and has the potential for volatile swings. CHA requested that the DOI update the definition of inflation to the latest CPI-U for medical care for the Denver-Aurora-Lakewood, Colo. Core Based Statistical based on the most recent annual CPI-U reported compared to the previous annual CPI-U reported.

DOI: PDAB Prioritizes Five Drugs for Affordability Review

On Aug. 4, the PDAB voted to prioritize five drugs for an affordability review – Enbrel (Amgen), Genvoya (Gilead), Cosentyx (Novartis), Stelara (Janssen), and Trikafta (Vertex). Stakeholders can provide feedback on the selection of these five drugs using this stakeholder engagement guide.

Additionally, on Friday, Sept. 15, the PDAB will hold rulemaking implementing HB 23-1225, which increases the number of prescription drugs that the board can establish upper payment limits to six additional drugs, totaling eighteen drugs. Register to join the Sept. 15 meeting here.

HCPF: CHA Secures Indefinite Delay to Portion of Inpatient Hospital Review Program

At the beginning of August, CHA secured an indefinite delay to the prior authorization component of the Inpatient Hospital Review Program (IHRP). Step 1 of IHRP would have required inpatient pre-admission reviews and was originally scheduled to go into effect on Sept. 1, 2023. During the soft launch testing period which started on May 1, care management teams identified significant technical issues with the claims review process and due to these concerns, HCPF has indefinitely deferred step 1. Since May 1, IHRP still requires hospitals to submit post-admission reviews on hospital inpatient day 6 (step 2) and days 30, 60, 90, every 30 days thereafter (step 3). HCPF plans to perform a claims analysis to confirm that hospitals are submitting the required post-admission reviews. More information can be found on HCPF’s website here.

HCPF: RAC Engagement Opportunities

The CHA-led coalition submitted a list of joint RAC requests to HCPF at the beginning of August. CHA’s whitepaper highlighted areas of concern including volume limits, clarity surrounding audits, and updates on the process for rebilling claims. During HCPF’s August provider meeting, the department listed ways that providers can weigh in on these efforts:

Colorado RAC Provider Advisory Board: Apply here
Colorado RAC Re-Billing Pilot Provider Request: Join here – HCPF is testing a new rebilling option
Email list: Join HCPF’s email listserv here

HCPF: ACC Phase III Public Listening Sessions and Concept Paper

On Aug. 29, HCPF released the ACC Phase III Concept Paper, which can be found here. The concept paper provides a high-level summary of policies, programs, and operational changes under consideration to evolve the program. HCPF is hosting a series of public listening sessions to discuss the ACC Phase III Concept Paper. For hospitals, the recommended session is the final meeting on Tuesday, Sept. 26.

All provider (including hospitals) session: 8-9:30 a.m. | Tuesday, Sept. 26 | Register here

Other sessions:

Advocates and Representatives from Community-Based Organizations: Noon – 1:30 p.m. | Wednesday, Sept. 6 | Register here
Behavioral Health Providers: 5-6:30 p.m. | Thursday, Sept. 14 | Register here

HCPF: Hospital Discounted Care Reporting Due, Settings Subject to Hospital Discounted Care Clarified

The first data reporting for Hospital Discounted Care (HDC) is due to HCPF today, Sept. 1. The data should cover Sept. 1, 2022, through June 30, 2023. Data will be submitted to Inzata through its portal. An instruction manual and recorded overview webinar is available on the HDC website.

The website has HCPF’s Excel template for the data submission and a file that shows which data elements are required and which are optional. Files may have tabs with no information entered, but all 10 tabs must be in the version submitted to the portal. Inzata’s systems will reject any files that have been altered or had tabs removed.

Additionally, HCPF sent an update about settings subject to HDC to clarify when HDC assistance must be offered. Specifically, the requirements of HDC must be followed for care provided at these facilities:

A hospital that is licensed or established as a general acute or critical access hospital
A licensed freestanding emergency department
Any outpatient health care facility that is licensed as an on-campus department or service of a hospital or that is listed as an off-campus location under a hospital’s license except:
- A Federally Qualified Health Center, or
- A student-learning medical and dental clinic that is established for the purpose of student learning, offering discounted patient care as part of a program of student learning, and is physically situated within a health sciences school.

HDC requirements do not apply for health care services provided at facilities that are not licensed as a general or acute care hospital or freestanding emergency department (e.g., hospital-based nursing facilities that are licensed as nursing facilities and are not operating under the hospital’s license, facilities licensed as an ambulatory surgery centers located on a hospital’s campus and are not operating under the hospital’s license).

If you have any questions, please contact HCPF at [email protected] or attend the weekly HDC office hours held at 9 a.m. on Wednesdays (details here).

HCPF: Releases Updated FAQ for Accessing Health First Colorado Behavioral Health Services

In August, HCPF released an FAQ for accessing Health First Colorado behavioral health services. This document presents the authority, parameters, and processes related to accessing Health First Colorado (Colorado’s Medicaid program) behavioral health services for members living in long-term care settings (LTCS), receiving supports from regional centers (RCs), or covered under a home and community-based services (HCBS) waiver. It is intended to be a resource for facilities and clinical staff to secure appropriate care for members needing additional services.

HCPF: Updated Data for Colorado’s End to Continuous Coverage Requirement

Colorado has returned to regular eligibility renewal processes for Medicaid and Child Health Plan Plus (CHP+), beginning with renewals due in May 2023. The renewal redetermination process will continue month by month, through April 2024 for all 1.75 million members. HCPF estimates that more than 325,000 participants will no longer be eligible for Health First Colorado or CHP+ and will need to find another form of health care coverage.

HCPF released the June renewal information and compared it to May data. HCPF also will be sharing demographic and regional data breakouts on quarterly partner webinars. The next webinar will be 1-2:30 p.m. on Wednesday, Oct. 25. Register here.

HCPF has developed partner toolkits regarding the end of the continuous coverage requirement.

HCPF: 23 Colorado Hospitals to Receive Rural Provider Access and Affordability Stimulus Grant

The Rural Provider Access and Affordability Stimulus Advisory Committee announced award recommendations for the Rural Provider Access and Affordability Stimulus Grant of $10.6 million to 23 rural Colorado hospitals. In total, 33 hospitals submitted 47 applications requesting $25.3 million, but only 42 percent of the requested funds can receive an award.

SB 22-200 created the Rural Provider Access and Affordability Stimulus Grant Program to award $10 million to qualified rural hospitals. The purpose of the grant payments is to improve health care affordability and access to care in rural Colorado, allocated into two categories – affordability related projects and care-related projects.

If you have any questions, please email [email protected].

Federal Updates

CDC: Launches Sepsis Program for Hospitals

The CDC announced the launch of its Hospital Sepsis Program Core Elements initiative, a new program to provide hospitals with a blueprint to managing medical emergencies stemming from sepsis. The program, which is modeled after a similar effort for antibiotic stewardship, is intended as a “manager’s guide” to organizing staff and making the resources available to improve sepsis care and bring survival rates up.

The program features seven Core Elements, and for each it provides “priority examples” of the top priorities for hospital sepsis programs. To get started, the CDC recommends that hospitals:

Identify a sepsis program leader
Secure support from hospital leadership
Conduct a needs analysis
Establish initial goals for a sepsis program based on the needs analysis

CDC: Releases Report Showing Significant Rates of Mistreatment During Maternity Care

A new report by the CDC says 20 percent of women reported experiences of mistreatment during pregnancy and delivery care, with 30 percent of Black, Hispanic, and multiracial women reporting mistreatment. Approximately 40 percent of Black, Hispanic, and multiracial mothers reported discrimination during maternity care, and 45 percent of all mothers reported holding back from asking questions or discussing concerns with their provider. Those surveyed reported mistreatment including receiving no response to requests for help; being shouted at or scolded; not having their physical privacy protected; or being threatened with withholding treatment or made to accept unwanted treatment.

The report also identified women with no insurance or public coverage experiencing mistreatment more frequently than those with private insurance.

CHA: Letter Sent to Delegation Advocating Against Site Neutral Payment Policies

On Aug. 4, CHA’s CEO Jeff Tieman sent a letter to the Colorado Congressional Delegation urging them to oppose any site-neutral payment policies. Over the past few months, several committees in Congress have been considering some concerning proposals that would impose site neutral payment policies on hospital outpatient departments. For more information, CHA developed a one pager summarizing the impact that site neutrality proposals would have on hospitals. ‘

CHA:

Sen. Bennet Joins Dear Colleague Letter on DSH Cuts After CHA Advocacy

After CHA advocacy, Colorado Senator Bennet signed a letter with 50 of his Senate colleagues urging Senate Majority Leader Chuck Schumer (D-NY) and Senate Minority Leader Mitch McConnell (R-KY) to address impending cuts to the Medicaid Disproportionate Share Hospital (DSH) program. If no action is taken before Sunday, Oct. 1, the program faces $8 billion in cuts, which could threaten access to care across the country. Colorado hospitals specifically face a $120.8 million yearly payment cut. On the House side, Colorado Representative DeGette is a lead sponsor of the Supporting Safety Net Hospitals Act (H.R. 2665), which would delay the pending DSH cuts. Additional information can be found in a one pager developed by CHA here.

CISA: Alert on Rhysida Ransomware Impacting U.S. Hospitals

The Cybersecurity and Infrastructure Agency (CISA) and Department of Homeland Security (DHS) shared an alert on the Rhysida Ransomware being used to target the health care and public health sector. So far, there have been 16 hospitals from five different states reporting attacks. At this time, there have been no Colorado hospitals or systems included or mentioned with this activity.

If any Colorado based entities believe they may also be victims, report both to the FBI via the Internet Crime Complaint Center and to CISA via Report to CISA.

CMS: Data Report Reveals One in Three Medicaid Patients Disenrolled in April

In the 18 states that began unwinding the continuous coverage requirement for Medicaid and Children’s Health Insurance Program enrollees in April, 46 percent of enrollees with coverage up for renewal had their coverage renewed, 32 percent were terminated and redeterminations for the rest are pending, CMS reported its first monthly data report on renewals. In Colorado, approximately 50,000 people have been disenrolled from Medicaid through July 31, with 33 percent of those being for procedural reasons.

For more information, see the CMS infographic or check out HCPF’s recommendations for providers on Medicaid unwinding. HCPF has developed extensive partner toolkits regarding the end of the continuous coverage requirement. Update Your Address, Understanding the Renewal Process, and Take Action on Your Renewal toolkits all include resources to help members take action to keep their coverage. A new joint webpage KeepCOCovered.com includes partner resources and information for those who may need to transition to other health coverage. Flyers have recently been developed for Colorado employers to distribute to their employees to help spread the word.

CMS: Issues Hospital IPPS Final Rule for FY 2024

CMS issued the final rule that would increase Medicare inpatient prospective payment system (IPPS) rates by a net 3.1 percent in fiscal year (FY) 2024, compared with FY 2023, for hospitals that are meaningful users of electronic health records and submit quality measure data.

This update reflects a hospital market basket increase of 3.3 percent as well as a productivity cut of 0.2 percent. Overall, the agency will increase hospital payments by $2.2 billion compared to FY 2023, which also includes a $957 million decrease in disproportionate share hospital payments and a $364 million decrease in new medical technology payments.

Among other provisions, the final rule will:

Change graduate medical education payments for rural emergency hospitals to better support graduate medical training in rural areas.
Continue the low wage index hospital policy for FY 2024 and treat rural reclassified hospitals as geographically rural for the purposes of calculating the wage index.
Stop New COVID-19 Treatment Add-on Payments due to the program’s expiration on Saturday, Sept. 30.
Revise the data and information required under the physician self-referral law and reinstate program integrity restrictions previously removed in the 2021 outpatient prospective payment system final rule for physician-owned hospitals meeting “high Medicaid facilities” requirements.

For more information, see the AHA Special Bulletin.

CMS: Releases Inflation Reduction Act First Anniversary Fact Sheet

On Aug. 21, the Centers for Medicare Medicaid Services (CMS) released an Inflation Reduction Act First Anniversary Fact Sheet. The fact sheet provides a summary of the milestones that CMS has met for implementing the provisions of the Inflation Reduction Act, which was signed into law in August of 2022.

The CMS Inflation Reduction Act Anniversary Fact Sheet is available here.

CMS: Releases Request for Applications for the Making Primary Care Model

CMS released a Request for Applications (RFA) detailing model payment, care delivery, quality, and other policies for the Making Care Primary (MCP) Model. Interested applicants may apply to the model later this month when the Application Portal opens.

CMS announced the MCP Model in June to increase the investment in primary care, allowing participants to provide patients with seamless, high-quality, whole-person care. Colorado is one of eight states where the model will launch on July 1, 2024. This model “aims to strengthen coordination between patients’ primary care clinicians, specialists, social service providers, and behavioral health clinicians, to drive improved chronic disease prevention, fewer emergency room visits, and better health outcomes,” according to CMS.

CMS: Revises ACO REACH Model for Next Year

CMSannounced changes to its Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model starting in performance year 2024 to advance health equity and make the model more predictable for participants and more consistent with other CMS programs and models.

CMS will incorporate two new variables into the composite measure used for the Health Equity Benchmark adjustment: 1) low-income subsidy status and 2) state-based area deprivation index. The model also will expand access to the HEB adjustment by revising the benchmarks and allow participating nurse practitioners and physician assistants to certify and order pulmonary rehabilitation care plans for beneficiaries with chronic obstructive pulmonary disease.

HHS/DOL/Treasury: New IDR Administrative Fee FAQs Available

On Aug. 11, HHS, theDepartment of Labor (DOL), and the Department of the Treasury (collectively, the departments) released the No Surprises Act (NSA) Independent Dispute Resolution (IDR) Administrative Fee Frequently Asked Questions (FAQs).

The No Surprises Act (NSA) established a Federal IDR process that allows out-of-network providers, facilities, and providers of air ambulance services, and group health plans, health insurance issuers in the individual and group markets, and Federal Employee Health Benefits (FEHB) carriers (disputing parties) to determine the out-of-network rate for out-of-network emergency services and certain items and services provided by out-of-network providers at in-network facilities and out-of-network air ambulance services.

Additionally, CMS released a FAQ explaining how it will handle the administrative fee for out-of-network providers and group health plans that initiate payment disputes under the No Surprises Act’s independent dispute resolution process on or after Aug. 3. The fee for disputes initiated on or after Aug. 3 or unpaid before Aug. 3 will return to $50 per party until the Departments of Health and Human Services, Labor, and the Treasury set a new fee amount.

DOL: Sues UnitedHealth Third Party Administrator for Improperly Denying ED Claims

The DOL sued a third-party administrator owned by UnitedHealth Group in the U.S. District Court for the Western District of Wisconsin, alleging it improperly denied claims for emergency services and urinary drug screening since 2015. The department asks the court to require the third-party administrator to reform its claims processing procedures for such claims, re-adjudicate the affected claims in compliance with the Employee Retirement Income Security Act, and enjoin it from committing future violations.

HRSA: Awards $100M to Grow the Nursing Workforce

The HRSA awarded $64.8 million to programs to train advanced practice nurses to provide primary care, mental health care and maternal care; $8.7 million to programs to train licensed practical nurses to become registered nurses; and $26.5 million for programs to provide and cancel loans for students who become nurse faculty.