Summary
With Congress in recess for the next two weeks, we look ahead to what is underway on the administrative front, including the phase-down of federal Medicaid matching funds on July 1 during the unwinding of the continuous enrollment condition and regulatory activity.
Medicaid
On July 1, the temporary increase in the Federal Medical Assistance Percentage (FMAP) will phase down from 5 percentage points to 2.5 percentage points. The next and final phasedown is 1.5 percentage points, October 1 through December 31. The phase-down of federal Medicaid matching funds provides an economic incentive for states to rapidly conduct redeterminations, though the Biden Administration has strongly encouraged states to use the maximum time allowed – 12 months to initiate, and 14 months to complete, a renewal.
In response to early reports of high Medicaid procedural disenrollment rates, Health and Human Services (HHS) Secretary Xavier Becerra is urging governors to adopt all available flexibilities to minimize terminations for procedural reasons during the COVID-19 unwinding period (press release). Earlier this month, HHS announced several new flexibilities and strategies to increase ex parte renewal rates, support enrollees with renewal form submission or completion, and facilitate reinstatement of eligible individuals disenrolled for procedural reasons. States may seek approval of a temporary 1902(e)(14)(A) waiver to implement the new flexibilities and other available strategies. A chart of unwinding strategies approved under this authority by state is available here.
Rulemaking
The Biden Administration recently released its Spring 2023 Unified Agenda, which outlines the Administration’s plans to issue regulations in the near and long term. The Office of Management and Budget (OMB) completed review of the proposed Medicare payment and policy updates for end-stage renal disease facilities in calendar year 2024. OMB is also reviewing a slew of rules:
- Medicare
- Calendar year 2024 Medicare payment policies – Proposed updates to the Physician Fee Schedule and payment and policy updates for hospital outpatient departments and ambulatory surgical centers, and home health agencies, and
- Episode-based Payment Model – Request for information on an episode-based payment model
- Minimum staffing standards for long-term care facilities – Proposed rule would address staffing requirements at long-term care facilities, including nursing homes.
- 340B Drug Pricing Program – Proposed rule regarding potential remedies for safety-net hospitals affecting cost years 2018-2022. In American Hospital Association v. Becerra, the Supreme Court ruled in favor of safety-net hospitals that challenged Medicare reimbursement cuts for prescription drugs provided in outpatient settings.
- Short-Term Plans – Proposed rule that would ensure short-term limited duration insurance includes protections for people with pre-existing conditions and other ACA protections.