Federal Regulatory Update

For more information about this blog post, please contact Khaled J. KleleRyan M. MageeBrianna J. SantolliConnor Breza, or Labinot Alexander Berlajolli

Hospice Payment Rate Update Proposed Rule for 2023

Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, 87 FR 19442, to establish a permanent mitigation policy to smooth the impact of year-to-year changes in hospice payments related to changes in the hospice wage index. To do so, the rule proposes updates to the hospice wage index, payment rates, and aggregate cap amount for Fiscal Year ("FY") 2023 and proposes updates to the Hospice Quality Reporting Program (“HQRP”). The latter changes include proposed changes to the Hospice Outcomes and Patient Evaluation tool, an update on Quality Measures ("QMs") that will be in effect in FY 2023 for the HQRP and future QMs, updates the Consumer Assessment of Healthcare Providers and Systems, Hospice Survey Mode Experiment, and discusses a request for information ("RFI") on health equity. CMS issued a fact sheet about the proposed rule.

Inpatient Psychiatric Facilities Proposed Rule for 2023

CMS issued a proposed rule, 87 FR 19415, to update the prospective payment rates, the outlier threshold, and the wage index for Medicare inpatient hospital services provided by Inpatient Psychiatric Facilities (“IPF”), which include psychiatric hospitals but exclude psychiatric units of an acute care hospital or critical access hospital. Similar to hospice payments, CMS seeks to establish a permanent mitigation policy to smooth the impact of year-to-year changes in IPF payments related to decreases in the IPF wage index.   Additionally, this proposed rule includes a request for comment on the results of the data analysis of the IPF Prospective Payment System adjustments. The proposed changes in this rule would be effective for IPF discharges occurring during the Fiscal Year ("FY") beginning October 1, 2022 through September 30, 2023 ("FY 2023"). Lastly, this proposed rule requests information on Measuring Equity and Healthcare Quality Disparities Across CMS Quality Programs. CMS issued a fact sheet about the proposed rule.

HHS Issues Guidance on HIPAA and Disclosures of Protected Health Information for Extreme Risk Protection Orders

The U.S. Department of Health and Human Services ("HHS") through its Office for Civil Rights ("OCR") has issued new guidance to help clarify how the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") Privacy Rule permits covered health care providers to disclose protected health information to support applications for extreme risk protection orders that temporarily prevent a person in crisis, who poses a danger to themselves or others, from accessing firearms. This guidance furthers implementation of the U.S. Department of Justice's model extreme risk protection order legislation that provides a framework for states to consider in creating laws allowing law enforcement, concerned family members, or others to seek these orders and to intervene in an effort to save lives. OCR’s recent guidance provides new direction to support an extreme risk protection order on how HIPAA allows covered health care providers to disclose protected health information about an individual, without the individual's authorization. The guidance includes specific examples for each permission.

HHS Designates Eight Organizations to Serve as Independent Dispute Resolution Entities

While providers and insurers await further guidance from the Department of Health and Human Services on the dispute resolution process regarding the No Surprises Act, keep in mind that HHS has certified eight (8) organizations to serve as independent dispute resolution entities in the federal independent dispute resolution process. The list of eight can be found here.