Medicare proposal spurs responsible care organizations – POLITICO


With the help of Daniel Lippman

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MEDICARE UNVEILS PROPOSED PAYMENTS FOR 2023 — The Centers for Medicare and Medicaid Services proposal for physician payments in 2023 focuses on expanding behavioral health, dental care, cancer screenings and patient access to accountable care organizations, but with payment cuts that have angered some groups of physicians.

Responsible care is changing: A key proposal would allow accountable care organizations — groups of healthcare providers and clinics that work together to improve care in a community — to use certain payments to meet the social needs of patients.

CMS noted that this is one of the first times Medicare payments could be used in this way and could motivate providers in rural and underserved areas to invest in becoming part of ACOs. The agency also offered to tinker with ACO metrics to add and reward care for underserved populations.

The National Association of ACOs applauded the move, saying the proposal would “save Medicare more than $15 billion and return $650 million in higher shared savings payments to ACOs.”

Mental health care: In an effort to address the shortage of behavioral care professionals in the country, the proposed payment plans would allow licensed counsellors, marriage and family therapists and related professionals to provide general covered care. The proposal also looks at providing treatment for opioid use disorder from mobile vans to help reach more rural residents.

Cancer screening: Medicare is proposing that follow-up colonoscopies performed after a positive home test be considered preventative services with waived fees for enrollees. The project also reflects recommended screening changes by lowering the coverage bar from 50 to 45 years.

Dental care: The agency would expand its narrow dental coverage—essentially only for treatments essential to the enlistee’s primary health condition—to include other services like dental exams before an organ transplant. But in a nod to pushes for more dental care in Medicare — including from Congress — the agency is asking for comment on what should be covered.

Not everyone is happy. The proposed conversion factor – a tool to calculate medical payments to doctors and hospitals – would be reduced from $1.53 to $33.08 next year.

This has earned the ire of the Surgical Care Coalition, which said the 4.42% cut and previous cuts “threaten patient care and are not sustainable in the long term”.

And after: The Physician Fee Schedule is open for public comment which could be incorporated into the final version released this fall. It will come into effect on January 1.

ADMIN TO SEND MORE PHOTOS OF MONKEYPOX — The Department of Health and Human Services will ship an additional 144,000 doses of the Jynneos monkeypox vaccine to states beginning early next week.

That’s nearly triple the 56,000 made available at the end of last month as health officials scramble to bring cases down. As of Thursday, nearly 700 cases in 36 US states and territories have been confirmed.

HHS said Thursday that 41,000 doses have already been delivered nationwide. He also ordered an additional 2.5 million doses last Friday, which should start arriving later this year. For now, vaccine recommendations are still limited to people with presumed or probable exposure.

“We are using all the tools at our disposal to increase and accelerate the availability of the Jynneos vaccine in the jurisdictions that need it most,” Steve Adams, director of the Strategic National Stockpile, said in a statement.

Global health officials are on high alert. Neither the United States nor the World Health Organization has yet declared the monkeypox outbreak an emergency, but doctors and public health experts are on guard for the spread of a virus they say , acts in an unusual way.

Health officials are considering broader recommendations, but the lack of data on some high-risk groups — like pregnant women and children — is making some leaders nervous.

The vaccine is expected to be administered as part of a clinical study, Mike Ryan, WHO’s executive director for health emergencies, said last week. “We should exercise a higher level of caution” over Covid-19 vaccines, he added.

BIDEN DOUBLE UP ON MEDICATED ABORTION – The president tweeted Thursday that the administration would defend a person’s access to Food and Drug Administration-approved abortion pills, pointing to a message echoed by Attorney General Merrick Garland and HHS Secretary Xavier Becerra following the Supreme Court decision. deer decision.

“If states try to prevent a woman from getting drugs that the FDA has already approved and that have been available for more than twenty years, we will act to protect that woman’s right to that drug,” Biden said. wrote on Twitter.

But how? Some state lawmakers are already preparing to challenge that claim and test the authority of the FDA. As we wrote earlier this week, Texas Republican Brian Harrison — a former Trump administration HHS official — tweeted that Biden had “no authority to force Texas to allow medical abortions contrary to our laws”.

NOVAVAX SHIPS FIRST DOSES — The Maryland Society boasted thursday that the first batch of coronavirus vaccines has landed in the United States

The FDA has yet to clear Novavax doses for use, but an advisory group has recommended it, constrained in part by the addition of different vaccine technology to the Covid-19 arsenal.

But that’s still well beyond Novavax’s original timeline for clearance and launch. As we reported last year, the company — which received $1.6 billion in federal funding — has struggled to mass-produce consistent batches at its US factories. Novavax’s Indian partner, the Serum Institute, produced the doses delivered this week.

NY STATE ISSUES ABORTION SAFETY GUIDELINES — Public and non-profit abortion providers can now submit proposals to receive funding from a new $10 million program to strengthen post-abortion safety.deer.

Governor Kathy Hochul announced Thursday that New York’s Division of Criminal Justice Services has issued a request for proposals, which will allow eligible reproductive health providers to receive up to $50,000 through the Securing Reproductive Health Care program. Centers, according to our reports from Shannon Young.

Grants can be used to improve the physical security of facilities, including things like perimeter lighting, fencing, access control systems, security cameras, and alarms. Applications are due by noon on August 18; award notifications are expected around September 15.

The agency plans to fund up to 200 projects statewide through the two-year program.

Laurie Rubiner is now Senior Government Relations Advisor at Kelley Drye and Warren. She most recently served as Executive Vice President of National Programs for the Tobacco Free Kids Campaign and is a Senator. Richard Blumenthal (D-Conn.) and Planned Parenthood alumnus.

Jennifer Brown joined Graphite Health as Administrative Director and General Counsel. Brown was most recently chief legal officer of Baylor Scott & White, a nonprofit health organization.

Senate Democrats are considering higher taxes for high-income Americans to expand the solvency of the Medicare trust fund, reports Alan Fram of The Associated Press.

Former White House adviser Kavita Patel and Global Health Network co-founders Eric Feigl-Ding and Yaneer Bar-Yam argued in a Washington Post op-ed that the government should declare monkeypox a pandemic.

Former Theranos executive Ramesh “Sunny” Balwani was found guilty on Thursday of 12 counts of wire fraud and conspiracy to commit wire fraud, mirroring previous convictions of co-founder Elizabeth Holmes, Bryan reports. Logan and Rob Wile of NBC News.

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