Week in Washington 072023

Week in Washington is brought to you by Michael Cohen, PhD. Tune in each week to read the latest on healthcare policy and get a glimpse of what’s on the horizon.

Week in Washington

07/20/2023

Medicaid Unwinding

Medicaid redetermination process continues to be a high profile topic. According to KFF, Medicaid disenrollment as part of the unwinding process is over 3 million individuals. The large increase from last week is a result of Texas releasing data. Texas currently has the highest disenrollment rate (82%) in the country. CMS announced a summary of state mitigation strategies for states to comply with redetermination requirements. While CMS has not yet announced any penalties, they have required six states to pause redeterminations to fix certain issues. Finally, it’s important to note certain states are prioritizing likely ineligible members so rates of termination today are not necessarily indicative of future trends. CMS released an updated timeline of redetermination and which states are prioritizing likely ineligible individuals here.

Payment Rules

CMS released two proposed payment rules last week. (Physician payments and outpatient).

A few highlights include: 

• CMS is proposing increasing payments for outpatient services by 2.8%.
• CMS, separately, is proposing to decrease physician payments.
• CMS is also proposing marriage and family therapists, mental health counselors and addiction counselors to be reimbursed by Medicare. The agency also increased payments for substance use treatment psychotherapy.

Congress

• Politico reported that lawmakers are exploring a short-term fix to the potential cuts to Medicare payments that CMS proposed for physicians. The short-term fix might come in the upcoming funding bills.
• A bipartisan bill was introduced this week that would require Medicare to cover obesity drugs. Currently Medicare is not allowed. Given the growing potential costs associated with obesity drugs this bill should be monitored. There is no current timeline for the bill.
• One issue to monitor is a growing concern over a potential government shutdown, which would happen at the end of September.

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