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Policy Round Up: Diagnostic equipment standards, drug pricing transparency, quality measures, and more

July 24, 2023
Vicki Gottlich, Deputy Administrator for Policy and Evaluation

In this Policy Round Up:

  • Input needed:
    • Due TODAY: Proposed rule to lower transfer height standards for medical diagnostic equipment
    • Due TOMORROW: Proposed rule to improve prescription drug transparency in Medicaid
    • Due SUNDAY: Input and nominations needed for quality measures development work
    • Coming soon: FCC proposed rule on accessibility for videoconferencing
    • ICYMI: Input needed: Proposed OAA updates
  • CMS ending COVID vaccination requirement for NH, ICF and other staff
  • CMS guidance on mandatory coverage requirements for adult vaccines
  • No Surprises Act – New consumer-friendly resources

Comments due TODAY: Proposed rule to lower transfer height standards for medical diagnostic equipment

The Architectural and Transportation Barriers Compliance Board, better known as the Access Board, seeks input on a proposed rule that would set accessibility standards for low-transfer height of medical diagnostic equipment (MDE) at 17 inches. This is important because there are a variety of wheelchair heights currently in use and using 17 inches as the standard allows more people to be able to be transferred to exam tables and chairs. This ensures that more people can get the care they need.

The Access Board is seeking input on a number of topics, including:

  • Recent studies regarding the population of wheelchair users in the United States, by gender, age, and device type.
  • The estimated cost of modifying current examination tables and examination chairs (specifically phlebotomy, OB–GYN, podiatry, and optometry/ophthalmology chairs) that currently have a low-transfer height of 18 or 19 inches in order to comply with the 17-inch requirement
  • If it is not possible to modify existing MDE, the difference between the cost of manufacturing MDE with a low-transfer height of 18 or 19 inches and the cost of manufacturing MDE that meets the 17-inch standard.
  • How much time manufacturers would need to be able to develop a sufficient number of examination chairs (other than dental chairs) and tables with a minimum low-transfer height of 17 inches to meet market demand.

Comments can be submitted by mail, email, or online until July 24, 2023.

Comments due tomorrow: Proposed rule to improve prescription drug transparency in Medicaid

The Centers for Medicare & Medicaid Services (CMS) published a proposed rule to increase its ability to hold drug manufacturers accountable for what Medicaid programs pay for drugs.

The proposed rule would give CMS and states additional tools, including a drug price verification survey completed by drug manufacturers and wholesalers, to provide greater transparency into manufacturers’ drug prices. It would also make contracts between states, Medicaid-managed care plans, and third-party contractors (such as pharmacy benefit managers).

The proposed rule also contains provisions to ensure states receive the appropriate rebates to which they are entitled as part of the Medicaid Drug Rebate program. These provisions would increase transparency to help states determine if manufacturers appropriately classified their covered outpatient drugs as generics. and if they did not, give CMS the ability to take action to correct the misclassification. This is significant because states receive a higher percentage of rebate dollars for brand-name drugs compared to generics.

In addition CMS is requesting feedback on the impact of a potential requirement that a patient's diagnosis be included on a prescription as a condition of receiving Medicaid funding for that prescription. CMS is particularly interested in input related to the burden and operational implications of such a requirement, privacy related concerns, and how to negate any foreseeable impact on beneficiaries and providers. (This requirement is not part of the proposed rule – this is a request for information only.)

Comments can be submitted online or by mail until July 25, 2023.

Input and Nominations Needed: Quality Measures Development

In March, the Centers for Medicare & Medicaid Services awarded a contract to Battelle’s “Partnership for Quality Measurement (PQM)” to serve as the consensus-based entity (CBE) for performance measurement. In that role, PQM will endorse (and maintain) quality measures, or standards for measuring and quantifying performance and improvement in health care processes, outcomes, patient perceptions, and health care organizations and systems.

PQM is soliciting nominations for the committees that support each phase in this process. In addition, PQM encourages people with lived experience to join as members. Finally, PQM seeks input on two guidebooks that outline policies, processes, and committee expectations for each of the three phases.  

Bottom line: It is important to ensure that the HCBS perspective is represented throughout this important work. By participating as a member, serving on committees, and providing comments on PQM’s guidebooks and proposed endorsements, you can help ensure that. Nominations and comments are due by this Sunday, July 30.

More information:

PQM includes health care providers, such as clinicians, health plans, health systems; patients and caregivers; measure experts; health information technology specialists; and others who are interested in health care quality standards. These members review and provide feedback on quality measures and evaluate whether measures should be endorsed based on their evidence, scientific rigor such as reliability and validity, feasibility, and whether they are safe and effective. Membership in PQM is free, and it is open to both individuals and organizations with lived experience and/or subject matter expertise.

PQM committees, each of which includes members representing all facets of the health care system, support each phase of the review and endorsement process. (You must be a member to serve on a committee, but committee service is not required to be a member.)  Members will be appointed for a term of up to three years, during which they commit to participating in scheduled calls and meetings, providing timely responses to requests for feedback, and being available for ad-hoc meetings and conference calls. (More information about requirements for serving on PQM committees can be found starting on page 10 of the guidebook for Endorsement and Maintenance Guidebook and starting on page 7 of the Pre-rulemaking Measure Review and Measure Set Review Guidebook.)

PQM will continue the work started by the National Quality Forum (NQF) to engage stakeholders in measure development efforts, including the development of stakeholder committees to gain consensus on measurement topics important to various stakeholder groups, and endorse measures that meet rigorous scientific standards.

This work is important to ACL, which previously led the work of NQF to develop two reports (available here and here) that continue to drive the development of quality measures in home and community-based services (HCBS) by creating 11 key measure domains and further define the scope of person-centered planning for measure development and implementation.

We are excited to continue this work with PQM in the coming months and years.

Coming soon: FCC proposed rule on accessibility for videoconferencing

The Federal Communications Commission (FCC) will soon be accepting comments on a proposed rule that would, for the first time, require video conferencing platforms, like Zoom, Microsoft Teams, or Webex, to comply with the accessibility requirements under the Communications Act and the FCC’s rules that govern interoperable video conferencing services.

These services are now integral in the workplace and in our daily lives, and making them more accessible is critical to full participation by people with disabilities. Some of the reported problems with these platforms that could make them inaccessible for people with disabilities include a lack of—or inferior—captioning; ineffective display of sign language interpreters; volume controls that are difficult for blind or low-vision users to find and use, and insufficient user control of accessibility tools.

Along with requiring video conferencing platforms to comply with accessibility requirements, the proposed rule would add specific performance objectives for enhancing the accessibility of these services, including: speech-to-text (captioning) capabilities; text-to-speech capabilities; and enabling the use of visual language interpreting. The FCC also seeks comment on the integration of telecommunication relay service (TRS) with video conferencing services without requiring a dial-up telephone call.

Comments will be due 30 days after the proposed rule is published in the Federal Register. While it hasn’t been published yet, you can review the proposal in its entirety here.

ICYMI: Input needed: Proposed OAA updates

ACL is seeking input on proposed updates to the regulations for its Older Americans Act (OAA) programs.

The last substantial update to most OAA program regulations was in 1988, and our world has changed dramatically in the 35 years since. The proposed rule addresses issues that have emerged since the last update and clarifies a number of requirements for programs authorized under Titles III (grants to state and community programs on aging), VI (grants to Indian tribes and Native Hawaiian grantees for supportive, nutrition, and caregiver services), and VII (allotments for vulnerable elder rights protection activities). It aims to better support the national aging services network that delivers OAA services and improve program implementation, with an ultimate goal of better serving older adults.

Comments can be submitted online or by mail until August 15, 2023.

CMS ending COVID vaccination requirement for health care staff

Now that the COVID-19 public health emergency has ended, CMS has published a final rule eliminating requirements for health care staff to be vaccinated against COVID-19. Those requirements were issued in light of surging COVID-19 cases during the height of the pandemic that hit nursing homes, intermediate care facilities, and other similar settings particularly hard. They required most Medicare- and Medicaid-certified providers and suppliers to ensure health care staff completed their COVID–19 primary vaccine series to help slow the spread of COVID-19.

While vaccines are no longer required, CMS will continue to require facilities to provide residents, clients, and staff with education regarding the benefits, risks, and potential side effects associated with the COVID-19 vaccine. When a vaccine is available to the facility, it must be offered to each resident and staff member unless the immunization is medically contraindicated or the resident or staff member has already been immunized.

CMS guidance on mandatory coverage requirements for adult vaccines

Recent CMS guidance to states outlines new mandatory coverage requirements for approved adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) and their administration, without cost sharing.

Under the Inflation Reduction Act, state Medicaid and Children’s Health Insurance Program (CHIP) programs are required to cover vaccination and administration of adult vaccines by October 1, 2023. That mandatory coverage includes both routine vaccines as well as non-routine vaccines based on risk factors. For example, not every adult meets ACIP’s recommended criteria for the mpox vaccine, but those who do and have Medicaid or CHIP will be able to receive that vaccine without cost sharing as of October 1.

For more, see CMS’ fact sheet.

No Surprises Act – New consumer-friendly resources

CMS has released new resources to help people understand their rights under the No Surprises Act (which we’ve discussed previously here and here). The Act established protections against surprise billing and excessive cost-sharing for people who are covered by commercial health plans. These tools are available online in both English and Spanish.

These new resources can help people:

  • Understand their rights under the No Surprises Act, including out-of-network billing protections and good-faith estimates for future care
  • Identify actions they can take to exercise their rights and find a resolution if they receive an unexpected medical bill, using a Q&A tool that asks about their situation
  • Submit a complaint if they think their provider, facility, or insurance company didn’t follow the rules of the No Surprises Act
  • Dispute a bill if they are uninsured or didn’t use insurance and they were charged more than their good faith estimate
  • Apply for financial assistance with medical bills
  • Check medical bills for errors and understand explanation-of-benefits documents.

The website also includes information about the No Surprises Help Desk, which can provide assistance in more than 350 languages. 

Last modified on 07/24/2023

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