Hart Health Strategies provides a comprehensive policy briefing on a weekly basis. This in-depth health policy briefing is sent out at the beginning of each week. The health policy briefing recaps the previous week and previews the week ahead. It alerts clients to upcoming congressional hearings, newly introduced bills, regulatory announcements, and implementation activity related to the Patient Protection and Affordable Care Act (PPACA) and other health laws.


Senators Express Support for Medicare Reimbursement Fix

Last week, Senators Debbie Stabenow (D-Mich.) and John Barrasso, MD (R-Wyo.) penned a bipartisan letter signed by forty-six senators urging Senate leadership to address the scheduled cuts to Medicare provider reimbursement before they take effect in the new year. The Centers for Medicare and Medicaid Services released its calendar year 2023 Physician Fee Schedule final rule last week, which confirms a reduction of 4.47% to the conversion factor. “Going forward,” the lawmakers state, “we support bipartisan, long-term payment reforms to Medicare in fiscally responsible manner.” They warn that failure to act could result in reduced staffing levels and office closures and negatively impact patient access to care.

Finance Chair Releases Report on MA Deceptive Marketing Practices

Senate Finance Committee Chair Ron Wyden (D-Ore.) has released a new report detailing his investigation into misleading advertising practices by Medicare Advantage (MA) plans. The investigation was prompted by a recent finding from the Centers for Medicare and Medicaid Services (CMS) indicating that the number of complaints about MA marketing approximately doubled from 15,497 in 2020 to 39,617 in the first 11 months of 2021; nine of the 10 states that track MA complaint data saw an increase in complaints between 2020 and 2021. According to the report, plans use in-person sales, television ads, telemarketing calls, and robocalls to encourage seniors to switch from traditional Medicare to MA plans. Many of the complaints involved deceptive or fraudulent marketing practices, including the targeting of people with dementia, the enrollment of people without their consent, and the use of marketing materials made to look as if they came from the federal government. The report recommends prohibiting the cold calling of Medicare seniors and reinstating rules changed during the Trump administration to specify which marketing materials are subject to CMS regulation. The report also suggests requiring marketing materials to include a plan’s complaint and appeals process.

Lawmakers Urge Extension of APM Incentive Payments

A bipartisan group of more than 40 lawmakers in the House of Representatives sent a letter to House leadership in support of the extension of the 5% alternative payment model (APM) incentive payment. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) included a 5% incentive payment to encourage practices to transition into APMs. The letter asks that Congress include Section 4 of the Value in Health Care Act (H.R. 4587) in an end-ofyear legislative package. This bipartisan legislation would extend the APM incentive payment and allow the Centers for Medicare and Medicaid Services to adjust qualifying thresholds to achievable levels in the coming years.

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