Legislation to fund the federal government through the remainder of FY22 includes temporary relief on hospitals’ eligibility criteria for the 340B Drug Pricing Program.
Some hospitals have been dropped from the program because of payer-mix changes triggered by the COVID-19 pandemic. The falloff in the share of Medicaid inpatient days relative to total inpatient days at those hospitals has taken Disproportionate Share Hospital patient percentages below the threshold needed to qualify for 340B.
The legislation, which was passed by Congress on March 10, ensures that hospitals can stay in the program through the end of this year if they otherwise would lose eligibility based on patient data included in Medicare cost reports spanning 2020 through 2022. To obtain the exemption, hospitals must attest that the loss of eligibility stemmed from the clinical and operational impact of COVID-19.
The appropriations bill also guarantees that Medicare telehealth coverage waivers will continue for five months after the end of the COVID-19 public health emergency, which was scheduled to expire April 16 when hfm went to press but was likely to be extended into July.
Federal funding bill doesn’t address key points of interest for hospitals
The appropriations bill that Congress passed in March left out several items on the wish lists of hospital advocacy groups.
Among the omissions from the bill:
- Additional money to be distributed through the Provider Relief Fund, which has no funding left as the Phase 4 general distribution wraps up
- Relief on the Medicare payment sequester, which as hfm went to press was scheduled to kick in at 1% starting April 1 and then increase to 2% on July 1
- Relief on the repayment terms for Medicare advance payments
Congress also didn’t immediately pass funding to combat COVID-19 after Republicans and Democrats couldn’t agree on how to pay for the White House’s $15.6 billion requested allocation. The Biden administration says the money will be needed in upcoming months to ensure a steady supply of vaccines, tests and treatments.
Administration officials have projected that the lack of funding would force a program that covers COVID-19-related services for the uninsured to cease accepting claims by April 5 and would exhaust the nation’s supply of monoclonal antibody treatments by May.
Judge rules for providers in a case about the new surprise billing regulations
A Texas federal judge ruled Feb. 23 that the U.S. Department of Health and Human Services (HHS) erred in implementing criteria for arbitrators to use as part of the independent dispute resolution (IDR) process that’s being implemented in accordance with the No Surprises Act.
The IDR process is available for scenarios in which patients can no longer be balance-billed and the provider and health plan can’t agree on payment for the outstanding amount. HHS established regulations instructing arbitrators to focus primarily on the median contracted rate for a given service in a given market — i.e., the qualifying payment amount — in deciding the payment.
The Texas Medical Association asserted in court that Congress had intended for other criteria, such as the provider’s level of training and experience and the patient’s acuity level, to be given equal weight in the IDR process. Judge Jeremy D. Kernodle agreed in a ruling that applies nationally.
HHS subsequently said it would issue new guidance that more closely mirrors the legislative language. All other regulations stemming from the No Surprises Act remain in place.
CISA, AHA issue warnings about cybersecurity threats stemming from the Ukraine conflict
U.S. hospitals should be on alert as global events potentially increase the risk of cyberattacks, according to recent guidance.
Russia’s invasion of Ukraine led to economic sanctions and other retaliatory steps by the United States, Europe and others. It’s possible that Russia, in turn, would retaliate by launching cyberattacks against the West. Hospitals could be among the targets, given their vital societal role.
The federal Cybersecurity & Infrastructure Security Agency (CISA) issued a “Shields Up” bulletin to all U.S. businesses around the time of the Feb. 24 invasion, stating, “Every organization — large and small — must be prepared to respond to disruptive cyber activity.”
The American Hospital Association (AHA) also issued an advisory, noting that, in addition to possibly being directly targeted by Russian state-sponsored actors, hospitals and health systems could be affected if malware or destructive ransomware is initiated overseas or in another industry and then “inadvertently penetrates U.S. healthcare entities.”
A cyberattack also could “disrupt hospitals’ mission-critical service providers,” such as utility companies, the AHA stated.
The AHA recommended that hospitals act to ensure their IT and cyber infrastructure teams have access to the latest news and guidance about the situation.
Analysis of hospital websites finds little compliance with transparency regulations
A large analysis by PatientRightsAdvocate.org, a patient advocacy group, has found that fewer than 15% of hospitals are in compliance with federal price transparency requirements.
The analysis of 1,000 hospital websites found that 85.7% did not include all the required information in their machine-readable files.
“The most significant finding of noncompliance is that the majority of hospitals did not post all payer-specific and plan-specific negotiated rates,” the analysts wrote. Problematic issues also included incomplete or missing data fields and fields with zeros, N/As and asterisks for negotiated rates.
Of the 1,000 hospitals, 287 presented charges for 300 shoppable services in the required format. Nearly 85% of the 1,000 offered a price estimator tool, but among that group, a fifth did not allow uninsured and self-pay patients to see discounted cash prices.
The design of the price transparency tools generally “makes it impossible for a consumer to access actual prices by procedure or code, and also inhibits the ability of consumers or developers to compare prices, scrape or parse the data within the tool,” the analysts wrote in their report.