Federal policy

White House launches new opioid overdose database

The Biden administration this week unveiled a new website that will track non-fatal opioid overdoses (Source: “The White House unveils a new system to track and better prevent opioid overdoses,” NPR, Dec. 8).

The new website will be updated every two weeks with reports collected at the county level by EMS first responders in all 50 states and the District of Columbia. Officials say the information will help shape the medical response when overdose clusters occur in different parts of the country.

Data on the new website will be managed by the National Highway Traffic Safety Administration, which collects EMS data. 

Officials acknowledge this data collection and reporting system will provide a limited snapshot of drug overdoses.

It focuses entirely on opioids — the leading cause of drug deaths — while excluding cocaine, methamphetamines and other substances. The website also won't include information from hospitals, schools, businesses, non-profits and academic programs that collect non-fatal overdose information.


CDC softens guidelines for opioid prescribing

The Centers for Disease Control and Prevention on Thursday softened its guidelines for U.S. doctors prescribing oxycodone and other opioid painkillers (Source: “US agency softens opioid prescribing guidelines for doctors,” Associated Press, Nov. 14).

The new CDC recommendations are an update to 2016 guidelines that added momentum to a decline in opioid painkiller prescriptions.

The previous guidance succeeded in reducing inappropriate and dangerous prescribing, some experts say. But they also were seen as a barrier to care, with some pharmacists refusing to fill prescriptions as doctors wrote them.

The new guidelines are designed to ensure that patients get compassionate and safe pain care, CDC officials said.

A draft released in February received 5,500 public comments. Some modifications were made, but several main changes stayed in place, including no longer suggesting limiting opioid treatment for acute pain to three days; dropping the specific recommendation that doctors avoid increasing dosage to a level equivalent to 90 milligrams of morphine per day; and urging doctors to not abruptly halt treatment for patients receiving higher doses of opioids unless there are indications of life-threatening danger.


Medicare mulls adding limited dental benefits

Proposed changes in Medicare rules could soon pave the way for a significant expansion in Medicare-covered dental services, while falling short of the comprehensive benefits that many Democratic lawmakers have advocated (Source: “After Congress fails to add dental coverage, Medicare weighs limited benefit expansion,” Kaiser Health News via Ohio Capital Journal, Oct. 18, 2022).

Under current law, Medicare can pay for limited dental care only if it is medically necessary to safely treat another covered medical condition. In July, officials proposed adding conditions that qualify and sought public comment. Any changes could be announced in November and take effect as soon as January.

The review by the Centers for Medicare & Medicaid Services follows an unsuccessful effort by congressional Democrats to pass comprehensive Medicare dental coverage for all beneficiaries, a move that would require changes in federal law. Sen. Bernie Sanders (I-Vt.) sought in vain to add that to the Democrats’ last major piece of legislation, the Inflation Reduction Act, which passed in August. As defeat appeared imminent, consumer and seniors’ advocacy groups along with dozens of lawmakers urged CMS to take independent action.


Feds increase ACA tax credits through fix to the ‘family glitch’

The Treasury Department on Tuesday announced new rules that determine the tax breaks for certain families when they buy private health insurance plans through the Affordable Care Act (ACA) (Source: “New rules fix ‘flaw’ for families seeking Obamacare coverage,” Associated Press, Oct. 11).

The new interpretation of the health law aims to fix the “family glitch,” which determines a family’s eligibility for ACA tax credits based on the cost of an individual’s work-sponsored health insurance plan rather than the cost of the plan for the whole family.

Since the law was enacted more than a decade ago, people who have access to health insurance plans through their employers are supposed to get price breaks on the Affordable Care Act marketplace if they pay more than 9.5% of their income toward monthly premiums.

But for years, the Internal Revenue Service arrived at that calculation based on the cost of a work-sponsored health insurance plan for a single individual, instead of a more expensive family plan. That meant many families didn’t qualify for the tax breaks offered through the ACA.

“Given the complexity of the policy, we encourage families to work with a certified and licensed Navigator organization by calling 833-628-4467 or visiting getcoveredohio.org,” said Zach Reat, Director of Health Initiatives for the Ohio Association of Foodbanks.  


Congress temporarily extends Medicare programs that boost pay to rural hospitals

Congress has cleared a short-term spending bill that includes extensions of two programs aimed at helping rural hospitals, punting the issue and others into December (Source: “Congress passes short-term spending bill that extends 2 key rural hospital programs,” Fierce Healthcare, Sept. 30). 

The House voted 230 to 201 to advance to President Biden’s desk a continuing resolution that funds the federal government through Dec. 16. Biden is expected to sign the legislation.
 
The legislation also extends through Dec. 16 the hospital payment adjustment for certain low-volume hospitals (LVH) and the Medicare-Dependent Hospital (MDH) program, which have helped shore up finances for rural hospitals that have been vulnerable to closures in recent years and strained further due to the COVID-19 pandemic. 
 
Both programs were set to expire after September. 


U.S. Preventive Services Task Force recommends anxiety screenings for all adults under 65

A panel of medical experts on Tuesday recommended for the first time that doctors screen all adult patients under 65 for anxiety, guidance that highlights the extraordinary stress levels that have plagued the United States since the start of the pandemic (Source: “Health Panel Recommends Anxiety Screening for All Adults Under 65,” New York Times, Sept. 20).

The advisory group, called the U.S. Preventive Services Task Force, said the guidance was intended to help prevent mental health disorders from going undetected and untreated for years or even decades. It made a similar recommendation for children and teenagers earlier this year.

The panel, appointed by an arm of the federal Department of Health and Human Services, has been preparing the guidance since before the pandemic. The recommendations come at a time of “critical need,” said Lori Pbert, a clinical psychologist and professor at the University of Massachusetts Chan Medical School, who serves on the task force. Americans have been reporting outsize anxiety levels in response to a confluence of stressors, including inflation and crime rates, fear of illness and loss of loved ones from Covid-19.


Uninsured rate for children dropped during pandemic, federal data shows

The rate of children without health insurance declined during the COVID-19 pandemic, likely the result of a provision passed by Congress that barred states from dropping anyone from Medicaid during the public health emergency (Source: “More Children Have Gained Health Insurance During Pandemic,” Pew Stateline, Sept. 21).

According to an analysis of new U.S. Census Bureau data by Georgetown University’s Center for Children and Families, the child uninsurance rate in 2021 was 5.4%, compared with 5.7% in 2019, the year before the pandemic took hold.

The center described that change as a “small but significant decline,” equating to 200,000 more children with health insurance in 2021 than in 2019. Overall, about 4.2 million children were uninsured in 2021, according to the analysis.

The data comes from the Census Bureau’s American Community Survey, which provides annual estimates of income, education, employment, health insurance coverage and housing costs and conditions for U.S. residents. The Census Bureau did not release standard results in 2020 because of difficulties in data collection in the pandemic’s first year.

The Georgetown analysis speculated that the downward trend in child uninsurance was the result of Congress’s provision in the Families First Coronavirus Response Act, passed in March 2020, that prohibited states from involuntarily dropping anyone from Medicaid, the health plan covering lower-income Americans.


Federal report finds telehealth fraud during pandemic cost Medicare $128 million

The federal government eased telehealth requirements at the beginning of the COVID-19 pandemic so more Americans could get remote care with fewer obstacles.
 
A report released last week by federal government investigators found that nearly $128 million in telehealth claims submitted during the first year of the pandemic may have been fraudulent (Source: “'Guardrails' needed? Telehealth fraud cost Medicare $128M in first year of COVID pandemic, feds say,” USA Today, Sept. 11).
 
Investigators said less than 1% of the 742,000 Medicare-certified doctors and other providers of telehealth services submitted roughly a half million problematic claims. Yet the billings are concerning enough that government investigators urged the Biden administration to tighten oversight to ensure millions of Americans can access remote care while safeguarding taxpayer dollars.
 
Before 2020, Medicare largely restricted telehealth to people who accessed medical care via video and audio connections set up in rural clinics. Amid the pandemic, Medicare allowed recipients in cities and suburbs to get care remotely, often from their home, via a phone call or a video chat. Medicare also more than doubled the types of services eligible for reimbursement to make it easier for people to get care without the risk of COVID-19 exposure during a visit to a clinic or hospital.


CMS proposes rule change to simplify Medicaid, CHIP enrollment

A proposed federal rule change was introduced last week that aims to make the Children’s Health Insurance Program (CHIP) and Medicaid enrollment easier (Source: “Proposed CMS rule would streamline Medicaid, CHIP enrollment,” Healthcare Dive, Sept. 1).

The Centers for Medicare and Medicaid Services on Aug. 31 issued a proposed rule with the goal of reducing coverage gaps by streamlining the application and renewal process for Medicaid enrollees and other programs such as CHIP by limiting renewals to once a year, establishing standardized statewide renewal processes and giving applicants 30 days to respond to information requests.

The proposed rule comes as states begin to notify Medicaid beneficiaries about potential losses of coverage due to the impending end of the COVID-19 public health emergency.

Earlier this year, HPIO released an Ohio Medicaid Basics update, Trends in Enrollment and Expenditures During the COVID-19 Pandemic, that provides information on enrollment and spending changes to the Ohio Medicaid program during the pandemic.


Following COVID missteps, CDC plans major overhaul

Following a series of missteps in the COVID-19 pandemic and monkeypox outbreak, the Centers for Disease Control and Prevention will undergo an “ambitious” overhaul, its director announced Wednesday (Source: “In an effort to address its missteps during Covid, CDC plans an ‘ambitious’ agency overhaul,” STAT News, Aug. 17).

In an email to staff, CDC Director Rochelle Walensky said the renewal effort will focus on making the agency more nimble and responsive to needs that arise in health emergencies. The priority will be to gather data that can be used to rapidly dispense public health guidance, rather than craft scientific papers.

Walensky also said the agency needs to acknowledge the flaws of its response to Covid-19. Those mistakes date to the earliest days of the pandemic, when a test designed by CDC scientists to detect the new disease failed to work on the ground — leaving the country blind to how quickly the SARS-CoV-2 virus was transmitting at a critical juncture when aggressive measures could have slowed Covid’s spread.

“For 75 years, CDC and public health have been preparing for Covid-19, and in our big moment, our performance did not reliably meet expectations,” Walensky said in the email, sent to the agency’s 11,000-person staff.  “My goal is a new, public health action-oriented culture at CDC that emphasizes accountability, collaboration, communication, and timeliness.”