Policy Corner: September 15, 2023
Categories: Policy Corner Archives
Clock Ticks While Congress Fails to Agree on How to Fund Federal Government
Although the House of Representatives returned to the Capitol this week after being on recess, Republican House members have yet to agree how to fund federal government past September 30, when the current federal fiscal year ends. As none of the twelve spending bills have passed the House and Senate, government will shut down October 1st, unless Congress passes a measure to continue funding for the new fiscal year. Republican Leadership has discussed passing a short-term continuing resolution (CR) to fund government starting October 1, but House Republicans have yet to agree on program funding amounts and duration of a CR. Usually, a CR continues federal spending at the current level, but many members want to continue spending at a reduced rate, even less than agreed to in the debt ceiling bill passed earlier this spring. Many House members are also holding out for concessions, including eliminating policies in the defense spending bill relating to diversity, equity, and inclusion initiatives; a policy to reimburse members who travel for reproductive care; and eliminating funding for the war in Ukraine.
Meanwhile, the Senate was moving forward with a package of three spending bills that ran into issues yesterday after a few Senators called for debate and amendments, which would slow the process. The three spending bills that were combined are the Fiscal Year 2024 Military Construction, Veterans Affairs, and Related Agencies; Agriculture, Rural Development, Food and Drug Administration (FDA), and Related Agencies; and Transportation, Housing and Urban Development (HUD), and Related Agencies — all of which passed out of Committee unanimously.
Senator Introduces Bill to Expand Health Care Access to Every Child
Today, U.S. Senator Bob Casey (D-Pa.), Chairman of the U.S. Senate Special Committee on Aging, introduced the Medicaid for Every Child Act. The bill would automatically enroll all children through age 18 in Medicaid. Under the Medicaid for Every Child Act, children would be automatically enrolled at birth and would retain that eligibility until the age of 18, with no redetermination requirement. Parents could proactively opt their child out of Medicaid if they have another form of coverage, such as being eligible for CHIP, securing coverage through the marketplace, or having coverage through their employer.
CMS Proposes Rule for Medicare Physician Fee Schedule and Caregiver Assessment
This summer, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule and solicited public comments on Calendar Year (CY) 2024 Medicare Physician Fee Schedule that also proposed other changes, including Medicare payment for Caregiver Training Service and to address health equity through the proposed assessment and navigation services. CMS proposed payment when practitioners train and involve caregivers to support patients with certain diseases or illnesses (e.g., dementia) in carrying out a treatment plan. CMS proposed paying for these services when furnished by a physician or a non-physician practitioner (e.g., nurse practitioners, clinical nurse specialists, certified nurse-midwives, physician assistants, and clinical psychologists) or therapist (i.e., physical therapist, occupational therapist, or speech language pathologist) under an individualized treatment plan or therapy plan of care.
The announcement also included provisions for paying separately for Community Health Integration, Social Determinants of Health (SDOH) Risk Assessment, and Principal Illness Navigation services to account for resources when clinicians involve community health workers, care navigators, and peer support specialists in furnishing medically necessary care. While these care support staff have been able to serve as auxiliary personnel to perform covered services incident to the services of a Medicare-enrolled billing physician or practitioner, the services described by the proposed codes are the first that are specifically designed to describe services involving community health workers, care navigators, and peer support specialists.
For CY 2024, CMS proposed to add health and well-being coaching services to the Medicare Telehealth Services List on a temporary basis for CY 2024, and Social Determinants of Health Risk Assessments on a permanent basis. CMS is also implementing Medicare Part B coverage and payment under the Medicare Physician Fee Schedule for the services of marriage and family therapists (MFTs) and mental health counselors (MHCs) when billed by these professionals. Additionally, CMS proposed to allow addiction counselors that meet all applicable requirements to be an MHC to enroll in Medicare as MHCs. CMS also sought comments on ways to continue to expand access to behavioral health services and requested information on digital therapies, including digital cognitive behavioral therapy. Comments were due Sept. 11.