Stay ahead of the latest regulatory shifts and healthcare breaking news with Headlines from the Hill.
In this month’s edition you will find:
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- 2025 IRF Final Rule: Key changes for rehabilitation hospitals and units.
- Behavioral health: $45.1m for mental health and youth wellness.
- Medicare Advantage prior authorization: Requests increase by 9 million in 3 years.
- Workforce shortages: Bipartisan bill proposed.
- Medicaid redetermination: CMS will issue guidance.
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2025 IRF Final Rule: Key changes for rehabilitation hospitals and units.
CMS recently released the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) for fiscal year (FY) 2025. The rule includes several changes that will impact IRFs and acute rehabilitation units (ARUs) and is set to go into effect October 1, 2024. Get the summary of its impact on rehabilitation hospitals.
Behavioral health: $45.1m for mental health and youth wellness.
The Department of Health and Human Services (HHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) have announced $45.1 million in grant awards to enhance mental health and substance use services.
This funding includes $15.3 million specifically allocated for children and youth to address their mental health needs. The awarded funds will support a range of programs such as services for the homeless with substance use disorders, school-based mental health programs, trauma-focused treatment for children, supported employment for adults with mental health issues, and treatment for underserved racial and ethnic populations at high risk for HIV/AIDS.
The grants also bolster statewide networks for mental health family organizations and consumer-run entities to improve mental health service systems.
Medicare Advantage prior authorization: Requests increase by 9 million in 3 years.
More than 46 million prior authorization requests were submitted to Medicare Advantage (MA) insurers in 2022, according to KFF analysis released yesterday. The analysis examined data submitted by MA insurers to the Centers for Medicare & Medicaid Services (CMS) on prior authorization requests, denials and appeals from 2019 through 2022.
The 46 million requests in 2022 increased from 37 million in 2019. MA insurers fully or partially denied 3.4 million (7.4%) prior authorization requests in 2022, which is a larger share of denied prior authorization requests by MA plans compared to previous years. Only one in 10 (9.9%) denials from that year were appealed, however, a majority of those appeals (83.2%) resulted in overturned denials.
Workforce shortages: Bipartisan bill proposed.
Senator Ron Wyden (D-OR) and Senator Marsha Blackburn (R-TN) introduced bipartisan legislation to address the persistent shortage of health professionals. The bill, the Health Workforce Innovation Act, provides federal support for innovative, community-led partnerships to educate and train more healthcare workers, especially in rural and underserved communities.
Medical assistants, pharmacy technicians and other allied health professionals work closely with physicians and nurses to deliver high-quality care to patients in every corner of America. These frontline providers make up more than 60% of the U.S. healthcare workforce, but there is a significant projected shortfall in these jobs over the next 10 years. As a result of rising shortages, patients face longer wait times for healthcare appointments while providers experience fatigue and burnout.
The Health Workforce Innovation Act would establish a new federal grant program to support community health centers and rural health clinics to carry out innovative, community-driven models to train and develop a pipeline of a wide range of allied health professionals, including through partnerships with high schools, community colleges and other entities.
The legislation is co-sponsored by Senator Ben Ray Luján (D-NM) and is endorsed by:
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- The American Physical Therapy Association
- American Health Information Management Association
- Association of Asian Pacific Community Health Organizations
- Community Catalyst
- Mental Health America
- National Association of Community Health Centers
- National Network for Oral Health Access
- National Association of Rural Health Clinics
- National Rural Health Association
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Medicaid redetermination: CMS will issue guidance.
CMS has embarked on a new era of Medicaid enrollment oversight after the disorderly redeterminations process highlighted widespread compliance issues at the state level. Inappropriate disenrollments and massive applications backlogs proliferated once states resumed Medicaid eligibility checks 15 months ago after suspending them during the COVID-19 public health emergency.
CMS activities such as collecting more enrollment data from states, pausing procedural terminations for certain populations, and improving automatic renewals are likely to become permanent fixtures. CMS told the GAO it would issue guidance to states after finding nearly all of them weren’t adhering to ex-parte renewal rules, according to the report.
