House passes CR to fund the government, maintaining pay cut to physicians

The House of Representatives on Tuesday passed a continuing resolution that would keep the federal government open and extend several expiring health programs through September but also keeps a cut to physicians' Medicare pay intact. The legislation, which passed 217-213, does not address the 2.9% Medicare reimbursement cut for physicians that took effect on Jan. 1, something that Rep. Greg Murphy (R-N.C.) worries will leave doctors unable to afford to run their own private practices.

"We're at a crucible where if we don't fight these cuts now, if we don't get rid of them, we don't reverse them, I don't see how private practice survives," Murphy said. Reimbursements were cut by 1.69% last year and by 2% the year before.

Bruce Scott, president of the American Medical Association (AMA), said the decision to keep the payment cut "is particularly devastating for rural and underserved communities. These physicians and their patients have borne the brunt of the rising practice costs — 3.5% this year according to Medicare's own estimate. When adjusted for inflation, Medicare payment to physician practices has dropped 33% since 2001. Let me be clear: these unsustainable cuts will force more practices to close and leave patients with fewer options for care."

The resolution also contains a provision extending CMS' "Hospital-at-Home" waiver program, which was set to expire on March 31. The program allows hospitals to provide hospital-level care to some patients in their homes, despite the fact that doing so would typically violate a condition of participation in Medicare and Medicaid that requires 24/7 availability of nursing care.

The bill still requires Senate approval. (Frieden, MedPage Today, 3/11; McAuliff, Modern Healthcare, 3/10; O'Connell-Domenech, The Hill, 3/6; Japsen, Forbes, 3/9; McAuliff, Modern Healthcare, 3/11)

CMS proposes rule aimed at tackling fraud in ACA plans

CMS on Monday proposed a rule that would require enrollees in Affordable Care Act (ACA) plans to provide more information to prove they're eligible for subsidies and special enrollment periods. It would charge a monthly premium to people automatically re-enrolled in subsidized coverage until they confirm their eligibility.

The rule would also shorten the open enrollment period for the individual marketplace, ending it on Dec. 15 rather than in January.

CMS said that access to fully subsidized payments from the temporary increase implemented in 2021, as well as the elimination of the eligibility verification process, significantly increased the opportunity and incentive for improper enrollments, which CMS defines as applications submitted to HealthCare.gov with information that fails to match federal data sources. CMS estimates the rule would lead to between 750,000 and 2 million people losing ACA coverage and would reduce improper spending on ACA subsidies by $11 billion.

Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University, said the rule will negatively impact ACA enrollees, including the most vulnerable.

"Under the auspices of, 'We have to go after fraud and improper enrollment' — which, yes, was well-documented last year, there was a lot of fraud from a handful of unscrupulous brokers — instead of going after the brokers who are guilty of this, this rule does nothing to prevent that behavior," she said, adding that the rule is "like making people crawl through broken glass" for coverage. (Pifer, Healthcare Dive, 3/11; Lagasse, Healthcare Finance, 3/11)

During an interview on Fox News in February, Kennedy said he had a "generic list" of staffers at HHS he'd like to see removed.

"If you've been involved in good science, you have nothing to worry about," he said. "If you care about public health, you've got nothing to worry about. If you're in there working for the pharmaceutical industry, then I'd say you should move out and work for the pharmaceutical industry." (Seitz, Associated Press, 3/9; Strickler, et. al., NBC News, 3/8)

CDC to investigate debunked link between vaccines and autism

CDC on Friday said it plans to conduct a large-scale study to reexamine whether there is a link between vaccines and autism, something that dozens of scientific studies have failed to find evidence of. It is unclear whether Kennedy — who has long promoted anti-vaccine views — would be involved in the study or how CDC is planning to carry it out, sources told Reuters.

"As President Trump said in his Joint Address to Congress, the rate of autism in American children has skyrocketed," said Andrew Nixon, a spokesperson for HHS. "CDC will leave no stone unturned in its mission to figure out what exactly is happening."

While the rate of autism in the United States has increased from around 1 in 150 children in 2000 to around 1 in 36 now, experts attribute most of that surge to increased awareness of the disorder and changes in how it's classified, though they say other factors — both genetic and environmental — could also be playing a role. (Nunn/Stolberg, New York Times, 3/7; George, MedPage Today, 3/10; Levine/Douglas, Reuters, 3/9; Sun/Weber, Washington Post, 3/7)

CMS sends alert to hospitals saying it's considering new policies regarding gender-affirming care

CMS on Wednesday sent a special alert to hospitals saying it "may begin taking steps to appropriately update its policies to protect children from chemical and surgical mutilation," using language the Trump administration used in its executive order to describe hormonal treatments and surgical procedures used in transition-related care.

The agency said in the alert that the U.S. government's previous support of these treatments is an "outlier" among other developed nations, pointing to policies or recommendations that emphasize psychotherapy as a first-line treatment in the United Kingdom, Sweden, and Finland.

Gender-affirming care treatments have been supported by major medical groups including the American Academy of Pediatrics, the AMA, the American Psychological Association, and others that have previously warned of transgender people's increased risk for self-harm when denied such treatments. (Muoio, Fierce Healthcare, 3/6)