IHA Daily Briefing: July 27

Wenesday, July 27, 2022
IHA-Supported Bill Passes U.S. House Committee
Congress Urges CMS to Increase Hospital Payments
Governor Extends COVID-19 Executive Orders
CY 2023 OPPS Fact Sheet
Illinois COVID-19 Update
Briefly Noted

IHA-Supported Bill Passes U.S. House Committee
Today, the U.S. House Committee on Ways and Means advanced IHA-supported legislation to streamline the prior authorization process for Medicare Advantage (MA) plans. The Improving Seniors’ Timely Access to Care Act (S. 3018/H.R. 3173) would establish requirements for the use of prior authorization under MA plans. A recording of today’s hearing is available here.

Specifically, the legislation would require MA plans to:

  • Establish an electronic prior authorization program that meets specified standards, including the ability to provide real-time decisions in response to requests for items and services that are routinely approved;
  • Annually publish specified prior authorization information, including the percentage of requests approved and the average response time; and
  • Meet other standards, as set by the Centers for Medicare & Medicaid Services, relating to the quality and timeliness of prior authorization determinations.

IHA has repeatedly urged Congress to advance this legislation to support access to care for seniors and reduce administrative burden on providers and healthcare workers.

The bill, which now moves to the full House for consideration, is cosponsored by Illinois Reps. Bobby Rush (IL-1), Darin LaHood (IL-18), Robin Kelly (IL-2), Rodney Davis (IL-13), Raja Krishnamoorthi (IL-8), Bill Foster (IL-11), Adam Kinzinger (IL-16), Mike Quigley (IL-5), Jan Schakowsky (IL-9), Danny Davis (IL-7), Sean Casten (IL-6), Mike Bost (IL-12) and Brad Schneider (IL-10).


Congress Urges CMS to Increase Hospital Payments
On Tuesday, a bipartisan group of House and Senate members sent letters to the Centers for Medicare & Medicaid Services (CMS) urging the agency to make critical changes to its hospital Inpatient Prospective Payment System (IPPS) proposed rule.

Specifically, the letters ask CMS to use its “special exemptions and adjustments” authority to make changes to the final fiscal year (FY) 2023 IPPS rule by retrospectively adjusting the market basket update for FY 2022 to account for unprecedented inflation, and to hold off on the productivity cut for FY 2023. (An AHA fact sheet is here.)

The House letter, which was led by Reps. Brad Schneider (IL-10) and Carol Miller (R-WV), was signed by Illinois Reps. Mike Bost (IL-12), Danny Davis (IL- 7), Raja Krishnamoorthi (IL-8), Darin LaHood (IL-18), Marie Newman (IL-3), Mike Quigley (IL-5), Bobby Rush (IL-1), Jan Schakowsky (IL-9), Robin Kelly (IL-2) and Sean Casten (IL-6).


Governor Extends COVID-19 Executive Orders
This week, Gov. J.B. Pritzker issued a new Executive Order, EO 2022-17, extending by 30 days prior COVID-19 executive orders that contain various waivers and flexibilities for healthcare providers, while providing notice that several provisions of previous executive orders will be allowed to sunset prior to Sept. 17, 2022.  

  • Sections 9 and 10 of the previous telehealth order EO 2020-09 as amended by EO 2021-15 was reissued and extended through Aug. 20. However, the EO states that Section 10 of the original telehealth order is expected to be rescinded no later than Sept. 17. That section currently reads as follows: “During the duration of the Gubernatorial Disaster Proclamation, the following requirements of the Medical Practice Act of 1987, 225 ILCS 60/21, for reinstatement of a license are suspended for licensees whose licenses have been lapsed or inactive for less than three years: (1) proof of meeting continuing education requirements for one renewal period; and (2) payment of a reinstatement fee.”
  • Actions by the Illinois Dept. of Financial and Professional Regulation (IDFPR) for licensed professionals engaged in disaster response (EO 2020-23) was reissued in its entirety through Aug. 20, 2022. This is the waiver that allows IDFPR to take actions to increase the number of licensed professionals responding to the disaster, including issuing variances to allow for out-of-state licensees to practice within Illinois.
  • Sections 2, 3, 5, 6, 7, 8 and 9 of EO 2021-22 (as amended by EO 2021-23, EO 2021-27, EO 2022-05 and most recently by EO 2022-16) are reissued and extended through Aug. 20, 2022. This action extends the recently amended once-weekly testing mandate of unvaccinated healthcare workers that now reads: Health Care Workers who work at hospitals and healthcare facilities that are certified by the Centers for Medicare & Medicaid Services (CMS) who are not fully vaccinated must undergo testing weekly only if the Level of COVID-19 Community Transmission is “high.” Testing of such workers is not required if the level is “low,” “moderate,” or “substantial.” Determination of community transmission level in the county in which the hospital is located can be determined by referencing the Centers for Disease Control and Prevention (CDC) website at this link: CDC Community Transmission Level
  • EO 2021-31, which suspends certain requirements for restoration of inactive or expired licenses of social workers, is extended through Aug. 20, 2022, but is set to be rescinded no later than Sept. 17.

CY 2023 OPPS Fact Sheet
IHA posted a fact sheet summarizing the Centers for Medicare & Medicaid Services (CMS) calendar year (CY) Medicare Outpatient Prospective Payment System (OPPS) proposed rule. Comments on the proposed rule are due to CMS by Sept. 13.

CY 2023 OPPS proposed rule policies include the reinstatement of 340B-acquired drug reimbursement at Average Sales Price + 6%, payment guidelines for Rural Emergency Hospitals and requirements specific to the provision of remote mental health services.


Illinois COVID-19 Update
The Illinois Dept. of Public Health (IDPH) today reported 2,585 new confirmed and probable COVID-19 cases and nineCOVID-19 deaths.

Most recent IDPH hospitalization data show 1,465 individuals in Illinois were reported to be in the hospital with COVID-19. Of those, 159 patients were in the ICU and 40 patients were on ventilators.

The seven-day rolling average of vaccines administered daily in Illinois is 12,990 doses. IDPH reported that 78.1% of Illinoisans (18 years and older) have been fully vaccinated, while 86.2% have received at least one vaccination dose. For the Illinois population 12 years and older, 76.9% have been fully vaccinated, while 84.9% have received at least one vaccination dose. For the Illinois population 5 years and older, 73.5% have been fully vaccinated and 81.2% have received at least one dose.


Briefly Noted
A White House Rural Stakeholders Call will take place this Thursday, July 28, at 2 p.m. to provide an update on CMS’s proposed rule to implement the Rural Emergency Hospitals designation, as well as additional bipartisan infrastructure investments for rural high-speed internet through U.S. Department of Agriculture. Click here to register.