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Jeffrey Davis Director of Regulatory and External Affairs at ACEP

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  • On September 17, CMS issued a final rule that updates payment parameters for Affordable Care Act (ACA) Exchanges and repeals certain provisions related to the Section 1332 waivers. Section 1332 of the ACA allows states to apply for a waiver, that, if granted by CMS, would enable the states to use a different approach to covering their populations than the traditional ACA Exchanges. The ACA includes guardrails to ensure that the alternate approach adopted by the state would provide coverage that is as comprehensive and affordable as the coverage would otherwise have been through the ACA Exchanges. The last administration issued guidance that provided an extremely flexible interpretation of the guardrails-- paving the way for the proliferation of Association Health Plans and short-term, limited-duration plans (which do not have to cover all ten essential health benefits). ACEP had opposed this guidance and therefore supports this administration’s decision to reverse course and eliminate it.
  • On September 14, the Office of the National Coordinator for Health Information Technology (ONC) hosted a webinar to discuss the implementation of regulations, mandated by the 21st Century Cures Act, which require that patient notes, lab results, and other information be shared with patients—with some limited exceptions. During the webinar, ONC clarified that having an organizational-wide policy of delaying the release of lab results or clinical notes is considered “interference.” However, not all cases of interference necessarily constitute information blocking violations. Towards the end of the webinar, ONC said that a potential strategy that hospitals could use is giving patients the choice of receiving results right away or waiting until they had a chance to review them with their doctor. ONC also stated that providers CANNOT use the harm exception as an excuse to delay data sharing. Finally, ONC said that HHS will be issuing proposed regulations sometime in the future regarding provider “disincentives” for non-compliance—although ONC was unable to give a timeframe on when those regulations would be released.
  • On September 10, the HHS announced that it is making $25.5 billion in new funding available for health care providers affected by the COVID-19 pandemic. This funding includes $8.5 billion in American Rescue Plan (ARP) resources for providers who serve rural Medicaid, Children's Health Insurance Program (CHIP), or Medicare patients, and an additional $17 billion for Provider Relief Fund (PRF) Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic. The application portal will open on September 29, 2021. It appears that the portal will be open for four weeks, so the deadline for applications will fall on/around October 27. Additionally, payments will go out in late November for the $8.5 billion in ARP funds and mid-December for the majority of the $17 billion in PRF Phase 4 funds. To promote transparency, HHS also released detailed information about the methodology utilized to calculate PRF Phase 3 payments. Additionally, HHS announced a final 60-day grace period to help providers come into compliance with their PRF Reporting requirementsif they fail to meet the deadline on September 30, 2021, for the first PRF Reporting Time Period. For more information about the new PRF payments, please click here.
  • On September 10, HHS and other federal agencies issued proposed rules to implement provisions of the No Surprises Act regarding new reporting requirements for air ambulances. The proposed rules also include provisions regarding disclosure of compensation for health insurance agents or brokers.


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