House appropriators included a trove of provisions for hospitals in their report that will accompany their bill to fund HHS.
Congress is far from reaching a bicameral budget deal as the government races toward a deadline to raise the debt limit.
That said, the House report included a wide-range of asks from the healthcare industry— and some could win support from the upper chamber.
Funding for hospitals denied CAH status
House appropriators want HHS to help hospitals that invested money to gain critical access status and secured "preliminary determinations" from the CMS, but then were ultimately denied after the agency revised its guidance.
"The Committee remains concerned about the financial and operational sustainability of these hospitals, which acted in good faith but may have been put in a difficult situation by revisions to Federal policy," the HHS appropriations committee wrote in its report.
HHS is urged to help the facilities who received these deniers find other opportunities for funding.
Medical workforce shortages
House appropriators would push the CMS to extend the time period for new medical residency training programs in areas with physician shortages, and includes a recommendation for the agency to convene stakeholders in those areas "to better understand changes in population health."
The agency would have to prepare a report for the committee within 90 days of the appropriation.
Appropriators also want to reduce the paperwork teaching clinicians must file on behalf of their nurse practitioner and physician assistant students. The report would "encourage" the HHS secretary to allow those clinicians to verify their students' notes during their evaluations, rather than re-document them.
Under another provision, the CMS would have to explain to Congress how it is evaluating nurse staffing levels in hospitals, and why those levels are deemed appropriate.
The committee report tells HHS that Congress is monitoring how payment policy may be driving providers to prescribe opioids instead of non-opioid alternatives, since the CMS pays the same for medication even if the non-opioid alternative brings extra treatment costs.
Additionally, the appropriators said they want the Substance Abuse and Mental Health Services Administration (SAMHSA) to evaluate the inpatient bed shortage for mental health and addiction treatment, and report back to the committee within 90 days of the final appropriations bill.
Medicare Advantage prior-authorization practices
House appropriators want the CMS to require Medicare Advantage plans to rein in their prior-authorization requirements, and issue guidance to bar them from excluding coverage of services "that align with evidence-based guidelines and have historically high prior-authorization approval rates."
MA insurers would also have to submit an annual list of everything they demand prior-authorization for to the HHS secretary. And the CMS would be prompted to boost electronic prior-authorization.
The House report throws its support behind the new national system for distributing livers—a policy that upends the old, geography-based system and has spurred sharp opposition from key senators. Leading the fight is the upper chamber's HHS appropriations panel chair Sen. Roy Blunt (R-Mo.), which makes it unlikely that this language will end up in the final deal.
The new policy is currently under litigation in a federal court.