The Health and Human Services Department released a detailed policy agenda Monday that expands on the health provisions included in President Joe Biden's fiscal 2023 budget.
The budget, which essentially functions as the administration's wish list for Congress and is not a binding document, focuses on mental health and public health preparedness. But HHS also wants lawmakers to make some specific policy changes to Medicare Advantage data collection, civil money penalties and more.
Here are five highlights from the HHS budget plan:
1. The Centers for Medicare and Medicaid Services wants Congress to accelerate alternative payment models by moving up the start date for a 0.75% physician fee increase by a year. Qualifying clinicians can receive 5% APM incentive payments from 2019 through 2024 and will be eligible for the 0.75% multiplier applied to Medicare Part B rates, but there are no incentive payments for 2025. CMS also proposes moving up the start date for a 0.25% multiplier for providers that don't meet the requirements for the higher rate.
"Beginning the enhanced conversion factor update in 2025 instead of 2026 would simplify physician payment policy, reduce regulations and paperwork and avoid confusion among stakeholders," the HHS budget plan says. The proposal would cost $3.5 billion over 10 years.
2. HHS wants lawmakers to require Medicare Advantage plans to collect referring provider identifier numbers and provide them to CMS as part of encounter data submissions. The department argues that additional provider data would improve its ability to hold bad actors accountable, prevent program losses and protect beneficiaries, while Medicare Advantage carriers would benefit from more information in their own systems.
3. HHS wants to reverse a law that requires it to terminate psychiatric hospitals from Medicare when they're out of compliance with participation conditions for six months, even if the noncompliance doesn't endanger patients. This policy doesn't apply to other provider types and can reduce access to mental health services, HHS contends. CMS needs more flexibility to continue Medicare reimbursements while it works with psychiatric hospitals to correct issues, according to the department.
4. HHS suggests increasing the amount of civil money penalties that can be imposed in a calendar year for Health Insurance Portability and Accountability Act noncompliance. The department also wants to allow the Office of Civil Rights to seek injunctive relief in federal court for such violations.
Allowing higher caps on penalties will strengthen HIPAA enforcement, and seeking relief from courts could prevent future harm in the most severe HIPAA compliance cases, the department says. The maximum annual penalty for HIPAA violations is $1,806,757 for multiple violations of the same provision. "In OCR's experience, the current limits on civil money penalties do not create a sufficient deterrent to industry noncompliance," the HHS plan says.
5. CMS proposes changing the subjects of civil money penalties for long-term care facilities from administrators to owners or operators. A facility's owner typically controls finances and has the authority to closes a site, not an administrator, CMS says. This change would enable CMS to impose penalties on owners when a facility has closed.