Feds’ Busy December Energizes Quality World

January 10, 2023 · Andy Reynolds

Big moves by Congress and CMS in late 2022 have given quality advocates who work in federal health policy a lot to read and respond to in early 2023.

Congressional Action on Quality

In a stroke of holiday bipartisanship, Congress and the Biden Administration agreed to a year-end omnibus spending package known as the Consolidated Appropriations Act.

This mega-legislation:

• Provides new resources to quality programs at the US Department of Health and Human Services.
• Sets health research priorities for federal agencies.

Parts of the legislation relevant to health care quality include:

• Telehealth Extension: Telehealth and Hospital at Home Public Health Emergency (PHE) waivers have been extended through 2024. Congress also wants HHS to report on telehealth utilization and compare the quality of inpatient care to the quality of hospital at home. (Care at home is a quality trend we cover online and at Quality Talks.)

• New Data-Sharing Expectations: To respond to future public health emergencies, the PREVENT Pandemics Act inside the omnibus bill provides new instructions and funding for the CDC to improve data sharing.
• More Mental Health Funding: Federal agencies and organizations that use federal grants will get bigger budgets to improve mental health care. Congress also required CMS to standardize mental health assessment and develop patient perspective quality measures for inpatient psychiatric care.

CMS’s Proposed Rules

Lawmakers weren’t the only ones in Washington who had a busy December. CMS proposed rules that could mean big things for quality.

• New (Old) Weighting of Quality Measures: CMS suggested reversing a 2021 decision that reduced the weighting of clinical measures in the Medicare Advantage (MA) Stars program. That earlier de-emphasis on clinical measures puzzled us. The renewed focus on clinical quality is a sensible restart that “align with other CMS quality programs.” CMS also proposed creating a health equity index for the 2027 Star ratings and wants MA plans to have more stringent policies for utilization management.
• New Rules for 2024 Exchange Plans: Exchange plans come up in more quality conversations these days—especially now that it’s possible to compare Exchange plans’ HEDIS results. Our own and others’ reading of proposed Exchange rules didn’t detect many changes in Exchange rules, at least when it comes to CMS priorities such as health equity. NCQA will continue our dialogue with CMS about Exchange plans in 2023. We have ideas for Exchange plans that others call “ambitious.”

• Rethinking Prior Auth and Electronic Files: CMS suggested new rules for prior authorization and for electronic files such as attachments and signatures. We’re keeping an eye on those changes. They could prompt us to rethink expectations we put in our Health Plan Accreditation and Utilization Management Accreditation.

 How You Can Get Involved

• NCQA’s Public Policy team follows these and other legislative and regulatory developments. When we advise government officials about quality and value, such as through public comment letters, you’re watching our Public Policy team in action.
• If the topics we’ve discussed here energize you like they do us, consider joining our team! We eager to hire a driven and dynamic Manager of Federal Affairs.