2023 Public Comments

When relevant legislation, regulations, guidance, and other opportunities to shape policy related to health services research arise, UnityPoint Health may decide it is appropriate to develop an official position. The UnityPoint Health Government & External Affairs department serves as the primary liaison for regulatory submissions in response to state and federal rule-making and public requests for information, as well as communications advocating changes in state and federal policy direction or strategic initiatives.

Federal Comments

Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting Proposed Rule

Agencies: Centers for Medicare and Medicaid Services
Date Submitted: November 3, 2023

This proposed rule would establish minimum staffing standards for long-term care facilities to ensure safe and quality care in long-term care facilities. In addition, this rule proposes to require States to report the percent of Medicaid payments for certain Medicaid-covered institutional services that are spent on compensation for direct care workers and support staff.

Ways and Means Committee Improving Access to Health Care in Rural and Underserved Areas Request for Information

Agencies: Ways and Means Committee
Date Submitted: October 5, 2023

This request for information (RFI) seeks to identify how geographic barriers, misaligned Medicare payment incentives, and consolidation may be driving facility closures and workforce shortage – hurting overall access to health care – while innovative care models and technology are improving such care. Input is sought on geographic payment differences; sustainable provider and facility financing; aligning sites of service; health care workforce; and innovative models and technology.

CY 2024 Hospital Outpatient Prospective Payment System

Agencies: Centers for Medicare & Medicaid Services (CMS)
Date Submitted: September 11, 2023

This proposed rule provides an annual rate update; authorized payment for Intensive Outpatient Services in Rural Health Clinics, Federally Qualified Health Centers, and Opioid Treatment Programs; revises hospital price transparency requirements; changes to Community Mental Health Centers Conditions of Participation; revises the Inpatient Prospective Payment System Medicare Code Editor; and corrects Rural
Emergency Hospital Conditions of Participation.

CY 2024 Physician Fee Schedule

Agencies: Centers for Medicare & Medicaid Services (CMS)
Date Submitted: September 11, 2023

This proposed rule provides CY 2024 payment policies under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; revisions to the Medicare Shared Savings Program Requirements, Medicare and Medicaid Provider and Supplier Enrollment Policies; and changes to the Basic Health Program.

340B-Acquired Drug Proposed Remedy

Agencies: Centers for Medicare & Medicaid Services (CMS)
Date Submitted: September 11, 2023

This proposed rule describes the agency’s proposed actions to comply with the remand from the district court to craft a remedy in light of the United States Supreme Court’s decision in American Hospital Association v. Becerra, 142 S. Ct. 1896 (2022), relating to the adjustment of Medicare payment rates for drugs acquired under the 340B Program from calendar year (CY) 2018 through September 27th of CY 2022.

CY 2024 Home Health Prospective Payment System

Agencies: Centers for Medicare & Medicaid Services (CMS)
Date Submitted: August 28, 2023

This proposed rule provides an annual rate update; revises the Home Health Quality Reporting Program and Home Health Value-Based Purchasing Expanded Model
requirements; and offers changes to home intravenous immune globulin items and services, the hospice informal dispute resolution and special focus program, and certain durable medical equipment, prosthetics, and supplies.

Stop Drug Shortages Discussion Draft

Agencies: House Energy and Commerce Committee
Date Submitted: August 25, 2023

This discussion draft addresses drug shortages through proposals impacting (1) Medicaid rebates and rebate caps; (2) 340B program – injectable drug exemption, GAO report, and HRSA guidance; (3) Medicare rebates, study on market-based pricing, CMMI model on alternative payment for generic sterile injectables, studies on Medicare coding and flat fee payments, hospital GPO reporting, and clarification of Medicare average sales price payment methodology; (4) transparency of GPO reporting; and (5) FDA flexibilities.

340B Drug Pricing Program RFI

Agencies: U.S. Senate – six members
Date Submitted: July 28, 2023

U.S. Senate Request for Information seeks input from stakeholders on bipartisan policy solutions to the 340B Drug Pricing Program that would ensure the program has stability and oversight to continue to achieve its original intention of serving eligible patients.

FY 2024 Hospital Inpatient Prospective Payment System

Agencies: Centers for Medicare & Medicaid Services (CMS)
Date Submitted: June 9, 2023

This proposed rule revises the Medicare hospital inpatient prospective payment systems for operating and capital-related costs for acute care hospitals; makes changes relating to Medicare graduate medical education (GME) for teaching hospitals; updates the payment policies and the annual payment rates for the Medicare prospective payment system for inpatient long-term care hospitals; and other policy-related changes.

FY 2024 Hospice Wage Index and Payment Rate Update

Agencies: Centers for Medicare & Medicaid Services (CMS)
Date Submitted: May 30, 2023

This proposed rule updates the hospice wage index, payment rates, and aggregate cap amount for fiscal year 2024.

Expansion of Induction of Buprenorphine via Telemedicine Encounter

Agencies: Drug Enforcement Administration, Department of Justice
Date Submitted: March 31, 2023

This proposed rule expands the circumstances under which individual practitioners are authorized to prescribe schedule III–V narcotic drugs or combinations of such drugs that have been approved for use in continuous medical treatment (also referred to as maintenance) or withdrawal management treatment (also referred to as detoxification)—via a telemedicine encounter, including an audio-only telemedicine encounter.

Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-Person Medical Evaluation

Agencies: Drug Enforcement Administration, Department of Justice
Date Submitted: March 31, 2023

This proposed rule applies only in limited circumstances when the prescribing practitioner wishes to prescribe controlled medications via the practice of telemedicine and has not otherwise conducted an in-person medical evaluation prior to the issuance of the prescription.

Confidentiality of Substance Use Disorder (SUD) Patient Records

Agencies: Office for Civil Rights (OCR), Office of the Secretary, Department of Health and Human Services; Substance Abuse and Mental Health Services Administration (SAMHSA), Department of Health and Human Services
Date Submitted: January 31, 2023

HHS issued a notice of proposed rulemaking (NPRM) to solicit public comment on its proposal to modify regulation regarding the confidentiality of substance use disorder (SUD) patient records.

340B Administrative Dispute Resolution (ADR)

Agencies: Health Resources and Services Administration (HRSA), Health and Human Services (HHS)
Date Submitted: January 30, 2023

HRSA solicits public comments on the notice of proposed rulemaking proposing revisions to the current 340B administrative dispute resolution final rule.

Patient Safety Action Alliance

Agencies: Agency for Healthcare Research and Quality (AHRQ), Health and Human Services (HHS)
Date Submitted: January 26, 2023

AHRQ solicits public comment about advancing patient and healthcare workforce safety through the development of a National Healthcare System Action Alliance to Advance Patient Safety in partnership with health systems, patients, families and caregivers.

CCBHC Certification Criteria

Agencies: Substance Abuse and Mental Health Services Administration (SAMHSA), Health and Human Services (HHS)
Date Submitted: January 19, 2023

SAMHSA solicits public comments on the revised draft Certified Community Behavioral Health Clinic (CCBHC) Certification Criteria.

State Comments
Legislative Positions and Collaborative Sign-On Letters

Senator Ernst Cosponsors Health Care Workforce Legislation

Leading Organization: Senator Joni Ernst

Audience: Public

Senator Joni Ernst (IA) has co-sponsored the Healthcare Workforce Resilience Act (S. 3211), a bipartisan bill to enhance our Nation’s nurse and physician workforce by recapturing unused immigrant visas. This legislation allows for the “recapture” of green cards that were authorized by Congress but unused in previous years, which includes 25,000 visas for nurses and 15,000 visas for physicians. UnityPoint Health supports this legislation and is quoted in the Senator’s press release.

Congressman Nunn Introduces Legislation to Prevent Overdoses

Leading Organization: Congressman Zach Nunn (IA-3)

Audience: Public

Congressman Zach Nunn introduced a bipartisan bill, Overdose Reversal Medication Act, to expand access to overdose reversal medication and save lives. This legislation will expand grant opportunities to assist with acquiring naloxone and provide training for using it to local businesses, individuals, and community organizations. UnityPoint Health supports this legislation, hosted the introduction announcement, and is quoted in the Congressman’s press release.

Senator Ernst Introduces Doctor Shortage Legislation

Leading Organization: Senator Joni Ernst

Audience: Public

Senator Joni Ernst introduced the Directing Our Country’s Transfer of Residency Slots (DOCTORS) Act, which reallocates unused Conrad 30 program waiver slots to states that used all 30 waivers in the previous year to increase access to health care in rural areas. Iowa historically has used its maximum 30-slot allotment. UnityPoint Health supports this legislation and is quoted in the Senator’s press release.

Extend Medicare Advanced Alternative Payment Model Incentive Payments to Congressional Leadership

Leading Organization: NAACOS

Audience: Congressional Leadership

Letter bolster and advance the ongoing transition to value-based payment models by extending the 5 percent advanced alternative payment model (APM) incentive payments for clinicians that were authorized under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

Chemotherapy Drug Shortages Letter to the Wisconsin Congressional Delegation

Leading Organization: UW Health, SSM Health Bellin Health, Gundersen Health System, Children’s Wisconsin, Marshfield Clinic Health System, UnityPoint Health-Meriter

Audience: Wisconsin Congressional Delegation

Letter to describe platinum drug shortage and urge the Wisconsin delegation to request a briefing from the Food and Drug Administration (FDA).

Senator Grassley Introduces Rural Hospital Legislation

Leading Organization: Senator Chuck Grassley

Audience: Public

Senator Chuck Grassley introduced the Rural Hospital Support Act that would extend the Medicare-dependent Hospital (MDH) and Low-Volume Hospital (LVH) programs and establish a new rebasing year for Sole Community Hospitals. UnityPoint Health supports this legislation and is quoted in the Senator’s press release.

Workforce Shortages Letter to Senate HELP Committee

Leading Organization: The Academy Advisors

Audience: Congress – Chairs of the Health, Education, Labor and Pension (HELP) Committee

A Sign-on Letter, dated March 20, 2023, was submitted in response to a Request for Information from Senators Bernie Sanders and Bill Cassidy. The RFI solicited input on the drivers of healthcare workforce shortages and potential solutions to those shortages. Solutions highlighted were to (1) Advance policies to increase the number of nurses and physicians that can be educated and licensed in the United States; (2) create opportunities for healthcare workers to be employed where they’re needed most; (3) support programs that improve workforce retention goals and the worker’s experience; and (4) invest in workforce development solutions that aim to upskill and develop the workforce of tomorrow across all sectors.

Executive Order Summaries

For Further Information:

Please email Cathy Simmons, Executive Director, Government & External Affairs.

Contact Us

UnityPoint Health
Government & External Affairs
1776 West Lakes Parkway
West Des Moines, Iowa 50266