joe, Author at DeBrunner & Associates

MedPAC Meets

Members of the Medicare Payment Advisory Commission met publicly last week in Washington, D.C. Their agenda consisted of the following issues: telehealth in Medicare alternative approaches to lowering Medicare payments for selected conditions in inpatient rehabilitation facilities considering approaches for updating the Medicare physician fee schedule assessing consistency between plan-submitted data sources for Medicare Advantage enrollees generic drug pricing under Part D initial findings from analysis of Medicare Part B payment rates and 340B ceiling prices Go here for a brief overview of each agenda item and links to the staff presentations on those issues. MedPAC is an independent congressional [...]

joe2024-04-16T15:35:18+00:00April 16, 2024|340b, Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for April 12

The following is the latest health policy news from the federal government for April 5-11. Some of the language used below is taken directly from government documents. CMS – Proposed FY 2025 Medicare Inpatient Prospective Payment System Regulation Earlier this week CMS issued its proposed FY 2025 Medicare inpatient prospective payment system regulation – the rule under which it envisions paying acute-care hospitals, critical access hospitals, and long-term care hospitals for inpatient care in the coming fiscal year. Highlights of the proposed rule include: Rate increases of 2.6 percent for acute-care and critical access hospitals and 2.8 percent for LTCHs. [...]

For-Profit Operators Opening Psychiatric Hospitals

Seeing a growing shortage of inpatient psychiatric beds for people with severe mental illness, a growing number of for-profit companies are establishing psychiatric hospitals in areas of need. Across the country, inpatient psychiatric hospitals have been closing for years and many acute-care hospitals have been closing their inpatient psychiatric units as well. Now, for-profit operators see opportunity and are attempting to seize it in underserved areas – and especially in underserved rural areas. Learn more about this trend of for-profit companies opening inpatient psychiatric hospitals from the KFF Health News article “For-Profit Companies Open Psychiatric Hospitals in Areas Clamoring for [...]

joe2024-04-09T17:02:14+00:00April 11, 2024|hospitals|

MACPAC to Talk Medicaid Financing, Supplemental Payments, More

Members of the Medicaid and CHIP Payment and Access Commission will meet publicly on Thursday, April 11 and Friday, April 12. Subjects on the two-day session’s agenda include: Medicaid and children’s health insurance program (CHIP) financing access to home- and community-based services supplemental Medicaid hospital payments such as Medicaid disproportionate share (Medicaid DSH) Medicaid unwinding recommendations for MACPAC’s June report to Congress Go here for a closer look at the MACPAC meeting agenda and for information about how to participate in the meeting.

joe2024-04-09T18:26:20+00:00April 10, 2024|hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH|

MedPAC to Talk Telemedicine, Doc Payments, 340B, More

Members of the Medicare Payment Advisory Commission will meet publicly on Thursday, April 11 and Friday, April 12. Medicare reimbursement subjects on the two-day session’s agenda include: telehealth inpatient rehabilitation hospital payments the physician fee schedule Medicare Advantage Part D generic drug pricing Part B rate and 340B ceilings Go here for a more detailed look at the MedPAC agenda and for information about how to participate in the meeting.

joe2024-04-09T17:14:42+00:00April 9, 2024|340b, Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC, Telehealth|

Federal Health Policy Update for April 4

The following is the latest health policy news from the federal government for March 29 – April 4. Some of the language used below is taken directly from government documents. The White House The White House has announced that the Office of Management and Budget (OMB) has issued a government-wide policy to attempt to mitigate the risks of artificial intelligence (AI) and harness its benefits. The order directs action to strengthen AI safety and security, protect privacy, advance equity and civil rights, stand up for consumers and workers, and promote innovation and competition. It includes components on addressing risks from [...]

joe2024-04-04T20:06:11+00:00April 4, 2024|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

Medicaid Unwinding After One Year

The process known as “Medicaid unwinding” has now been under way for a year. When Congress expanded Medicaid eligibility in response to the COVID-19 pandemic it also banned states from removing participants from their Medicaid rolls; the penalty for doing so was reduced federal Medicaid funding, a price no state was willing to pay. During the course of the pandemic, nationwide Medicaid enrollment rose 22 million, to 94 million last March. But a year ago states were directed to begin reviewing the eligibility of those then on their Medicaid rolls and to remove those who no longer met eligibility criteria. [...]

joe2024-04-02T20:56:42+00:00April 3, 2024|COVID-19, Medicaid|

Federal Health Policy Update for March 28

The following is the latest health policy news from the federal government for March 22-28. Some of the language used below is taken directly from government documents. The Cyberattack on Change Healthcare HHS, its Administration for Strategic Preparedness and Response, and CMS have published a resource guide for providers seeking assistance in response to the Change Healthcare cyberattack. Find that guide here. Centers for Medicare & Medicaid Services CMS has issued a proposed rule to update Medicare payment policies and rates under its Inpatient Rehabilitation Facility (IRF) Prospective Payment System and the IRF Quality Reporting Program (QRP) for FY 2025. The proposed rule [...]

joe2024-03-28T19:23:45+00:00March 28, 2024|Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

Hospital Transparency Violators Falling Into Line

Hospitals cited by the federal government for failing to comply with hospital price transparency requirements are quickly coming into compliance with those requirements once cited. According to an analysis by Becker’s Hospital Review, of the 14 hospitals actually fined for transparency violations, 10 have been informed by the Centers for Medicare & Medicaid Services that they now meet the law’s requirements. Information about the other four of the 14 hospitals was not available. Learn more from the Becker’s Hospital Review article “Hospitals coming into compliance after price transparency fines.”

joe2024-03-26T19:07:11+00:00March 27, 2024|Centers for Medicare & Medicaid Services, hospitals|

Feds Tackling Prior Authorization

The Centers for Medicare & Medicaid Services has ambitious plans to improve the prior authorization process between providers and payers – and to save $15 billion over 10 years in the process. The tools it envisions using in its efforts include digitization, better data exchange, and streamlined prior authorization processes. It also will seek to foster greater transparency, requiring payers to be clearer about their policies and guidelines and to provide better explanations when they deny requests for care. Doing so, CMS believes, will reduce health care costs by $15 billion over ten years. Learn more about CMS’s prior authorization [...]

joe2024-03-21T21:31:16+00:00March 25, 2024|Centers for Medicare & Medicaid Services|

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