joe, Author at DeBrunner & Associates

Feds Set End Date for “Medicaid Unwinding”

States need to complete their “Medicaid unwinding” activities by the end of 2026, the Centers for Medicare & Medicaid Services informed state Medicaid programs in a recent memo. According to the agency, … all states are required to complete a compliance assessment, demonstrate compliance with federal Medicaid and CHIP renewal requirements described at 42 C.F.R. §§ 435.916 and 457.343, and submit a plan outlining steps and milestones for addressing identified areas of non-compliance to CMS by December 31, 2024. Compliance plans will detail how states will achieve compliance with all applicable requirements no later than December 31, 2026. “Medicaid unwinding” [...]

joe2024-09-24T16:50:11-04:00September 25, 2024|Medicaid|

Administration Launches Patient Safety Initiatives

In response to World Patient Safety Day, the administration has launched a multi-faceted approach to reducing harm for patients and workers in the delivery of health care. The initiative will fall under the umbrella of a new multi-agency, public/private National Action Alliance for Patient and Workforce Safety administered by the Department of Health and Human Services’ Agency for Health Care Research and Quality. Other federal agencies to be involved in the initiative include the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, the Veterans Health Administration, the Department of Defense, the Health Resources and Services [...]

joe2024-09-19T17:44:03-04:00September 23, 2024|Centers for Medicare & Medicaid Services, Uncategorized|

Federal Health Policy Update for September 19

The following is the latest health policy news from the federal government for September 13-29. Some of the language used below is taken directly from government documents. Congress Energy and Commerce Committee. Yesterday the House Energy and Commerce Committee marked up 16 bills, including several that address health care. These bills are unlikely to proceed to votes in the full House until after Congress returns following the November elections. The committee passed a bill that would extend the current telehealth waivers, scheduled to expire on December 31, for two years and would extend the Medicare Hospital at Home program, also [...]

joe2024-09-19T14:56:55-04:00September 19, 2024|340b, Centers for Medicare & Medicaid Services, COVID-19, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare disproportionate share, Medicare DSH, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for September 12

The following is the latest health policy news from the federal government for September 6-12. Some of the language used below is taken directly from government documents. 340B A federal court has declined to issue a preliminary order to block implementation of a Maryland law that requires pharmaceutical companies to provide discounts on drugs dispensed by eligible 340B providers by contract pharmacies. The challenge to the Maryland law, filed by Pharmaceutical Research and Manufacturers of America (PhRMA) and several pharmaceutical companies, will be heard without a temporary order suspending the law’s implementation. Learn more from the court order. Centers for [...]

joe2024-09-12T15:22:15-04:00September 12, 2024|340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, COVID-19, hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare regulations, Medicare reimbursement policy, MedPAC|

Clock Ticking on Some Telehealth Prescribing?

The COVID-inspired flexibility to prescribe some medicines via telehealth will soon expire – and it is not clear whether the practice will be extended. While there is general support for telehealth prescribing, policymakers appear to be divided over whether to permit continued use of telehealth to prescribe Schedule 2 drugs such as Adderall. The next step in clearing the path to extending the flexibility was supposed to be a proposed regulation from the Drug Enforcement Agency. The DEA has submitted a draft to the Office of Management and Budget for review but published reports suggest that the Department of Health [...]

joe2024-09-11T12:32:44-04:00September 12, 2024|Telehealth|

Federal Health Policy Update for September 5

The following is the latest health policy news from the federal government for August 31 – September 5. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has posted a bulletin outlining changes coming in the FY 2025 inpatient and long-term-care hospital prospective payment system. Find that bulletin here. The changes it presents take effect on October 1. CMS has posted a bulletin about new waived laboratory tests that outlines Clinical Laboratory Improvement Amendments (CLIA) requirements, new CLIA-waived tests approved by the FDA, and use of the modifier QW for [...]

joe2024-09-05T15:20:05-04:00September 5, 2024|Centers for Medicare & Medicaid Services, COVID-19, Medicare, Medicare regulations, Medicare reimbursement policy|

Telehealth Gains in Jeopardy?

The ability of doctors to use telehealth to prescribe medicines like buprenorphine for patients with opioid use disorder may be in jeopardy. While COVID-19 inspired an expanded use for caring for patients using telehealth, the regulatory flexibility that made remote prescribing possible expires at the end of 2024 and the federal Drug Enforcement Agency appears reluctant to call for its extension without modification. In particular, an unreleased DEA proposal reportedly would limit individual physicians to issuing no more than half of their prescriptions virtually. Some people think this would detract from the overall effectiveness of telehealth in treating opioid use [...]

joe2024-09-03T17:44:07-04:00September 4, 2024|Telehealth|

Federal Health Policy Update for August 30

The following is the latest health policy news from the federal government for August 23-30. Some of the language used below is taken directly from government documents. 340B Johnson & Johnson, the pharmaceutical, biotechnology, and medical technologies company, told health care providers this week that it would shift from the long-time 340B upfront discount approach to a rebate model for two of its drugs and that eligible 340B hospitals and other providers will need to purchase the prescription drugs Stelara and Xarelto at list price and then, after dispensing them to patients, will need to submit 340B rebate claims to [...]

joe2024-08-30T15:03:18-04:00August 30, 2024|340b, Centers for Medicare & Medicaid Services, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid long-term services and supports, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, social determinants of health|

States Stepping Into Prior Authorization Void

While federal lawmakers continue to weigh how to address the problem of prior authorization requirements that cause delays in the delivery of health care, many state governments are acting more decisively by implementing prior authorization reforms of their own. This year, 10 states have enacted 18 laws designed to facilitate prior authorization of medical services and in 2023, nine states and the District of Columbia did so. In all, 23 states have introduced prior authorization reforms in recent years. At the same time, some health insurers have reduced the number of medical services for which they require prior authorization. The [...]

joe2024-08-28T10:39:07-04:00August 29, 2024|Medicare|

Federal Health Policy Update for August 22

The following is the latest health policy news from the federal government for August 16-22. Some of the language used below is taken directly from government documents. The Courts The federal government must include uninsured patients whom hospitals serve under state Medicaid waivers when calculating hospitals’ Medicare DSH payments, a federal court has ruled. In the case of Baylor All Saints Medical Center, et al. v. Xavier Becerra, federal policymakers had invoked a 2023 regulation that excluded counting care provided to patients served by DSH-eligible hospitals providing care through state Medicaid waivers – generally, through uncompensated care pools. A group [...]

joe2024-08-22T15:11:48-04:00August 22, 2024|Alternative payment models, Center for Medicare and Medicaid Innovation, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy, Telehealth|

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