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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 [...]

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 [...]

August 30, 2024|Categories: 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|Tags: 340B, AHRQ News, CEHRT, certified electronic health record technology, FY 2025 end-stage renal disease prospective payment system regulation, FY 2025 home health prospective payment system regulation, HRSA eNews, MACPAC and long-term services and supports, Medicaid and budget neutrality for 1115 waiver programs, Medicaid and CHIP Payment and Access Commission and long-term services and supports, Medicaid eligibility renewals, medicaid unwinding, Medicare FY 2025 inpatient psychiatric facilities prospective payment system, Medicare Part B pneumonia vaccine coverage, Medicare Payment Advisory Commission, Medicare Promoting Interoperability Program, Medicare social determinants of health risk assessment, MedPAC, MLB Connects|

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 [...]

August 29, 2024|Categories: Medicare|Tags: health care prior authorization, Medicare Advantage and prior authorization, prior authorization, state prior authorization reforms|

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 [...]

August 22, 2024|Categories: 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|Tags: AHRQ News Now, Baylor All Saints Medical Center vs Becerra, CMS Cell and Gene Therapy Access Model, FDA and first home syphilis test, federal Basic Health Program, Federal Trade Commission non-compete agreements, FTC and non-compete agreements, hospital price transparency requirements, hospital price transparency requirements and machine-readable files, HRSA eNews, MACPAC, maternal health crisis, Medicaid and CHIP Payment and Access Commission, Medicaid eligibility, Medicaid HCBS, Medicaid home and community based services, Medicaid waivers, Medicare disproportionate share, Medicare DSH, Medicare Part B and pneumonia vaccines, MLN Connects, National Action Plan for Combating Antibiotic Resistant Bacteria, No Surprises Act, opioid prescribing guidelines, provider relief fund, Ryan White HIV/AIDS program, telehealth|

Jury Still Out on Revised 2-Midnight Rule

A regulation that requires Medicare Advantage plans to comply with Medicare’s 2-midnight rule in the same manner as traditional Medicare as of 2024 is bringing mixed results for hospitals. Some hospitals report increased admissions – and inpatient revenue – as they admit Medicare patients previously kept under observation status. Others, though, report that with those increased admissions has come a reduction of case-mix index because these newly admitted patients are not as acutely ill as the typical hospital patient. Still others report no clear impact yet of the requirement that [...]

August 22, 2024|Categories: Medicare regulations, Medicare reimbursement policy|Tags: Medicare 2-midnight rule, Medicare Advantage and Medicare 2-midnight rule, Medicare regulations, Medicare reimbursement policy|

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