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MedPAC Meets

MedPAC’s commissioners held their latest public meetings on Thursday, November 7 and Friday, November 8. The subjects on the meetings’ agenda were: reforming physician fee schedule updates and improving the accuracy of payments considering the participation bonus for clinicians in advanced alternative payment models structural differences between the prescription drug plan and Medicare Advantage prescription drug plan markets assessing Medicare Advantage provider networks Medicare’s coverage limits on stays in freestanding inpatient psychiatric facilities Go here for summaries of the issues and key points and links to the presentations delivered by [...]

November 18, 2024|Categories: Alternative payment models, hospitals, Medicare, Medicare reimbursement policy, MedPAC|Tags: Medicare, Medicare Advantage, Medicare and alternative payment models, Medicare and freestanding inpatient psychiatric facilities, Medicare APMs, Medicare Payment Advisory Commission, Medicare physician fee schedule, Medicare prescription drug plans|

Federal Health Policy Update for November 14

The following is the latest health policy news from the federal government for November 8-14. Some of the language used below is taken directly from government documents. Election Update House of Representatives Though the outcome of nine races for seats in the House remains undecided, Republicans have won enough seats to control the House in the new Congress. Yesterday, Republicans voted to nominate the current Speaker of the House, Mike Johnson (LA), for Speaker in the new Congress and will hold the vote for that position when the 119th Congress convenes [...]

November 14, 2024|Categories: ACO, Alternative payment models, Centers for Medicare & Medicaid Services, CMMI, COVID-19, health equity, hospitals, Medicaid, Medicaid DSH, Medicaid DSH allotments, Medicare reimbursement policy, MedPAC, Telehealth|Tags: 2024 elections, Access and Community Health Model, ACO REACH, ACO Realizing Equity, Acute Hospital at Home Program, federal hospital price transparency rule, health care cybsecurity, health insurance market concentration, Hospital-acquired infections, lame duck session of Congress, Medicaid disproportionate share, Medicaid DSH, Medicare 2025 coinsurance, Medicare 2025 deductibles, Medicare Advantage, Medicare alternative payment models, Medicare and PrEP treatment, Medicare and urban and rural differences, Medicare ICD-10, Medicare Payment Advisory Commission, Medicare physician fee schedule, Medicare prior authorization requirements, MedPAC, rural health care, telehealth flexibilities|

Federal Health Policy Update for November 7

The following is the latest health policy news from the federal government for November 1-7. Some of the language used below is taken directly from government documents. Medicare Payment Regulations Late last week CMS published four regulations describing how Medicare will pay certain providers in 2025. The following is a brief overview of those regulations. Medicare Outpatient Prospective Payment System Rate increase of 2.9 percent for outpatient and ambulatory surgical center services. New Conditions of Participation for obstetrical services. Additional payments for selected non-opioid treatments for pain relief. Minor modifications [...]

Federal Health Policy Update for October 31

The following is the latest health policy news from the federal government for October 25-31. Some of the language used below is taken directly from government documents. The White House The White House has announced a new private sector pilot program to maintain uninterrupted access to seven pre-selected pediatric cancer medications. Pilot participants in this program, which is part of the Biden Cancer Moonshot, will develop stewardship standards focused on identifying shortage risks, promoting transparent inventory awareness, and fostering an effective approach to preventing patient care disruptions and maintaining consistent [...]

October 31, 2024|Categories: Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations, Medicare regulations, Medicare reimbursement policy, Telehealth|Tags: AHEAD Model, Behavioral Health Integration Evidence-Based Telehealth Network Program, medicaid managed care directed payments, Medicare Compare for hospitals, Medicare end-stage renal disease rule, Medicare home health prospective payment system rule, Medicare hospital price transparency, Medicare outpatient prospective payment system rule, Medicare physician fee schedule, Medicare Qualified Medicare Beneficiary, Medicare shared savings program, MedPAC and Medicare Payment Basics series, Merit-Based Incentive Payment System MIPS, MLN Connects, States Advancing All-Payer Health Equity Approaches and Development Model, strategies to conserve intravenous fluid products|

Looking Ahead to Lame Duck

When the dust clears after next week’s presidential election, Congress will return to Washington with numerous unfinished matters on its agenda – including many with implications for health care organizations. They include: Federal government funding, authorization for which expires on December 20. Medicare payments to physicians, which many in Congress want to increase if, as proposed, the Centers for Medicare & Medicaid Services reduces those payments for 2025. A potential temporary extension of the continued use of telehealth to prescribe Schedule 2 drugs such as Adderall. Payment adjustments for low-volume [...]

October 31, 2024|Categories: COVID-19, hospitals, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare cuts, Medicare regulations, Medicare reimbursement policy, Telehealth|Tags: Acute Hospital Care at Home program, community health center funding, Medicare and telehealth, Medicare disproportionate share payments, Medicare DSH payments, Medicare outpatient payments, Medicare physician payments|

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