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MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days recently in Washington, D.C. The following is MACPAC’s own summary of the meeting. To kick off MACPAC’s November meeting, the Commission continued its work on denials and appeals in Medicaid managed care with a review of findings from beneficiary focus groups. Medicaid managed care organizations (MCOs) manage and provide care to beneficiaries enrolled in their plans. Beneficiaries have the right to appeal MCO coverage decisions. Federal rules require that states have monitoring systems in place to provide oversight of [...]

November 14, 2023|Categories: Centers for Medicare & Medicaid Services, Congress, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid long-term services and supports, Medicaid managed care, Medicaid regulations, Medicaid regulations for long-term care|Tags: MACPAC, Medicaid and CHIP Payment Advisory Commission, Medicaid and health disparities, Medicaid and home and community-based services, Medicaid and language proficiency and health disparities, Medicaid and school-based behavioral health services, Medicaid continuous coverage unwinding, Medicaid managed care, Medicaid managed care appeals process, Medicaid managed care organizations, Medicaid MCOs, Medicaid medical care advisory committees, Medicare Advantage dual eligible special needs plans|

MedPAC Meets

The commissioners of the Medicare Payment Advisory Commission recently met virtually. The subjects on the agenda of their two-day meeting were: rural emergency hospitals dual-eligible special needs plans MedPAC’s work plan for hospice issues Medicare coverage of and payment for software as a medical service favorable selection in Medicare Advantage network management and prior authorization and their impact on access in Medicare Advantage MedPAC is an independent congressional agency that advises Congress on issues involving Medicare. While its recommendations are not binding on either Congress or the administration, MedPAC is [...]

November 13, 2023|Categories: Medicare, Medicare post-acute care, Medicare reimbursement policy, post-acute care|Tags: dual-eligible special needs plans, Medicare Advantage, Medicare and hospice care, Medicare Payment Advisory Commission, MedPAC, rural emergency hospitals|

Federal Health Policy Update for November 9

The following is the latest health policy news from the federal government for November 3-9. Some of the language used below is taken directly from government documents. Congress Senate Finance Committee Earlier this week the Senate Finance Committee passed the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023. The bill, which passed out of the committee by a vote of 26-0, would: eliminate $16 billion in cuts to Medicaid DSH for 2024 and 2025; soften the 2024 cut to Medicare physician payments by reducing the conversion factor [...]

November 9, 2023|Categories: 340b, Centers for Medicare & Medicaid Services, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|Tags: 2023 continuing resolution, 340B, AHRQ News Now, Better Mental Health Care Lower-Cost Drugs and Extenders Act of 2023, Birthing Friendly hospital, health equity, HHS Office of Civil Rights, HHS Office of the Inspector General, MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid and CHIP renewals, Medicaid and doulas, Medicaid and nursing home staffing requirements, Medicaid continuous eligibility rewinding, Medicaid disproportionate share, Medicaid DSH, Medicare Advantage, Medicare and behavioral health, Medicare Payment Advisory Commission, MedPAC, MLN Connects, proposed Medicare Advantage regulation|

Federal Health Policy Update for November 2

The following is the latest health policy news from the federal government for October 27 – November 2. Some of the language used below is taken directly from government documents. 340B Remedy Payments Late Thursday afternoon CMS published its final Medicare remedy for underpayments for 340B prescription drugs that was implemented in 2018 but rejected by the Supreme Court last year. According to the regulation, 340B remedy payments to hospitals will be made after this rule takes effect, which is 60 days after it is officially published in the Federal [...]

Medicare Leaving Gaps in Care

Medicare is leaving large numbers of the program’s beneficiaries without at least some of the care they need. According to the Commonwealth Fund’s annual health care affordability survey, One-third of Medicare beneficiaries said it was difficult to afford health care costs, including more than half of beneficiaries under age 65. More than one in five beneficiaries reported delaying or skipping needed health care because of the cost, including more than four in 10 under age 65. More than one in five beneficiaries said health care costs made it harder for [...]

November 2, 2023|Categories: Medicare|Tags: Medicare, Medicare and health care affordability|

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