Bulletin Board
Bulletin Board
CMS Tinkers With ACO REACH Model
Medicare’s ACO REACH Model will undergo some changes when it heads into its 2025 performance year. To help ensure that the program controls costs and saves money, the Centers for Medicare & Medicaid Services will implement a series of changes in its voluntary Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. According to the agency, it is: adjusting the financial methodology to improve model sustainability based on the findings in the PY [performance year] 2022 Evaluation Report; responding to feedback from interested parties on improvements [...]
Court Sides Again With Providers on No Surprises Act
A federal appellate court has affirmed a lower court ruling that the manner in which federal regulations tell No Surprises Act dispute arbiters to evaluate competing fee claims unfairly favors health care payers over providers. At issue is a regulatory directive that arbiters weigh what is known as the qualifying payment amount – the median of what insurers contract to pay providers in a given geographic area – when deciding on payments. In February a federal court ruled that using this measure in what is known as the independent dispute [...]
Federal Health Policy Update for August 8
The following is the latest health policy news from the federal government for August 3-8. Some of the language used below is taken directly from government documents. No Surprises Act A federal appeals court has upheld a February lower court ruling that found that the current No Surprises Act’s arbitration process for addressing payment disagreements between payers and providers favored payers by giving too much weight to “qualifying payment amounts,” which are the median of what insurers contract to pay providers in a given geographic area. Learn more from the [...]
Number of Uninsured on the Rise
The number of uninsured Americans has risen significantly over the past year: from 25 million in March of 2023 to 27 million in March of 2024, according to new data from the Centers for Disease Control and Prevention (CDC), with the uninsured rate rising from a record low of 7.7 percent to 8.2 percent. The rise in the number of uninsured people results primarily from individuals who became eligible for Medicaid during the COVID-19 public health emergency, a period during which states could not redetermine eligibility without losing some of [...]
Federal Health Policy Update for August 5
The following is the latest health policy news from the federal government for July 19 – August 5. Some of the language used below is taken directly from government documents. CMS – Medicare Payment Regulations Final FY 2025 Inpatient Prospective Payment System Regulation CMS has finalized its hospital inpatient prospective payment system rule for FY 2025. In the next fiscal year CMS will increase Medicare inpatient payments 2.9% while cutting Medicare disproportionate share hospital payments (Medicare DSH) $200 million. It also has: finalized its use of new core-based statistical area [...]