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MedPAC Meets, Offers Preliminary 2026 Rate Proposals

MedPAC’s commissioners held their latest public meeting on Thursday, December 12 and Friday, December 13. The subjects on the meeting’s agenda were: assessing payment adequacy and updating payments: physician and other health professional services assessing payment adequacy and updating payments: hospital inpatient and outpatient services; and mandated report on rural emergency hospitals assessing payment adequacy and updating payments: skilled nursing facility services assessing payment adequacy and updating payments: inpatient rehabilitation facility services assessing payment adequacy and updating payments: home health care services assessing payment adequacy and updating payments: hospice services [...]

Federal Health Policy Update for December 12

The following is the latest health policy news from the federal government for December 6-12. Some of the language used below is taken directly from government documents. Congress Funding the Federal Government With funding for the federal government set to expire in eight days, Congress is still negotiating the details of the next continuing resolution. Speaker Johnson has indicated that the next continuing resolution will extend until an unspecified date in March. Last week, the House majority and House minority exchanged proposals for additional items to include in the next [...]

December 12, 2024|Categories: 340b, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, COVID-19, Federal Update, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare regulations, Medicare reimbursement policy|Tags: 340B, 340B prescription drug discount program, health-relate social needs, Hospital Preparedness Program, HRSA sickle cell disease programs, ICD-10-PCS, Medicaid disproportionate share, Medicaid DSH, Medicare site-neutral payments, National Action Alliance for Patient and Workforce Safety, PREP Act, Public Readiness and Emergency Preparedness Act, SAMHSA Unified Performance Reporting Tool, Social determinants of health, social drivers of health, SUPRT, TEFCA, telehealth prescribing of controlled medications, Trusted Exchange Framework and Common Agreement|

182 House Members Ask for Halt to Medicaid DSH Cut

182 members of the House of Representatives have written to House Speaker Mike Johnson and House minority leader Hakeem Jeffries to ask them to prevent a major cut in Medicaid disproportionate share hospital payments (Medicaid DSH) that is scheduled to take effect on January 1. As members of Congress negotiate how to fund the federal government when the current continuing resolution ends on December 20, the bipartisan group of legislators as urges its leaders to prevent the $8 billion cut in Medicaid DSH allocations to the states. Their letter states [...]

December 11, 2024|Categories: Congress, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments|Tags: Alliance of Safety-Net Hospitals, community safety-net hospitals, Medicaid disproportionate share, Medicaid DSH|

Federal Health Policy Update for December 5

The following is the latest health policy news from the federal government for November 22 – December 5. Some of the language used below is taken directly from government documents. Congress The House has posted its session calendar for 2025. Find that calendar here. Yesterday, House Republicans made an offer to House Democrats regarding health care provisions to be included in the continuing resolution (CR) that must pass before December 20. The offer is a conversation-opener and very few details are available. Although most of the proposed policies have bipartisan [...]

December 5, 2024|Categories: Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, Federal Update, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, Pennsylvania Update|Tags: 2025 Medicare Advantage Regulation, 2025 Medicare Part D Regulation, 2025 Medicare physician fee schedule regulation quality improvement changes, Cell and Gene Therapy Access Model, health care anti-kickback statute, health care immediate jeopardy, health care provisions in the Inflation Reduction Act, health care safe harbor regulations, HIV Organ Policy Equity Act, Increasing Organ Transplant Access Model, Medicaid eligibility verification, medicaid unwinding, Medicare Part D, Medicare physician payments, Medicare Prescription Payment Plan, Medicare weight-loss drug coverage|

Providers Winning Big on No Surprises Act Disputes

Health care providers are winning more than 86 percent of the emergency care payment disputes they take to adjudication through the Independent Dispute Resolution process established under the 2020 No Surprises Act. The abstract of the article “No Surprises Act independent dispute resolution outcomes for emergency services,” published by the journal Health Affairs Scholar, explains that The No Surprises Act banned surprise billing and established a final-offer arbitration system, independent dispute resolution (IDR), to resolve disagreements between health plans and providers. One factor that arbiters must consider in the IDR [...]

December 5, 2024|Categories: hospitals|Tags: No Surprises Act, No Surprises Act Independent Dispute Resolution (IDR) process|

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