Bulletin Board
Bulletin Board
Putting Some Meat on CMS’s WISeR Bones
In June, the Centers for Medicare & Medicaid Services announced a new CMS Innovation Center model: The Wasteful and Inappropriate Service Reduction Model, or WISeR. The idea behind WISeR is for Medicare to seek to reduce waste, fraud, and abuse in the program by working through technology companies to make greater use of prior authorization and pre-payment reviews for a small group of medical items and services that the agency considers susceptible to misuse or unnecessary use. While the program is scheduled to start next January 1 and CMS has [...]
The Likelihood of Major Medicare Cuts
While the potential for significant Medicaid cuts resulting from passage of the FY 2025 federal budget reconciliation bill – the so-called One Big Beautiful Bill – has received a great detail of attention, the possibility of Medicare cuts as well has flown mostly under the radar. Until now. In a letter to Democratic congressional committee leaders, the Congressional Budget Office has put a price tag on prospective Medicare cuts. According to the CBO, the FY 2025 budget reconciliation bill could lead to more than $500 billion in federal Medicare payment [...]
Survey Looks at Prior Authorization in Medicaid
A recently published study takes a closer look at the state of prior authorization practices in state Medicaid managed care programs. The survey explored prior authorization decision time frames, the use of electronic denial notices, patient access to external medical review, and processes and time frames for prior authorization decisions and appeals based on federal Medicaid managed care rules. Among the survey’s findings: “Nearly half of responding states (17 of 36) reported requiring standard prior authorization decisions within 7 calendar days (18 states) or a shorter timeframe (9 states). “About [...]
Federal Health Policy Update for August 14
The following is the latest health policy news from the federal government for August 8-14. Some of the language used below is taken directly from government documents. Congress The House and Senate are both in recess and will return to Washington D.C. on September 2. Funding for the federal government, along with health care extenders including extensions of telehealth flexibilities, the Acute Hospital Care at Home program, the Medicare-dependent hospital and low-volume hospital programs, and delays to Medicaid disproportionate share (Medicaid DSH) allotments, all expire September 30. In the fall, [...]
Potential Medicaid Implications of the “One Big Beautiful Act”
Growing uncompensated care. Service cuts. Reduced access to care, especially in rural areas. Expansion projects placed on hold. These are among the potential implications of the Medicaid cuts included in the recently passed FY 2025 budget reconciliation bill, often referred to as the “One Big Beautiful Act.” A significant portion of those cuts will come through limits on state directed payments: supplemental Medicaid payments proposed by the states and approved by the federal government to selected providers for high-cost, high-demand, low-payment services delivered through Medicaid managed care plans. The new [...]