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Federal Health Policy Update for February 29

The following is the latest health policy news from the federal government for February 23-29. Some of the language used below is taken directly from government documents. Congress This afternoon the House passed H.R. 7463, which changed the dates for the March 1 and March 8 funding deadlines to March 8 and March 22 and includes no new health care policies. Health care extenders included in the current continuing resolution, including the delay to Medicaid DSH cuts, are not included in the bill that passed the House; the March 8 [...]

Medicaid DSH Cut In, Medicare Site-Neutral Payments Out of Health Bill?

With Congress at a stalemate on spending legislation, lawmakers are considering a narrower scope of issues to address in near-term health care legislation. According to published reports, scheduled cuts in Medicaid disproportionate share allotments to states (Medicaid DSH), already delayed several times, could be delayed once again. In addition, a proposal to require Medicare to pay for outpatient services on a site-neutral basis, rather than paying higher rates to hospital-based outpatient departments higher rates, might not be included. Also under consideration: restoring some cuts in Medicare’s payments to physicians and [...]

February 28, 2024|Categories: Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare cuts, Medicare reimbursement policy|Tags: hospital price transparency, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare physician payments, site-neutral Medicare outpatient payments|

New Way of Calculating Medicaid DSH

Hospitals will soon see federal regulators take a new approach to calculating their Medicaid DSH payments. Specifically, their Medicaid disproportionate share hospital-specific payment limit. A new CMS regulation changes how third-party payments are factored into the calculation of hospitals’ Medicaid disproportionate share hospital-specific payment limit. That limit, in turn, affects hospitals’ Medicaid DSH payments. This final rule implements changes CMS proposed last year to comply with a congressional mandate to include in the calculation of hospitals’ Medicaid disproportionate share hospital-specific payment limits only costs and payments for services furnished to [...]

February 26, 2024|Categories: Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH|Tags: Medicaid disproportionate share, Medicaid disproportionate share regulation, Medicaid DSH, Medicaid DSH hospital-specific payment limit, Medicaid DSH regulation|

Federal Health Policy Update for February 22

The following is the latest health policy news from the federal government for February 16-22. Some of the language used below is taken directly from government documents. CMS and Medicaid DSH Payments CMS has published a final rule governing how third-party payers are factored into the calculation of hospitals’ Medicaid disproportionate share hospital-specific payment limit. This change requires that the calculation be based solely on Medicaid costs and payments and that costs and payments associated with dually eligible (Medicare and Medicaid) patients be excluded from the calculation of that limit. [...]

February 22, 2024|Categories: Alternative payment models, Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid regulations, Medicaid upper-payment limit, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|Tags: AHEAD Model, American Rescue Plan rural payments, Behavioral Health Integration Evidence-Based Telehealth Network Program, federal Independent Dispute Resolution, HIPAA, Medicaid disproportionate share, Medicaid DSH, Medicaid regulations, Medicaid reimbursement regulations, Medicare overpayment recoupment, Medicare Prescription Plan, MLN Connects, National Advisory Council for Healthcare Research and Quality, No Surprises Act, provider relief fund, States Advancing All-Payer Health Equity Approaches and Development Model, surprise medical billing|

Providers Faring Well in Surprisingly Busy Dispute Resolution Process

Health care providers are winning more than three-quarters of all payment disputes being brought through an unexpectedly active federal Independent Dispute Resolution process. The process, created under the 2020 No Surprises Act to settle payment disagreements between providers and payers and to spare consumers surprise medical bills – especially for receiving emergency care from providers outside of their insurer’s network. 2023 saw 13 times more disputes during the first half of 2023 – nearly 300,000 cases in all – than federal officials anticipated. With more than 20 percent of the [...]

February 21, 2024|Categories: Uncategorized|Tags: federal Independent Dispute Resolution, No Surprises Act, surprise billing, surprise medical billing|

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