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Medicare ACO Participation Rising

Participation in Medicare’s various accountable care organizations is increasing, the Centers for Medicare & Medicaid Services reports. According to CMS, 50 new ACOs will participate in its Medicare Shared Savings Program in 2024 along with another 19 that will participate in a new, permanent payment option version of that program. Another 71 ACOs renewed their participation in the program, bringing the total number of ACOs in the program to 480 that together will serve nearly 11 million traditional Medicare beneficiaries. Other Medicare ACOs account for another three million participants. Among [...]

February 7, 2024|Categories: Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services|Tags: Access, accountable care organizations, ACO REACH, ACOs, and Community Health Reach Program, Kidney Care Choices, Medicare shared savings program, Realizing Equity|

Federal Health Policy Update for February 1

The following is the latest health policy news from the federal government for January 26 – February 1. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has released its calendar year (CY) 2025 Advance Notice for the Medicare Advantage and Medicare Part D Prescription Drug Programs that would update payment and other policies for these programs. Under the notice, federal Medicare Advantage spending would increase an expected 3.7 percent, or more than $16 billion, but the agency also proposes reducing [...]

February 1, 2024|Categories: Accountable Care Organization, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, Federal Update, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|Tags: 2025 Advance Notice for Medicare Advantage and the Medicare Part D Prescription Drug Programs, Cell and Gene Therapy Access Model, Center for Medicare and Medicaid Innovation, Enhancing Maternal Health Initiative, Medicaid and CHIP Payment and Access Commission, Medicare Advantage, Medicare Drug Price Negotiation Program, Medicare Part D, Medicare provider enrollment process, Medicare value-based care, MLN Connects, Paxlovid, Sickle Cell model, Substance Abuse and Mental Health Services Administration, telehealth and opioid treatment|

Preventable Medicaid Hospitalizations Vary Based on Race, Eligibility Path

Preventable hospitalizations among Medicaid patients vary based on the race of the patient and how that patient came to be eligible for Medicaid, according to a new analysis by the Urban Institute. According to a review of preventable hospitalizations in 21 states, the report concluded that: … the three most common types of potentially preventable hospitalizations for Medicaid-enrolled adults were asthma/COPD (0.2 percent of enrollees had at least one such hospitalization in 2019), diabetes (0.4 percent of enrollees had at least one such hospitalization in 2019), and heart failure (0.2 [...]

January 30, 2024|Categories: health equity, Medicaid|Tags: Medicaid, Medicaid preventable hospitalizations|

Federal Health Policy Update for January 25

The following is the latest health policy news from the federal government for January 12 - 25. Some of the language used below is taken directly from government documents. Department of Health and Human Services – Funding Models HHS has announced a new model to test approaches for addressing the behavioral and physical health and health-related social needs of people with Medicaid and Medicare. The goal of the Innovation in Behavioral Health Model (IBH) is to improve the overall quality of care and outcomes for adults with mental health conditions and/or [...]

January 25, 2024|Categories: Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC, social determinants of health, Telehealth|Tags: ARPA-H PARADIGM, ARPA-H Platform Accelerating Rural Access to Distributed and Integrated Medicare Care, Emergency Medical Treatment and Labor Act, EMTALA, health equity, HHS Cybersecurity Performance Goals, Inflation Reduction Act, MACPAC, Medicaid and access to behavioral health care, Medicaid and CHIP Payment and Access Commission, Medicaid and contraception, Medicaid and Hepatitis C treatment, Medicaid and prior authorization, Medicaid payment policies, Medicare and prior authorization, Medicare Behavioral Health Model, Medicare Payment Advisory Commission, Medicare payment policies, MedPAC, MedPAC Medicare payment recommendations, National Advisory Council on Nurse Education and Practice, No Surprises Act|

Analysis Looks at Problems Plaguing Unwinding of Medicaid Continuous Eligibility

Since the end of the continuous Medicaid eligibility that was a major part of the Families First Coronavirus Response Act, more than 14 million Americans have lost their Medicaid eligibility. In a new analysis, KFF looks at the challenges both consumers and states have encountered in attempting to review the eligibility of the Medicaid population and to ensure that those who are no longer eligible can be directed to other options for health insurance. Among the factors addressed in this analysis are: State outreach to affected individuals, the effectiveness of [...]

January 24, 2024|Categories: hospitals, Medicaid|Tags: Medicaid continuous eligibility, medicaid unwinding|

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