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Feds Tackling Prior Authorization

The Centers for Medicare & Medicaid Services has ambitious plans to improve the prior authorization process between providers and payers – and to save $15 billion over 10 years in the process. The tools it envisions using in its efforts include digitization, better data exchange, and streamlined prior authorization processes. It also will seek to foster greater transparency, requiring payers to be clearer about their policies and guidelines and to provide better explanations when they deny requests for care. Doing so, CMS believes, will reduce health care costs by $15 [...]

March 25, 2024|Categories: Centers for Medicare & Medicaid Services|Tags: Centers for Medicare & Medicaid Services, prior authorization|

Federal Health Policy Update for March 21

The following is the latest health policy news from the federal government for March 15-21. Some of the language used below is taken directly from government documents. The White House The White House has announced new actions to advance women’s health research and innovation and issued an executive order in support of that objective. The order directs executive branch agencies to integrate women’s health across the federal research portfolio; prioritize investments in women’s health research; pursue new research on women’s midlife health; and assess unmet needs to support women’s health [...]

March 21, 2024|Categories: Accountable Care Organization, ACO, Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, social determinants of health, Uncategorized|Tags: 2025 Medicare home health rates, 2025 Medicare hospice rates, 2025 Medicare inpatient rates, 2025 Medicare inpatient rehabilitation facility rates, 2025 Medicare outpatient dialysis rates, 2025 Medicare outpatient rates, 2025 Medicare physician fee schedule, 2025 Medicare skilled nursing facility rates, ACO Primary Care Flex Model, CDC and measles, Change Healthcare cyberattack, HHS Office of the Inspector General, HIPAA and tracking technology, MACPAC annual report to Congress, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid renewal, medicaid unwinding, Medicare Advantage, Medicare Payment Advisory Commission, MedPAC, MedPAC annual report to Congress, MedPAC safety-net index, MLN Connects, US measles outbreak|

MACPAC Issues Annual Report to Congress

The Medicaid and CHIP Payment and Access Commission has issued its annual report to Congress. This year’s MACPAC report primarily addresses three issues: How state Medicaid agencies can improve beneficiary engagement with state medical care advisory committees and what the federal government can do to facilitate that engagement. The current process for monitoring and overseeing denials of care and appeals of those denials by Medicaid managed care plans and how states and the federal government can improve those processes and make them more transparent. MACPAC’s annual review of Medicaid disproportionate [...]

March 21, 2024|Categories: MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments|Tags: MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share allotment, Medicaid disproportionate share payments, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicaid managed care appeals of denial of care, Medicaid managed care denial of care, Medicaid managed care transparency, state medical care advisory committees|

MedPAC Recommends Medicare Rate Updates to Congress

Some health care providers deserve larger Medicare payments in 2025, some should receive payment cuts, and others should see their payments go unchanged according to new recommendations from the Medicare Payment Advisory Commission to Congress. In its annual report to Congress, MedPAC recommended the following changes in Medicare rates for 2025: Medicare inpatient rates – the rate increase currently scheduled by law for 2025 plus 1.5 percent. Medicare outpatient rates – the rate increase currently scheduled by law for 2025 plus 1.5 percent. Medicare physician rates – the rate increase [...]

Federal Health Policy Update for March 14

The following is the latest health policy news from the federal government for March 8-14. Some of the language used below is taken directly from government documents. The White House The Biden administration this week released its proposed FY 2025 federal budget. Health care highlights include: Making permanent the expanded health care premium tax credits introduced to make health insurance marketplace plans more affordable for middle-class Americans. Extension of coverage similar to Medicaid to residents of the 10 states that have not taken advantage of the Affordable Care Act opportunity [...]

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