340b – DeBrunner & Associates

Federal Health Policy Update for April 25

The following is the latest health policy news from the federal government for April 9-25. Some of the language used below is taken directly from government documents. Updated 340B Arbitration Process Last week HHS’s Health Resources and Services Administration (HRSA) published a regulation modifying the administrative dispute resolution (ADR) process it uses to adjudicate payment disputes between 340B-eligible providers and pharmaceutical companies. The major changes in the ADR process include the use of HRSA experts to serve on ADR panels; elimination of the $25,000 damage threshold for filing a claim; 340B-eligible providers may now challenge manufacturers that seek to prevent [...]

joe2024-04-25T20:25:44+00:00April 25, 2024|340b, Accountable Care Organization, ACO, Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid long-term services and supports, Medicaid managed care, Medicaid regulations, Medicaid regulations for long-term care, Medicaid regulations for the disabled, Medicare, Medicare post-acute care, Medicare regulations, post-acute care|

Federal Health Policy Update for April 18

The following is the latest health policy news from the federal government for April 12-18. Some of the language used below is taken directly from government documents. The White House The administration has launched a new global health security strategy that seeks to drive action across federal departments and agencies and rally support from other countries, the private sector, and civil society to better prevent, detect, respond to, and recover from infectious disease threats. The strategy seeks to build on the lessons learned from the response to the COVID-19 pandemic. Learn more from this White House statement; the administration’s strategy [...]

joe2024-04-18T19:03:57+00:00April 18, 2024|340b, Centers for Medicare & Medicaid Services, COVID-19, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare regulations, MedPAC|

MedPAC Meets

Members of the Medicare Payment Advisory Commission met publicly last week in Washington, D.C. Their agenda consisted of the following issues: telehealth in Medicare alternative approaches to lowering Medicare payments for selected conditions in inpatient rehabilitation facilities considering approaches for updating the Medicare physician fee schedule assessing consistency between plan-submitted data sources for Medicare Advantage enrollees generic drug pricing under Part D initial findings from analysis of Medicare Part B payment rates and 340B ceiling prices Go here for a brief overview of each agenda item and links to the staff presentations on those issues. MedPAC is an independent congressional [...]

joe2024-04-16T15:35:18+00:00April 16, 2024|340b, Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

MedPAC to Talk Telemedicine, Doc Payments, 340B, More

Members of the Medicare Payment Advisory Commission will meet publicly on Thursday, April 11 and Friday, April 12. Medicare reimbursement subjects on the two-day session’s agenda include: telehealth inpatient rehabilitation hospital payments the physician fee schedule Medicare Advantage Part D generic drug pricing Part B rate and 340B ceilings Go here for a more detailed look at the MedPAC agenda and for information about how to participate in the meeting.

joe2024-04-09T17:14:42+00:00April 9, 2024|340b, Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC, Telehealth|

CMS Clarifies Medicare Advantage Rule

To help clarify its final Medicare Advantage rule for 2024, the Centers for Medicare & Medicaid Services has published an FAQ providing additional guidance to Medicare Advantage plans and Medicare-Medicaid plans about prior authorization for admission to post-acute-care facilities and plans’ future use of artificial intelligence (AI), algorithms, and other software tools in their coverage criteria and utilization management practices. The rule has broad implications for most health care providers but especially for post-acute-care providers, which the FAQ reflects by addressing major issues and long-running challenges for such providers, including prior authorization for discharge from acute-care hospitals into post-acute care, [...]

joe2024-02-08T21:14:52+00:00February 12, 2024|340b, Centers for Medicare & Medicaid Services, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, post-acute care|

Federal Health Policy Update for February 8

The following is the latest health policy news from the federal government for February 2 - 8. Some of the language used below is taken directly from government documents. Congress Members of the Senate’s 340B bipartisan working group have released a discussion draft of legislation that would update the 340B prescription drug discount program. Last year the group sought stakeholder input on policy solutions that might provide stability and transparency to the 340B program to ensure that the program can continue to achieve its original intent of supporting entities serving eligible patients. Find a news release describing the discussion draft [...]

joe2024-02-08T20:43:44+00:00February 8, 2024|340b, Centers for Medicare & Medicaid Services, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, post-acute care, Telehealth|

Federal Health Policy Update for December 14

The following is the latest health policy news from the federal government for December 8-14. Some of the language used below is taken directly from government documents. MedPAC Rate Recommendations At their latest public meeting, members of the Medicare Payment Advisory Commission voted preliminary approval of the following rate updates for 2025 Medicare payments: Inpatient and outpatient services –update provided for in current law plus 1.5% and adoption of a safety-net index policy to pay safety-net hospitals another $4 billion. Physicians and other health professionals –update of 50% of the Medicare economic index and a new add-on payment for services [...]

joe2023-12-14T22:30:50+00:00December 14, 2023|340b, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, health equity, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care, Telehealth|

Federal Health Policy Update for December 7

The following is the latest health policy news from the federal government for December 1-7. Some of the language used below is taken directly from government documents. Congress While Congress has more than a month before the next federal funding deadline of January 19, committees are working to prepare and pass health care legislation. On the House calendar for floor votes next week is H.R. 5378, the Lower Costs, More Transparency Act. This bill would eliminate the pending cuts to Medicaid DSH for two years (those cuts are temporarily suspended through January 19); introduce site-neutral payments for drug administration services [...]

joe2023-12-07T21:50:17+00:00December 7, 2023|340b, Centers for Medicare & Medicaid Services, Congress, COVID-19, health equity, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for November 9

The following is the latest health policy news from the federal government for November 3-9. Some of the language used below is taken directly from government documents. Congress Senate Finance Committee Earlier this week the Senate Finance Committee passed the Better Mental Health Care, Lower-Cost Drugs, and Extenders Act of 2023. The bill, which passed out of the committee by a vote of 26-0, would: eliminate $16 billion in cuts to Medicaid DSH for 2024 and 2025; soften the 2024 cut to Medicare physician payments by reducing the conversion factor by 2.15 percent rather than the 3.4 percent that CMS [...]

admin2023-11-09T15:41:22+00:00November 9, 2023|340b, Centers for Medicare & Medicaid Services, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for November 2

The following is the latest health policy news from the federal government for October 27 – November 2. Some of the language used below is taken directly from government documents. 340B Remedy Payments Late Thursday afternoon CMS published its final Medicare remedy for underpayments for 340B prescription drugs that was implemented in 2018 but rejected by the Supreme Court last year. According to the regulation, 340B remedy payments to hospitals will be made after this rule takes effect, which is 60 days after it is officially published in the Federal Register; publication is scheduled for November 16. The final regulation [...]

admin2023-11-02T18:01:15+00:00November 2, 2023|340b, Centers for Medicare & Medicaid Services, COVID-19, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare reimbursement policy|