Accountable Care Organization

Federal Health Policy Update for February 13

The following is the latest health policy news from the federal government for February 7 - 13.  Some of the language used below is taken directly from government documents. Introduction With the pause in external communication that the new administration imposed on HHS three weeks ago, including announcements, advisories, regular publications, and web site updates, there has been very little public communication from or activity involving HHS in the past week.  While an HHS spokesperson explained that the moratorium has been eased and agencies are now permitted to engage in some public communication, subject to review, such activity remains very [...]

2025-02-13T15:23:17-05:00February 13, 2025|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations, Medicare, Medicare reimbursement policy, MedPAC, Telehealth|
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Federal Health Policy Update for January 16

The following is the latest health policy news from the federal government for January 11-17.  Some of the language used below is taken directly from government documents. Congress   House Budget Committee Republican members of the House Budget Committee have circulated a list of possible policy changes that would reduce federal spending by between $5.3 trillion and $5.7 trillion over a period of ten years.  Up to $3.4 trillion of those possible cuts could include reductions in federal health care spending.  The health care cuts the document lists (all figures are ten-year reductions) are: Medicare introducing Medicare site-neutral outpatient payments - [...]

2025-01-16T16:45:18-05:00January 16, 2025|Accountable Care Organization, ACO, Affordable Care Act, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, COVID-19, Federal Update, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations, Medicare, Medicare bad debt reimbursement, Medicare cuts, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy, Pennsylvania Update, Telehealth|
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Federal Health Policy Update for December 19

The following is the latest health policy news from the federal government for December 13-19.  Some of the language used below is taken directly from government documents. Congress Funding for the operation of the federal government will expire tomorrow, December 20, unless Congress passes a funding bill.  Earlier this week, congressional leaders agreed on a continuing resolution that included a number of health care priorities, including relief from scheduled Medicaid DSH cuts, relief for Medicare physician payment cuts, extension of telehealth flexibilities, extension of the Acute Hospital Care at Home program, a number of changes in the practices of pharmacy [...]

2024-12-19T16:06:57-05:00December 19, 2024|340b, Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare reimbursement policy, MedPAC, Telehealth|
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Federal Health Policy Update for December 5

The following is the latest health policy news from the federal government for November 22 – December 5.  Some of the language used below is taken directly from government documents. Congress The House has posted its session calendar for 2025.  Find that calendar here. Yesterday, House Republicans made an offer to House Democrats regarding health care provisions to be included in the continuing resolution (CR) that must pass before December 20.  The offer is a conversation-opener and very few details are available.  Although most of the proposed policies have bipartisan support, there are some tangible policy differences, including House Democrats’ [...]

2024-12-05T17:14:33-05:00December 5, 2024|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, Federal Update, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, Pennsylvania Update|
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Federal Health Policy Update for October 31

The following is the latest health policy news from the federal government for October 25-31.  Some of the language used below is taken directly from government documents. The White House The White House has announced a new private sector pilot program to maintain uninterrupted access to seven pre-selected pediatric cancer medications.  Pilot participants in this program, which is part of the Biden Cancer Moonshot, will develop stewardship standards focused on identifying shortage risks, promoting transparent inventory awareness, and fostering an effective approach to preventing patient care disruptions and maintaining consistent drug distribution to children and families facing cancer.  The pilot [...]

2024-10-31T15:10:55-04:00October 31, 2024|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations, Medicare regulations, Medicare reimbursement policy, Telehealth|
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Federal Health Policy Update for September 26

The following is the latest health policy news from the federal government for September 20-26.  Some of the language used below is taken directly from government documents. Congress Yesterday, Congress passed a continuing resolution to fund the federal government when the new federal fiscal year begins on October 1.  The continuing resolution will extend funding for federal agencies at current levels through December 20 of this year.  The bill did not include other significant policy provisions.  President Biden will sign the bill this week and avoid a shutdown of the federal government.  Find the bill text here. Following passage of [...]

2024-09-26T16:49:25-04:00September 26, 2024|Accountable Care Organization, ACO, Affordable Care Act, Alternative payment models, Centers for Medicare & Medicaid Services, COVID-19, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|
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Federal Health Policy Update for August 15

The following is the latest health policy news from the federal government for August 9-15.  Some of the language used below is taken directly from government documents. Department of Health and Human Services To advance its implementation of the 2009 Health Information Technology for Economic and Clinical Health Act (HITECH Act), HHS has published a proposed regulation that would amend and update its Health and Human Services Acquisition Regulation.  The proposed regulation would require health care organizations that contract with HHS to comply with standards for data exchange adopted by the Office of the National Coordinator for Health Information Technology [...]

2024-08-15T16:35:34-04:00August 15, 2024|Accountable Care Organization, ACO, Alternative payment models, COVID-19, health equity, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, post-acute care|
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CMS Tinkers With ACO REACH Model

  Medicare’s ACO REACH Model will undergo some changes when it heads into its 2025 performance year. To help ensure that the program controls costs and saves money, the Centers for Medicare & Medicaid Services will implement a series of changes in its voluntary Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model.  According to the agency, it is: adjusting the financial methodology to improve model sustainability based on the findings in the PY [performance year] 2022 Evaluation Report; responding to feedback from interested parties on improvements to the accuracy of benchmarks; and strengthening operational flexibility and [...]

2024-08-13T15:57:16-04:00August 14, 2024|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicare, Medicare reimbursement policy|
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Federal Health Policy Update for June 6

The following is the latest health policy news from the federal government for May 31-June 6.  Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services The deadline for stakeholders to submit comments on CMS’s proposed FY 2025 Medicare inpatient prospective payment system and long-term-care hospital prospective payment system regulation is Monday, June 10.  Go here for further information about the proposed rule and how to submit comments. CMS has posted a bulletin describing billing changes in the Medicare hospital outpatient prospective payment system that will take effect on July 1.  Find [...]

2024-06-06T20:37:05-04:00June 6, 2024|Accountable Care Organization, ACO, Centers for Medicare & Medicaid Services, COVID-19, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|
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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 [...]

2024-04-25T20:25:44-04:00April 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|
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