Accountable Care Organization

Federal Health Policy Update for Friday, January 28

The following is the latest health policy news from the federal government as of 3:45 p.m. on Friday, January 28.  Some of the language used below is taken directly from government documents. Provider Relief Fund HHS and its Health Resources and Services Administration (HRSA) announced that this week they made more than $2 billion in Provider Relief Fund Phase 4 General Distribution payments to more than 7,600 providers.  Nearly $11 billion of the $17 billion allocated for Provider Relief Fund Phase 4 payments have now been distributed.  Phase 4 payments have an increased focus on equity, including reimbursing a higher [...]

Federal Health Policy Update for Monday, December 6

The following is the latest health policy news from the federal government as of 2:45 p.m. on Monday, December 6.  Some of the language used below is taken directly from government documents. The White House The White House has published a plan outlining the steps the administration will take to combat the delta and omicron variants of COVID-19 in the coming months. The major components of this plan are boosters for all adults, vaccinations for children, expanded free home testing, stronger public health protocols for international travel, workplace protections, rapid response teams to help battle rising cases, and supplying treatment [...]

Federal Health Policy Update for Monday, November 15

The following is the latest health policy news from the federal government as of 2:45 p.m. on Monday, November 15.  Some of the language used below is taken directly from government documents. The White House The White House has posted a transcript of the November 10 press briefing given by its COVID-19 response team and public officials.  Go here for the slides presented during that briefing. Centers for Medicare & Medicaid Services – Final Guidance on Shared/Co-Located Hospital Spaces In a memo to state survey agencies, CMS has published final guidance for the evaluation of compliance with the Medicare Conditions [...]

CMS Funds Expanded Telehealth in Four States

The Centers for Medicare & Medicaid Services is building on its Community Health Access and Rural Transformation (CHART) Model by awarding up to $20 million to organizations in four states to expand the use of telehealth in their communities and introduce other improvements that enhance access to care in rural areas. Organizations in Alabama, South Dakota, Texas, and Washington state will receive $2 million for planning and up to $3 million each for achieving specific objectives. The CHART model seeks to use telehealth and other means, reimbursed through an accountable care organization model, to address health disparities and reduce hospital [...]

Federal Health Policy Update for Monday, August 30

The following is the latest health policy news from the federal government as of 2:30 p.m. on Monday, August 30.  Some of the language used below is taken directly from government documents. Temporary Suspension of COVID-19 Data Reporting Requirements for Some Hospitals The Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response has announced that federal hospital COVID-19 reporting requirements for the entire state of Louisiana and parts of Mississippi have been suspended for seven days in response to Hurricane Ida.  While hospitals in the affected areas may still report their data if they [...]

Federal Health Policy Update for Wednesday, July 14

The following is the latest health policy news from the federal government as of 2:45 p.m. on Wednesday, July 14.  Some of the language used below is taken directly from government documents. CMS – Proposed 2022 Medicare Physician Fee Schedule Rule CMS has released its proposed Medicare physician fee schedule rule for 2022.  Highlights of the proposed rule, which is more than 1700 pages, include: loosening current restrictions on the use of telehealth and expanding its use for behavioral health services; expanding the reach of the Medicare Diabetes Prevention Program; requiring clinicians to meet a higher performance threshold to receive [...]

MedPAC Reports to Congress

MedPAC has submitted its annual report to Congress. The congressionally mandated report, titled Report to Congress: Medicare and the Health Care Delivery System, consists of seven chapters: Realizing the promise of value-based payment in Medicare: an agenda for change. Challenges in maintaining and increasing savings from accountable care organizations (ACOs). Replacing the Medicare Advantage quality bonus program. Mandated report: Impact of changes in the 21st Century Cures Act to risk adjustment for Medicare Advantage enrollees. Realigning incentives in Medicare Part D. Separately payable drugs in the hospital outpatient prospective payment system (OPPS). Improving Medicare’s end-state renal disease (ESRD) prospective payment [...]

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s March agenda were: Addressing Medicare Shared Savings Program vulnerabilities The role of specialists in alternative payment models and accountable care organizations Realigning incentives in Medicare Part D Redesigning the Medicare Advantage quality bonus program Mandated report: Impact of changes in the 21st Century Cures Act to risk adjustment for Medicare Advantage enrollees Improving Medicare’s end-stage renal disease prospective payment system Separately payable drugs in the hospital outpatient prospective payment system MedPAC is an independent congressional agency that advises [...]

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s January agenda were: The Medicare prescription drug program (Part D):  status report and options for restructuring Redesigning the Medicare Advantage quality program:  initial modeling of a value incentive program Hospital inpatient and outpatient payments Physician payments Outpatient dialysis payments Skilled nursing facility, home health, inpatient rehabilitation facility, and long-term-care hospital payments Hospice and ambulatory surgery center payments The 340B program ACO beneficiary assignment MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  [...]

Mandatory Payment Models Coming to Medicare?

Even as CMS rolls out new, voluntary Medicare alternative payment models, it is contemplating making participation in future models mandatory rather than voluntary, as is currently the case. Or so Centers for Medicare & Medicaid Services administrator Seema Verma told a gathering in Baltimore last week. At the heart of the idea, Verma told her audience, is that while CMS is pleased with participation in voluntary accountable care organization models, organizations are choosing to participate in ACO models they think would benefit them most while posing little or no downside financial risk.  The agency may need to move away from [...]

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