Center for Medicare and Medicaid Innovation

Federal Health Policy Update for August 22

The following is the latest health policy news from the federal government for August 16-22.  Some of the language used below is taken directly from government documents. The Courts The federal government must include uninsured patients whom hospitals serve under state Medicaid waivers when calculating hospitals’ Medicare DSH payments, a federal court has ruled.  In the case of Baylor All Saints Medical Center, et al. v. Xavier Becerra, federal policymakers had invoked a 2023 regulation that excluded counting care provided to patients served by DSH-eligible hospitals providing care through state Medicaid waivers – generally, through uncompensated care pools.  A group [...]

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 [...]

Federal Health Policy Update for August 5

The following is the latest health policy news from the federal government for July 19 – August 5.  Some of the language used below is taken directly from government documents. CMS – Medicare Payment Regulations Final FY 2025 Inpatient Prospective Payment System Regulation CMS has finalized its hospital inpatient prospective payment system rule for FY 2025.  In the next fiscal year CMS will increase Medicare inpatient payments 2.9% while cutting Medicare disproportionate share hospital payments (Medicare DSH) $200 million.  It also has: finalized its use of new core-based statistical area (CBSA) delineations for use in Medicare wage index calculations; established [...]

Federal Health Policy Update for July 12

The following is the latest health policy news from the federal government for July 6-12.  Some of the language used below is taken directly from government documents. The Courts A federal court has blocked implementation of the FTC’s rule banning non-compete clauses in most employment contracts, a regulatory development with potentially significant implications for the health care industry.  The temporary ban affects only the five plaintiffs in the case and it is not yet clear whether the ruling will have broader implications in the wake of the recent reversal of the Chevron decision that could potentially curtail the rulemaking authority [...]

Federal Health Policy Update for July 5

The following is the latest health policy news from the federal government for June 29-July 5.  Some of the language used below is taken directly from government documents. Department of Health and Human Services Because it has found that Medicare Advantage organizations sometimes deny prior authorization requests for post-acute care after a qualifying hospital stay even though the requests met Medicare coverage rules, HHS’s Office of the Inspector General will examine selected Medicare Advantage plans’ processes for reviewing prior authorization requests for post-acute care in long-term acute-care hospitals, inpatient rehabilitation facilities, and skilled nursing facilities. It also will review the [...]

Federal Health Policy Update for June 28

The following is the latest health policy news from the federal government for June 21-28.  Some of the language used below is taken directly from government documents. The Courts The Supreme Court has overturned the court’s own decision in the 1984 case of Chevron U. S. A. Inc. v. Natural Resources Defense Council, Inc. that gave federal agencies considerable leeway to interpret ambiguous laws enacted by Congress.  While the Chevron decision called for the courts to defer to federal agency interpretation of ambiguous statutes if they found them to be reasonable, the latest Supreme Court decision calls for the courts [...]

Federal Health Policy Update for May 9

The following is the latest health policy news from the federal government for May 3-9.  Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services HHS and CMS have announced the Increasing Organ Transplant Access Model, which seeks to increase access to kidney transplants for people living with end-stage renal disease (ESRD), improve the quality of care for people seeking kidney transplants, reduce disparities among individuals undergoing the process of receiving a kidney transplant, and increase the efficiency and capability of transplant hospitals selected to participate.  Hospitals eligible to be selected for [...]

Federal Health Policy Update for April 12

The following is the latest health policy news from the federal government for April 5-11.  Some of the language used below is taken directly from government documents. CMS – Proposed FY 2025 Medicare Inpatient Prospective Payment System Regulation Earlier this week CMS issued its proposed FY 2025 Medicare inpatient prospective payment system regulation – the rule under which it envisions paying acute-care hospitals, critical access hospitals, and long-term care hospitals for inpatient care in the coming fiscal year.  Highlights of the proposed rule include: Rate increases of 2.6 percent for acute-care and critical access hospitals and 2.8 percent for LTCHs. [...]

Federal Health Policy Update for April 4

The following is the latest health policy news from the federal government for March 29 – April 4.  Some of the language used below is taken directly from government documents. The White House The White House has announced that the Office of Management and Budget (OMB) has issued a government-wide policy to attempt to mitigate the risks of artificial intelligence (AI) and harness its benefits.  The order directs action to strengthen AI safety and security, protect privacy, advance equity and civil rights, stand up for consumers and workers, and promote innovation and competition.  It includes components on addressing risks from [...]

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 research.  Learn more from this White House fact sheet, which [...]

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