Centers for Medicare & Medicaid Services

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, [...]

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 [...]

Medicare ACO Participation Rising

Participation in Medicare’s various accountable care organizations is increasing, the Centers for Medicare & Medicaid Services reports. According to CMS, 50 new ACOs will participate in its Medicare Shared Savings Program in 2024 along with another 19 that will participate in a new, permanent payment option version of that program.  Another 71 ACOs renewed their participation in the program, bringing the total number of ACOs in the program to 480 that together will serve nearly 11 million traditional Medicare beneficiaries. Other Medicare ACOs account for another three million participants.  Among them are 2.6 million served by 122 ACOs in the [...]

Federal Health Policy Update for February 1

The following is the latest health policy news from the federal government for January 26 – February 1.  Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has released its calendar year (CY) 2025 Advance Notice for the Medicare Advantage and Medicare Part D Prescription Drug Programs that would update payment and other policies for these programs.  Under the notice, federal Medicare Advantage spending would increase an expected 3.7 percent, or more than $16 billion, but the agency also proposes reducing by 0.16 percent the program’s base rate.  CMS also detailed [...]

Federal Health Policy Update for January 25

The following is the latest health policy news from the federal government for January 12 - 25.  Some of the language used below is taken directly from government documents. Department of Health and Human Services – Funding Models HHS has announced a new model to test approaches for addressing the behavioral and physical health and health-related social needs of people with Medicaid and Medicare.  The goal of the Innovation in Behavioral Health Model (IBH) is to improve the overall quality of care and outcomes for adults with mental health conditions and/or substance use disorders by connecting them with the physical, behavioral, [...]

Acute Hospital Care at Home Shows Promise

The Acute Hospital Care at Home program, launched by the Centers for Medicare & Medicaid Services during the COVID-19 pandemic to free hospital beds for COVID and other sick patients, is showing promise as an alternative to hospital care for at least some patients. In an analysis of more than 5000 Medicare patients participating in the Acute Hospital Care at Home program from mid-2022 through mid-2023, only 0.5 percent of participants passed away while being served by the program at home and only 6.2 percent required a return to a hospital for more than 24 hours. With the waiver enacted [...]

2024-01-16T14:21:27+00:00January 17, 2024|Centers for Medicare & Medicaid Services, Medicare|

“Drivers of Health” Drive Most Health Outcomes

A recent analysis has found that newly coined “drivers of health” are the primary drivers of health outcomes. According to a Commonwealth Fund report, Research indicates that an estimated 20 percent of health outcomes are linked to medical care; the remaining 80 percent stem from socioeconomic, environmental, and behavioral factors referred to as social drivers of health (DOH).  These factors – such as homelessness, food insecurity, and exposure to intimate partner violence – are associated with chronic illness, mental health issues, acute hospitalizations, and high health care costs and disproportionately impact communities of color. In its proposed 2023 Medicare physician [...]

Federal Health Policy Update for January 4

The following is the latest health policy news from the federal government for December 21 to January 4.  Some of the language used below is taken directly from government documents. No Surprises Act HHS, the departments of Labor and the Treasury, and the Office of Personnel Management intend to reopen the comment period for submitting comments on a proposed rule governing federal Independent Dispute Resolution (IDR) operations.  They plan to publish a notice to this effect in the near future with further details on reopening the comment period. Department of Health and Human Services HHS’s Office of the National Coordinator [...]

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the meeting. MACPAC’s December 2023 meeting opened with a session that highlighted findings related to sexual orientation and gender identity (SOGI) data collection as part of the Commission’s focus on the collection of primary language and limited English proficiency, SOGI, and disability data for the purposes of assessing and addressing health disparities. During this discussion, we reviewed the purpose of SOGI data and federal and state priorities for collecting these data, which includes an overview of [...]

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 [...]

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