Centers for Medicare & Medicaid Services

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|

MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met publicly last week in Washington, D.C. The following is MACPAC’s own summary of its meeting. The April 2024 Commission meeting began with a presentation of a draft chapter on demographic data collection in Medicaid for the June Report to Congress. Racial and ethnic health disparities persist throughout the U.S. health care system. Previous meetings have focused on the collection of primary language and limited English proficiency, sexual orientation and gender identity (SOGI), and disability data to help assess and address these health disparities. Measuring differences in access and use of [...]

joe2024-04-16T17:34:59+00:00April 17, 2024|Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid long-term services and supports, Medicaid regulations|

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|

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 [...]

joe2024-04-04T20:06:11+00:00April 4, 2024|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for March 28

The following is the latest health policy news from the federal government for March 22-28. Some of the language used below is taken directly from government documents. The Cyberattack on Change Healthcare HHS, its Administration for Strategic Preparedness and Response, and CMS have published a resource guide for providers seeking assistance in response to the Change Healthcare cyberattack. Find that guide here. Centers for Medicare & Medicaid Services CMS has issued a proposed rule to update Medicare payment policies and rates under its Inpatient Rehabilitation Facility (IRF) Prospective Payment System and the IRF Quality Reporting Program (QRP) for FY 2025. The proposed rule [...]

joe2024-03-28T19:23:45+00:00March 28, 2024|Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

Hospital Transparency Violators Falling Into Line

Hospitals cited by the federal government for failing to comply with hospital price transparency requirements are quickly coming into compliance with those requirements once cited. According to an analysis by Becker’s Hospital Review, of the 14 hospitals actually fined for transparency violations, 10 have been informed by the Centers for Medicare & Medicaid Services that they now meet the law’s requirements. Information about the other four of the 14 hospitals was not available. Learn more from the Becker’s Hospital Review article “Hospitals coming into compliance after price transparency fines.”

joe2024-03-26T19:07:11+00:00March 27, 2024|Centers for Medicare & Medicaid Services, hospitals|

Feds Tackling Prior Authorization

The Centers for Medicare & Medicaid Services has ambitious plans to improve the prior authorization process between providers and payers – and to save $15 billion over 10 years in the process. The tools it envisions using in its efforts include digitization, better data exchange, and streamlined prior authorization processes. It also will seek to foster greater transparency, requiring payers to be clearer about their policies and guidelines and to provide better explanations when they deny requests for care. Doing so, CMS believes, will reduce health care costs by $15 billion over ten years. Learn more about CMS’s prior authorization [...]

joe2024-03-21T21:31:16+00:00March 25, 2024|Centers for Medicare & Medicaid Services|

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 [...]