Centers for Medicare & Medicaid Services

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 [...]

joe2024-09-26T16:49:25-04:00September 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|

Administration Launches Patient Safety Initiatives

In response to World Patient Safety Day, the administration has launched a multi-faceted approach to reducing harm for patients and workers in the delivery of health care. The initiative will fall under the umbrella of a new multi-agency, public/private National Action Alliance for Patient and Workforce Safety administered by the Department of Health and Human Services’ Agency for Health Care Research and Quality. Other federal agencies to be involved in the initiative include the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, the Veterans Health Administration, the Department of Defense, the Health Resources and Services [...]

joe2024-09-19T17:44:03-04:00September 23, 2024|Centers for Medicare & Medicaid Services, Uncategorized|

Federal Health Policy Update for September 19

The following is the latest health policy news from the federal government for September 13-29. Some of the language used below is taken directly from government documents. Congress Energy and Commerce Committee. Yesterday the House Energy and Commerce Committee marked up 16 bills, including several that address health care. These bills are unlikely to proceed to votes in the full House until after Congress returns following the November elections. The committee passed a bill that would extend the current telehealth waivers, scheduled to expire on December 31, for two years and would extend the Medicare Hospital at Home program, also [...]

joe2024-09-19T14:56:55-04:00September 19, 2024|340b, Centers for Medicare & Medicaid Services, COVID-19, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare disproportionate share, Medicare DSH, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for September 12

The following is the latest health policy news from the federal government for September 6-12. Some of the language used below is taken directly from government documents. 340B A federal court has declined to issue a preliminary order to block implementation of a Maryland law that requires pharmaceutical companies to provide discounts on drugs dispensed by eligible 340B providers by contract pharmacies. The challenge to the Maryland law, filed by Pharmaceutical Research and Manufacturers of America (PhRMA) and several pharmaceutical companies, will be heard without a temporary order suspending the law’s implementation. Learn more from the court order. Centers for [...]

joe2024-09-12T15:22:15-04:00September 12, 2024|340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, COVID-19, hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for September 5

The following is the latest health policy news from the federal government for August 31 – September 5. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has posted a bulletin outlining changes coming in the FY 2025 inpatient and long-term-care hospital prospective payment system. Find that bulletin here. The changes it presents take effect on October 1. CMS has posted a bulletin about new waived laboratory tests that outlines Clinical Laboratory Improvement Amendments (CLIA) requirements, new CLIA-waived tests approved by the FDA, and use of the modifier QW for [...]

joe2024-09-05T15:20:05-04:00September 5, 2024|Centers for Medicare & Medicaid Services, COVID-19, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for August 30

The following is the latest health policy news from the federal government for August 23-30. Some of the language used below is taken directly from government documents. 340B Johnson & Johnson, the pharmaceutical, biotechnology, and medical technologies company, told health care providers this week that it would shift from the long-time 340B upfront discount approach to a rebate model for two of its drugs and that eligible 340B hospitals and other providers will need to purchase the prescription drugs Stelara and Xarelto at list price and then, after dispensing them to patients, will need to submit 340B rebate claims to [...]

joe2024-08-30T15:03:18-04:00August 30, 2024|340b, Centers for Medicare & Medicaid Services, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid long-term services and supports, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, social determinants of health|

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 [...]

joe2024-08-13T15:57:16-04:00August 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|

Federal Health Policy Update for August 8

The following is the latest health policy news from the federal government for August 3-8. Some of the language used below is taken directly from government documents. No Surprises Act A federal appeals court has upheld a February lower court ruling that found that the current No Surprises Act’s arbitration process for addressing payment disagreements between payers and providers favored payers by giving too much weight to “qualifying payment amounts,” which are the median of what insurers contract to pay providers in a given geographic area. Learn more from the appeals court’s decision in the case. Department of Health and [...]

joe2024-08-08T15:01:05-04:00August 8, 2024|340b, Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare regulations, Medicare reimbursement policy, social determinants of health, Telehealth|

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 [...]

joe2024-08-06T14:25:10-04:00August 6, 2024|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, health equity, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care|

Federal Health Policy Update for July 18

The following is the latest health policy news from the federal government for July 13-18. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has issued a notice alerting certain clinicians who are qualifying alternative payment model (APM) participants and who have earned an APM incentive payment that the agency does not have the current contact information it needs to disburse their payments. The notice provides information to qualified participants on how to update their Medicare billing information so that CMS can disburse these payments. Learn more from this CMS [...]

joe2024-07-18T20:57:21-04:00July 18, 2024|Alternative payment models, Centers for Medicare & Medicaid Services, COVID-19, hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care, Telehealth|