Centers for Medicare & Medicaid Services

Federal Health Policy Update for March 30

The following is the latest health policy news from the federal government for March 24-30. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS’s Center for Medicare and Medicaid Innovation (CMMI) has extended its Medicare Advantage Value-Based Insurance Design (VBID) Model for calendar years 2025 through 2030 and will introduce changes intended to address more fully the health-related social needs of patients, advance health equity, and improve care for patients with serious illness. Learn more from this CMS announcement, which includes a link to additional information about the program. CMS [...]

iqtsupport2023-03-30T17:20:37-04:00March 30, 2023|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for March 23

The following is the latest health policy news from the federal government for March 17-23. Some of the language used below is taken directly from government documents. No Surprises Act After a February ruling in federal court that aspects of CMS’s implementation of the 2020 No Surprises Act contradicted the language of the act itself and unfairly favored payers over providers, CMS ordered a moratorium on new arbitration decisions for disputes filed on or after October 25, 2022 while it reviewed and revised its guidance on how payment disputes should be decided. Now, CMS has completed that task and issued [...]

iqtsupport2023-03-23T16:11:42-04:00March 23, 2023|Centers for Medicare & Medicaid Services, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare|

Hospitals Sue Over Medicare DSH Payments

Fifteen years ago, a federal court ruled that the Centers for Medicare & Medicaid Services was calculating Medicare disproportionate share payments (Medicare DSH) incorrectly and ordered the agency to fix the problem and reimburse eligible hospitals for the underpayments they had experienced. Now, after 15 years of waiting, 40 of those hospitals are suing for their money. In a suit filed in federal court, the hospitals outline the actions CMS has and has not taken to correct the problem and write that The agency's contractors have not performed the revised determinations required under the ruling and the rule and have [...]

iqtsupport2023-03-21T06:00:22-04:00March 21, 2023|Centers for Medicare & Medicaid Services, Medicare disproportionate share, Medicare DSH, Medicare reimbursement policy|

Federal Health Policy Update for March 16

The following is the latest health policy news from the federal government for March 13-16. Some of the language used below is taken directly from government documents. Medicare Payment Advisory Commission (MedPAC) MedPAC has published its “March 2023 Report to the Congress: Medicare Payment Policy.” In this year’s report MedPAC considers the context of the Medicare program, including the near-term consequences of COVID-19 and the longer-term effects of program spending on the federal budget and the program’s financial sustainability. It evaluates payment adequacy and make recommendations concerning Medicare payment policy in 2024 for selected fee-for-service payment systems but explains that [...]

iqtsupport2023-03-16T17:31:47-04:00March 16, 2023|Centers for Medicare & Medicaid Services, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for Friday, March 10

The following is the latest health policy news from the federal government for March 6-10. Some of the language used below is taken directly from government documents. White House FY 2024 Budget Proposal The Biden administration this week released its proposed FY 2024 federal budget. Among its many proposals are measures to extend the life of the Medicare hospital trust fund and reduce Medicare beneficiaries’ health care costs; to reduce prescription drug costs for consumers, Medicare, and Medicaid; to return high Medicaid managed care organization profits to the federal government; to make behavioral health care more affordable for seniors; to [...]

iqtsupport2023-03-10T15:57:42-05:00March 10, 2023|340b, Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, COVID-19, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicaid regulations, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

Seven Apply for Rural Emergency Hospital Designation

With more than 140 rural hospitals closing since 2010 and more currently in financial trouble, a modest number of such facilities are hoping to avoid a similar fate by applying to the Centers for Medicare & Medicaid Services to become “rural emergency hospitals,” a new Medicare provider type created to preserve access to care in rural areas. Hospitals that become rural emergency hospitals will receive an annual fee of more than $3 million from Medicare and a five percent increase in their Medicare payments but must retain 24-hour emergency services while limiting their inpatient services to leave just enough time [...]

iqtsupport2023-03-08T06:00:26-05:00March 8, 2023|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for March 3

The following is the latest health policy news from the federal government for February 27 to March 3. Some of the language used below is taken directly from government documents. No Surprises Act The Independent Dispute Resolution (IDR) entities empowered by the No Surprises Act to adjudicate disagreements between providers and payers may resume their work – but only some of it. CMS has directed IDRs entities to resume processing payment determinations on February 27 for disputes involving items or services furnished before October 25, 2022 but not to issue decisions involving items or services furnished on or after October [...]

iqtsupport2023-03-03T13:20:02-05:00March 3, 2023|Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, MedPAC, Telehealth|

CMS Proposes Regulation Governing Medicare DSH

The Centers for Medicare & Medicaid Services has proposed altering its regulations governing the calculation of eligible hospitals’ Medicare disproportionate share payments (Medicare DSH). According to CMS, This proposed rule would revise our regulations on the counting of days associated with individuals eligible for certain benefits provided by section 1115 demonstrations in the Medicaid fraction of a hospital's disproportionate patient percentage. This is essentially the same change CMS included in its proposed FY 2022 and FY 2023 inpatient prospective payment system rules and then did not adopt in the final rule. In proposing this change again CMS suggests that this [...]

iqtsupport2023-03-01T06:00:58-05:00March 1, 2023|Centers for Medicare & Medicaid Services, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations|

Federal Health Policy Update for February 16

The following is the latest health policy news from the federal government for February 6-16. Some of the language used below is taken directly from government documents. No Surprises Act A federal judge in Texas has vacated parts of a regulation governing the arbitration process that is a major aspect of implementation of the No Surprises Act. In his ruling, the judge found that the arbitration process unfairly favored payers over providers, most notably by placing undue emphasis on the qualified payment amount (QPA) that is a major part of the arbitration process. The decision explains that “The Court first [...]

iqtsupport2023-02-16T17:02:31-05:00February 16, 2023|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, health equity, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations|

Federal Health Policy Update for February 6

The following is the latest health policy news from the federal government for the week of January 23 to February 6. Some of the language used below is taken directly from government documents. 340B Pharmaceutical companies may restrict the ability of providers to use specialty and community pharmacies to distribute 340B-covered drugs, a federal appeals court has decided. See the court’s ruling here. Centers for Medicare & Medicaid Services CMS has revised its fact sheets about COVID-19 public health emergency waivers and flexibilities for different types of providers, updating which waivers and flexibilities have already been terminated, which have been [...]

iqtsupport2023-02-06T17:03:31-05:00February 6, 2023|340b, Centers for Medicare & Medicaid Services, COVID-19, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare reimbursement policy, MedPAC|