Centers for Medicare & Medicaid Services

Federal Health Policy Update for March 14

The following is the latest health policy news from the federal government for March 8-14. Some of the language used below is taken directly from government documents. The White House The Biden administration this week released its proposed FY 2025 federal budget. Health care highlights include: Making permanent the expanded health care premium tax credits introduced to make health insurance marketplace plans more affordable for middle-class Americans. Extension of coverage similar to Medicaid to residents of the 10 states that have not taken advantage of the Affordable Care Act opportunity to expand their Medicaid programs. Permission for states to extend [...]

joe2024-03-14T20:46:56-04:00March 14, 2024|Affordable Care Act, Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare reimbursement policy, MedPAC, Telehealth|

Federal Health Policy Update for March 7

The following is the latest health policy news from the federal government for March 1-7. Some of the language used below is taken directly from government documents. Congress On Wednesday, March 16 the House passed, by a vote of 339-85, the first package of spending bills to fund some federal agencies through the remainder of the 2024 federal fiscal year. The House bills include several health care provisions extending programs that were set to expire on Friday, March 8. The bills would extend the following provisions and programs through December 31, 2024: The continued delay of cuts to Medicaid disproportionate [...]

joe2024-03-07T21:42:53-05:00March 7, 2024|Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care|

Federal Health Policy Update for February 29

The following is the latest health policy news from the federal government for February 23-29. Some of the language used below is taken directly from government documents. Congress This afternoon the House passed H.R. 7463, which changed the dates for the March 1 and March 8 funding deadlines to March 8 and March 22 and includes no new health care policies. Health care extenders included in the current continuing resolution, including the delay to Medicaid DSH cuts, are not included in the bill that passed the House; the March 8 expiration date still applies to those extenders. The new continuing [...]

joe2024-02-29T22:41:47-05:00February 29, 2024|Centers for Medicare & Medicaid Services, COVID-19, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare reimbursement policy|

New Way of Calculating Medicaid DSH

Hospitals will soon see federal regulators take a new approach to calculating their Medicaid DSH payments. Specifically, their Medicaid disproportionate share hospital-specific payment limit. A new CMS regulation changes how third-party payments are factored into the calculation of hospitals’ Medicaid disproportionate share hospital-specific payment limit. That limit, in turn, affects hospitals’ Medicaid DSH payments. This final rule implements changes CMS proposed last year to comply with a congressional mandate to include in the calculation of hospitals’ Medicaid disproportionate share hospital-specific payment limits only costs and payments for services furnished to beneficiaries for whom Medicaid is the primary payer; this means [...]

joe2024-02-23T16:37:23-05:00February 26, 2024|Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH|

Federal Health Policy Update for February 22

The following is the latest health policy news from the federal government for February 16-22. Some of the language used below is taken directly from government documents. CMS and Medicaid DSH Payments CMS has published a final rule governing how third-party payers are factored into the calculation of hospitals’ Medicaid disproportionate share hospital-specific payment limit. This change requires that the calculation be based solely on Medicaid costs and payments and that costs and payments associated with dually eligible (Medicare and Medicaid) patients be excluded from the calculation of that limit. The effect of this change is that hospitals that are [...]

joe2024-02-22T22:00:03-05:00February 22, 2024|Alternative payment models, Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid regulations, Medicaid upper-payment limit, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

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, [...]

joe2024-02-08T21:14:52-05:00February 12, 2024|340b, Centers for Medicare & Medicaid Services, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, 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 [...]

joe2024-02-08T20:43:44-05:00February 8, 2024|340b, Centers for Medicare & Medicaid Services, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, post-acute care, Telehealth|

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 [...]

joe2024-02-06T20:51:47-05:00February 7, 2024|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services|

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 [...]

joe2024-02-01T21:47:38-05:00February 1, 2024|Accountable Care Organization, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, Federal Update, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

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, [...]

joe2024-01-25T22:30:26-05:00January 25, 2024|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC, social determinants of health, Telehealth|