Centers for Medicare & Medicaid Services

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

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 [...]

MedPAC Posts Annual Data Book

The Medicare Payment Advisory Commission has published its annual data book Health Care Spending and the Medicare Program.  The book provides information on national health care and Medicare spending, Medicare beneficiary demographics, and data on dual-eligible beneficiaries, quality of care in the Medicare program, and Medicare beneficiary and other payer liabilities. MedPAC presents its data in 11 sections: national health care and Medicare spending Medicare beneficiary demographics Medicare beneficiary and other payer financial liability dual-eligible beneficiaries alternative payer models acute inpatient services – general acute-care hospitals and inpatient psychiatric hospitals ambulatory care – physicians and other health professionals, hospital outpatient [...]

Federal Health Policy Update for July 12

The following is the latest health policy news from the federal government for July 6-12.  Some of the language used below is taken directly from government documents. The Courts A federal court has blocked implementation of the FTC’s rule banning non-compete clauses in most employment contracts, a regulatory development with potentially significant implications for the health care industry.  The temporary ban affects only the five plaintiffs in the case and it is not yet clear whether the ruling will have broader implications in the wake of the recent reversal of the Chevron decision that could potentially curtail the rulemaking authority [...]

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