Congress

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|

Medicaid DSH Cut In, Medicare Site-Neutral Payments Out of Health Bill?

With Congress at a stalemate on spending legislation, lawmakers are considering a narrower scope of issues to address in near-term health care legislation. According to published reports, scheduled cuts in Medicaid disproportionate share allotments to states (Medicaid DSH), already delayed several times, could be delayed once again. In addition, a proposal to require Medicare to pay for outpatient services on a site-neutral basis, rather than paying higher rates to hospital-based outpatient departments higher rates, might not be included. Also under consideration: restoring some cuts in Medicare’s payments to physicians and additional funding for community health centers. Also in jeopardy at [...]

joe2024-02-27T18:53:55-05:00February 28, 2024|Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare cuts, 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|

Proposal Would Establish New “Essential Health System” Designation

The newly proposed “Reinforcing Essential Health Systems for Communities Act” would create a new federal hospital designation that would create a mechanism for directing more federal resources to safety-net hospitals that care for more low-income and uninsured patients. The bipartisan bill, sponsored by Representatives Lori Trahan (D-MA) and David Valadao (R-CA), would, according to Rep. Trahan, … provide federal lawmakers with the avenues necessary to target funding and resources to these critical facilities – just as we’ve done with other types of hospitals that serve specific populations or regions. Hospitals would qualify for “essential health system” status by meeting one [...]

joe2024-02-20T17:02:55-05:00February 20, 2024|Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for December 7

The following is the latest health policy news from the federal government for December 1-7. Some of the language used below is taken directly from government documents. Congress While Congress has more than a month before the next federal funding deadline of January 19, committees are working to prepare and pass health care legislation. On the House calendar for floor votes next week is H.R. 5378, the Lower Costs, More Transparency Act. This bill would eliminate the pending cuts to Medicaid DSH for two years (those cuts are temporarily suspended through January 19); introduce site-neutral payments for drug administration services [...]

joe2023-12-07T21:50:17-05:00December 7, 2023|340b, Centers for Medicare & Medicaid Services, Congress, COVID-19, health equity, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for November 16

The following is the latest health policy news from the federal government for November 10-16. Some of the language used below is taken directly from government documents. Congress This week Congress passed another continuing resolution (CR) to fund the federal government beyond Friday, when the current CR expires. This bill establishes two separate deadlines for lawmakers to pass certain spending bills so they can avoid an omnibus bill that includes all 12 appropriations bills. Congress must pass four of the spending bills by January 19 and the other bills by February 2. The Labor, HHS, and Education bill, one of [...]

Bill Would Halt Medicaid DSH Cuts, Bring Other Changes

A wide-ranging bill passed by the Senate Finance Committee would eliminate $16 billion in Medicaid disproportionate share (Medicaid DSH) payments over the next two years. The Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, passed by the committee with unanimous, bipartisan support, also seeks to improve access to mental health care for Medicare patients living in rural and underserved areas; improve access to behavioral health services via telehealth for Medicaid and CHIP beneficiaries; reduce some of the recently adopted cuts in Medicare payments to physicians that will take effect in 2024; toughen federal regulations governing pharmacy benefit managers (PBMs); [...]

iqtsupport2023-11-15T13:00:58-05:00November 15, 2023|Congress, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicare reimbursement policy, Telehealth|

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days recently in Washington, D.C. The following is MACPAC’s own summary of the meeting. To kick off MACPAC’s November meeting, the Commission continued its work on denials and appeals in Medicaid managed care with a review of findings from beneficiary focus groups. Medicaid managed care organizations (MCOs) manage and provide care to beneficiaries enrolled in their plans. Beneficiaries have the right to appeal MCO coverage decisions. Federal rules require that states have monitoring systems in place to provide oversight of MCOs and their appeals systems. This session described key challenges [...]

iqtsupport2023-11-14T06:00:32-05:00November 14, 2023|Centers for Medicare & Medicaid Services, Congress, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid long-term services and supports, Medicaid managed care, Medicaid regulations, Medicaid regulations for long-term care|

Federal Health Policy Update for October 26

The following is the latest health policy news from the federal government for October 20-26. Some of the language used below is taken directly from government documents. Congress More than three weeks after House Republicans voted Rep. Kevin McCarthy (CA) out of the speaker’s office, the House has elected Rep. Mike Johnson (LA) to the position. Speaker Johnson is a social conservative and has pushed for cuts to Medicare and Medicaid, including plans to roll back Medicaid expansion in 2019. The Speaker has said he intends for the House to take up as many FY 2024 spending bills as possible [...]

iqtsupport2023-10-26T15:51:16-04:00October 26, 2023|340b, Centers for Medicare & Medicaid Services, Congress, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare reimbursement policy, MedPAC|

MedPAC Outlines Plans for the Coming Year

The Medicare Payment Advisory Commission has shared its agenda for its 2023-2024 public meeting cycle. According to MedPAC, it will engage in its regular work of offering recommendations to Congress on the adequacy of Medicare payments to providers and, as needed, suggest changes in those payments. In addition, it will fulfill two statutory requirements in the coming year: to evaluate Medicare Advantage special needs plans for individuals eligible for both Medicare and Medicaid and to review the new “Rural Emergency Hospital” designation. In addition, MedPAC writes that We are working on several other issues in the Medicare program as well, [...]

iqtsupport2023-10-24T16:43:49-04:00October 24, 2023|Centers for Medicare & Medicaid Services, Congress, Medicare, Medicare reimbursement policy, MedPAC, Telehealth|