hospitals

MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met publicly last week in Washington, D.C. The following is MACPAC’s own summary of its meeting. The MACPAC December 2024 meeting began with a discussion on accountability in Medicaid managed care, which is the predominant delivery system in Medicaid. MACPAC will examine the tools the Centers for Medicare & Medicaid Services (CMS) and state Medicaid agencies use to manage managed care organizations’ (MCOs) performance and hold plans accountable to contractual obligations. Staff presented findings from MACPAC’s review of federal policy and a 40-state review of accountability tools as described in [...]

joe2024-12-17T15:23:53-05:00December 18, 2024|Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations|

MedPAC Meets, Offers Preliminary 2026 Rate Proposals

MedPAC’s commissioners held their latest public meeting on Thursday, December 12 and Friday, December 13. The subjects on the meeting’s agenda were: assessing payment adequacy and updating payments: physician and other health professional services assessing payment adequacy and updating payments: hospital inpatient and outpatient services; and mandated report on rural emergency hospitals assessing payment adequacy and updating payments: skilled nursing facility services assessing payment adequacy and updating payments: inpatient rehabilitation facility services assessing payment adequacy and updating payments: home health care services assessing payment adequacy and updating payments: hospice services assessing payment adequacy and updating payments: outpatient dialysis services In [...]

joe2024-12-17T13:33:44-05:00December 17, 2024|Centers for Medicare & Medicaid Services, hospitals, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for December 12

The following is the latest health policy news from the federal government for December 6-12. Some of the language used below is taken directly from government documents. Congress Funding the Federal Government With funding for the federal government set to expire in eight days, Congress is still negotiating the details of the next continuing resolution. Speaker Johnson has indicated that the next continuing resolution will extend until an unspecified date in March. Last week, the House majority and House minority exchanged proposals for additional items to include in the next continuing resolution and both parties listed health care extenders – [...]

joe2024-12-12T16:16:50-05:00December 12, 2024|340b, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, COVID-19, Federal Update, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for December 5

The following is the latest health policy news from the federal government for November 22 – December 5. Some of the language used below is taken directly from government documents. Congress The House has posted its session calendar for 2025. Find that calendar here. Yesterday, House Republicans made an offer to House Democrats regarding health care provisions to be included in the continuing resolution (CR) that must pass before December 20. The offer is a conversation-opener and very few details are available. Although most of the proposed policies have bipartisan support, there are some tangible policy differences, including House Democrats’ [...]

joe2024-12-05T17:14:33-05:00December 5, 2024|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, Federal Update, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, Pennsylvania Update|

Providers Winning Big on No Surprises Act Disputes

Health care providers are winning more than 86 percent of the emergency care payment disputes they take to adjudication through the Independent Dispute Resolution process established under the 2020 No Surprises Act. The abstract of the article “No Surprises Act independent dispute resolution outcomes for emergency services,” published by the journal Health Affairs Scholar, explains that The No Surprises Act banned surprise billing and established a final-offer arbitration system, independent dispute resolution (IDR), to resolve disagreements between health plans and providers. One factor that arbiters must consider in the IDR process is the qualifying payment amount (QPA), the median contracted [...]

joe2024-12-04T10:41:08-05:00December 5, 2024|hospitals|

Hospital Compliance With Price Transparency Rules Erodes

Hospitals’ compliance with federal price transparency regulations declined during 2024. According to the organization PatientRightsAdvocate.org, hospital compliance with the federal standard fell from 34.5 percent in February of this year to 21.1 percent in November. Under federal guidelines, hospitals are required to post payer-specific rates for their 300 most common procedures and those postings must be made in a consumer-friendly format. PatientRightsAdvocate.org reviewed the postings of 2000 hospitals and found that while all of them posted data in the appropriate format, the quality of that data varied greatly. While the objective of the requirement is to enable consumers to use [...]

joe2024-12-04T09:57:50-05:00December 4, 2024|hospitals|

Federal Health Policy Update for November 21

The following is the latest health policy news from the federal government for November 15-21. Some of the language used below is taken directly from government documents. The Incoming Administration President Trump has nominated Robert F. Kennedy, Jr. for Secretary of Health and Human Services and Dr. Mehmet Oz for Administrator of the Centers for Medicare & Medicaid Services (CMS). Both positions require confirmation by the Senate. Senators will start the process of confirming the President-elect’s cabinet nominees when the new Congress convenes in January. Congress Funding for the federal government will expire on December 20 and it is still [...]

joe2024-11-21T15:14:52-05:00November 21, 2024|Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

MedPAC Meets

MedPAC’s commissioners held their latest public meetings on Thursday, November 7 and Friday, November 8. The subjects on the meetings’ agenda were: reforming physician fee schedule updates and improving the accuracy of payments considering the participation bonus for clinicians in advanced alternative payment models structural differences between the prescription drug plan and Medicare Advantage prescription drug plan markets assessing Medicare Advantage provider networks Medicare’s coverage limits on stays in freestanding inpatient psychiatric facilities Go here for summaries of the issues and key points and links to the presentations delivered by MedPAC staff and find a transcript of the two-day session [...]

joe2024-11-14T16:54:24-05:00November 18, 2024|Alternative payment models, hospitals, Medicare, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for November 14

The following is the latest health policy news from the federal government for November 8-14. Some of the language used below is taken directly from government documents. Election Update House of Representatives Though the outcome of nine races for seats in the House remains undecided, Republicans have won enough seats to control the House in the new Congress. Yesterday, Republicans voted to nominate the current Speaker of the House, Mike Johnson (LA), for Speaker in the new Congress and will hold the vote for that position when the 119th Congress convenes in Washington, D.C. on January 3. It is expected, after [...]

joe2024-11-14T15:18:02-05:00November 14, 2024|ACO, Alternative payment models, Centers for Medicare & Medicaid Services, CMMI, COVID-19, health equity, hospitals, Medicaid, Medicaid DSH, Medicaid DSH allotments, Medicare reimbursement policy, MedPAC, Telehealth|

Federal Health Policy Update for November 7

The following is the latest health policy news from the federal government for November 1-7. Some of the language used below is taken directly from government documents. Medicare Payment Regulations Late last week CMS published four regulations describing how Medicare will pay certain providers in 2025. The following is a brief overview of those regulations. Medicare Outpatient Prospective Payment System Rate increase of 2.9 percent for outpatient and ambulatory surgical center services. New Conditions of Participation for obstetrical services. Additional payments for selected non-opioid treatments for pain relief. Minor modifications of the inpatient-only list. A change in the review time [...]

joe2024-11-07T16:26:47-05:00November 7, 2024|Centers for Medicare & Medicaid Services, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, Telehealth|