Medicare post-acute care

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 [...]

Federal Health Policy Update for August 15

The following is the latest health policy news from the federal government for August 9-15.  Some of the language used below is taken directly from government documents. Department of Health and Human Services To advance its implementation of the 2009 Health Information Technology for Economic and Clinical Health Act (HITECH Act), HHS has published a proposed regulation that would amend and update its Health and Human Services Acquisition Regulation.  The proposed regulation would require health care organizations that contract with HHS to comply with standards for data exchange adopted by the Office of the National Coordinator for Health Information Technology [...]

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 5

The following is the latest health policy news from the federal government for June 29-July 5.  Some of the language used below is taken directly from government documents. Department of Health and Human Services Because it has found that Medicare Advantage organizations sometimes deny prior authorization requests for post-acute care after a qualifying hospital stay even though the requests met Medicare coverage rules, HHS’s Office of the Inspector General will examine selected Medicare Advantage plans’ processes for reviewing prior authorization requests for post-acute care in long-term acute-care hospitals, inpatient rehabilitation facilities, and skilled nursing facilities. It also will review the [...]

Federal Health Policy Update for June 28

The following is the latest health policy news from the federal government for June 21-28.  Some of the language used below is taken directly from government documents. The Courts The Supreme Court has overturned the court’s own decision in the 1984 case of Chevron U. S. A. Inc. v. Natural Resources Defense Council, Inc. that gave federal agencies considerable leeway to interpret ambiguous laws enacted by Congress.  While the Chevron decision called for the courts to defer to federal agency interpretation of ambiguous statutes if they found them to be reasonable, the latest Supreme Court decision calls for the courts [...]

Federal Health Policy Update for June 20

The following is the latest health policy news from the federal government for June 14-20.  Some of the language used below is taken directly from government documents. No Surprises Act HHS and the departments of Labor and the Treasury have announced a policy that offers extra time to health care providers whose desire to engage in No Surprises Act adjudication of payment disagreements with payers was affected by the Change Healthcare cybersecurity attack.  Under this temporary policy,  providers, facilities, and providers of air ambulance services whose ability to initiate timely No Surprises Act open negotiation for any item or service [...]

Federal Health Policy Update for May 30

The following is the latest health policy news from the federal government for May 24-30.  Some of the language used below is taken directly from government documents. Congress When the House and Senate return to Washington, DC from the Memorial Day recess next week committees will resume holding hearings and markups on health care policy while appropriators will focus on funding for federal fiscal year 2025, which begins October 1.  While there seems to be plenty of activity in Congress it is widely expected that only the most essential bills, like emergency supplemental packages and bills to keep the federal [...]

Federal Health Policy Update for April 25

The following is the latest health policy news from the federal government for April 9-25.  Some of the language used below is taken directly from government documents. Updated 340B Arbitration Process Last week HHS’s Health Resources and Services Administration (HRSA) published a regulation modifying the administrative dispute resolution (ADR) process it uses to adjudicate payment disputes between 340B-eligible providers and pharmaceutical companies.  The major changes in the ADR process include the use of HRSA experts to serve on ADR panels; elimination of the $25,000 damage threshold for filing a claim; 340B-eligible providers may now challenge manufacturers that seek to prevent [...]

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