Medicare post-acute care

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, [...]

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 [...]

MedPAC Meets, Finalizes 2025 Payment Recommendations

2025 Medicare payments led the agenda at last week’s meeting of the Medicare Payment Advisory Commission. After hearing presentations on the various Medicare payment systems and discussing the adequacy of current Medicare reimbursement, MedPAC’s commissioners voted to recommend the following changes in 2025 Medicare payments. Inpatient and outpatient services – an update provided for in current law plus 1.5 percent and a shift to a safety-net index policy that would pay safety-net hospitals another $4 billion. Physicians and other health professionals – an increase of 50 percent of the Medicare economic index and introduction of an add-on payment for services [...]

Federal Health Policy Update for December 20

The following is the latest health policy news from the federal government December 14-20.  Some of the language used below is taken directly from government documents. Congress The House is in recess until January 9.  The Senate has delayed its recess to continue negotiations on a possible foreign aid and border policy deal. Democrats from the House Ways and Means Committee have published a report on the relationship between the U.S. health care system and climate change.  View their report “Health Care and the Climate Crisis:  Preparing America’s Health Care Infrastructure.” No Surprises Act The federal government has reopened the [...]

Federal Health Policy Update for December 14

The following is the latest health policy news from the federal government for December 8-14.  Some of the language used below is taken directly from government documents. MedPAC Rate Recommendations At their latest public meeting, members of the Medicare Payment Advisory Commission voted preliminary approval of the following rate updates for 2025 Medicare payments: Inpatient and outpatient services –update provided for in current law plus 1.5% and adoption of a safety-net index policy to pay safety-net hospitals another $4 billion. Physicians and other health professionals –update of 50% of the Medicare economic index and a new add-on payment for services [...]

MedPAC Meets, Makes 2025 Payment Recommendations

2025 Medicare payments led the agenda at last week’s meeting of the Medicare Payment Advisory Commission. After hearing presentations on the various Medicare payment systems and discussing the adequacy of current Medicare reimbursement, MedPAC’s commissioners provisionally endorses the following changes in 2025 Medicare payments. Inpatient and outpatient services – an update provided for in current law plus 1.5 percent and a shift to a safety-net index policy that would pay safety-net hospitals another $4 billion. Physicians and other health professionals – an increase of 50 percent of the Medicare economic index and introduction of an add-on payment for services provided [...]

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 [...]

MedPAC Meets

The commissioners of the Medicare Payment Advisory Commission recently met virtually.  The subjects on the agenda of their two-day meeting were: rural emergency hospitals dual-eligible special needs plans MedPAC’s work plan for hospice issues Medicare coverage of and payment for software as a medical service favorable selection in Medicare Advantage network management and prior authorization and their impact on access in Medicare Advantage MedPAC is an independent congressional agency that advises Congress on issues involving Medicare.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find [...]

Federal Health Policy Update for November 2

The following is the latest health policy news from the federal government for October 27 – November 2.  Some of the language used below is taken directly from government documents. 340B Remedy Payments Late Thursday afternoon CMS published its final Medicare remedy for underpayments for 340B prescription drugs that was implemented in 2018 but rejected by the Supreme Court last year.  According to the regulation, 340B remedy payments to hospitals will be made after this rule takes effect, which is 60 days after it is officially published in the Federal Register; publication is scheduled for November 16. The final regulation [...]

Federal Health Policy Update for October 19

The following is the latest health policy news from the federal government for October 13-19.  Some of the language used below is taken directly from government documents. Congress At this moment there is still no Speaker of the House of Representatives.  After 20 and then 22 House Republicans voted against Rep. Jim Jordan (R-Ohio) on Tuesday and Wednesday this week, Mr. Jordan has joined others, including senior Democrats, in supporting a plan to expand the powers of the temporary speaker, Rep. Patrick McHenry (R-NC).  Mr. Jordan remains the speaker designee, an option that will enable him to continue to seek [...]

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