Medicare regulations

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 [...]

joe2024-04-25T20:25:44+00:00April 25, 2024|340b, Accountable Care Organization, ACO, Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid long-term services and supports, Medicaid managed care, Medicaid regulations, Medicaid regulations for long-term care, Medicaid regulations for the disabled, Medicare, Medicare post-acute care, Medicare regulations, post-acute care|

Federal Health Policy Update for April 18

The following is the latest health policy news from the federal government for April 12-18. Some of the language used below is taken directly from government documents. The White House The administration has launched a new global health security strategy that seeks to drive action across federal departments and agencies and rally support from other countries, the private sector, and civil society to better prevent, detect, respond to, and recover from infectious disease threats. The strategy seeks to build on the lessons learned from the response to the COVID-19 pandemic. Learn more from this White House statement; the administration’s strategy [...]

joe2024-04-18T19:03:57+00:00April 18, 2024|340b, Centers for Medicare & Medicaid Services, COVID-19, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare regulations, MedPAC|

Federal Health Policy Update for April 12

The following is the latest health policy news from the federal government for April 5-11. Some of the language used below is taken directly from government documents. CMS – Proposed FY 2025 Medicare Inpatient Prospective Payment System Regulation Earlier this week CMS issued its proposed FY 2025 Medicare inpatient prospective payment system regulation – the rule under which it envisions paying acute-care hospitals, critical access hospitals, and long-term care hospitals for inpatient care in the coming fiscal year. Highlights of the proposed rule include: Rate increases of 2.6 percent for acute-care and critical access hospitals and 2.8 percent for LTCHs. [...]

Federal Health Policy Update for April 4

The following is the latest health policy news from the federal government for March 29 – April 4. Some of the language used below is taken directly from government documents. The White House The White House has announced that the Office of Management and Budget (OMB) has issued a government-wide policy to attempt to mitigate the risks of artificial intelligence (AI) and harness its benefits. The order directs action to strengthen AI safety and security, protect privacy, advance equity and civil rights, stand up for consumers and workers, and promote innovation and competition. It includes components on addressing risks from [...]

joe2024-04-04T20:06:11+00:00April 4, 2024|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for March 28

The following is the latest health policy news from the federal government for March 22-28. Some of the language used below is taken directly from government documents. The Cyberattack on Change Healthcare HHS, its Administration for Strategic Preparedness and Response, and CMS have published a resource guide for providers seeking assistance in response to the Change Healthcare cyberattack. Find that guide here. Centers for Medicare & Medicaid Services CMS has issued a proposed rule to update Medicare payment policies and rates under its Inpatient Rehabilitation Facility (IRF) Prospective Payment System and the IRF Quality Reporting Program (QRP) for FY 2025. The proposed rule [...]

joe2024-03-28T19:23:45+00:00March 28, 2024|Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for March 21

The following is the latest health policy news from the federal government for March 15-21. Some of the language used below is taken directly from government documents. The White House The White House has announced new actions to advance women’s health research and innovation and issued an executive order in support of that objective. The order directs executive branch agencies to integrate women’s health across the federal research portfolio; prioritize investments in women’s health research; pursue new research on women’s midlife health; and assess unmet needs to support women’s health research. Learn more from this White House fact sheet, which [...]

MedPAC Recommends Medicare Rate Updates to Congress

Some health care providers deserve larger Medicare payments in 2025, some should receive payment cuts, and others should see their payments go unchanged according to new recommendations from the Medicare Payment Advisory Commission to Congress. In its annual report to Congress, MedPAC recommended the following changes in Medicare rates for 2025: Medicare inpatient rates – the rate increase currently scheduled by law for 2025 plus 1.5 percent. Medicare outpatient rates – the rate increase currently scheduled by law for 2025 plus 1.5 percent. Medicare physician rates – the rate increase for physician and other health professional services currently scheduled by [...]

joe2024-03-19T21:02:54+00:00March 20, 2024|Centers for Medicare & Medicaid Services, Congress, hospitals, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

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+00:00March 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|

Federal Health Policy Update for February 22

The following is the latest health policy news from the federal government for February 16-22. Some of the language used below is taken directly from government documents. CMS and Medicaid DSH Payments CMS has published a final rule governing how third-party payers are factored into the calculation of hospitals’ Medicaid disproportionate share hospital-specific payment limit. This change requires that the calculation be based solely on Medicaid costs and payments and that costs and payments associated with dually eligible (Medicare and Medicaid) patients be excluded from the calculation of that limit. The effect of this change is that hospitals that are [...]

joe2024-02-22T22:00:03+00:00February 22, 2024|Alternative payment models, Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid regulations, Medicaid upper-payment limit, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

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, [...]

joe2024-02-08T21:14:52+00:00February 12, 2024|340b, Centers for Medicare & Medicaid Services, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, post-acute care|