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’ [...]

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 [...]

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 [...]

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 [...]

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 [...]

Federal Health Policy Update for October 31

The following is the latest health policy news from the federal government for October 25-31.  Some of the language used below is taken directly from government documents. The White House The White House has announced a new private sector pilot program to maintain uninterrupted access to seven pre-selected pediatric cancer medications.  Pilot participants in this program, which is part of the Biden Cancer Moonshot, will develop stewardship standards focused on identifying shortage risks, promoting transparent inventory awareness, and fostering an effective approach to preventing patient care disruptions and maintaining consistent drug distribution to children and families facing cancer.  The pilot [...]

Looking Ahead to Lame Duck

When the dust clears after next week’s presidential election, Congress will return to Washington with numerous unfinished matters on its agenda – including many with implications for health care organizations. They include: Federal government funding, authorization for which expires on December 20. Medicare payments to physicians, which many in Congress want to increase if, as proposed, the Centers for Medicare & Medicaid Services reduces those payments for 2025. A potential temporary extension of the continued use of telehealth to prescribe Schedule 2 drugs such as Adderall. Payment adjustments for low-volume and Medicare-dependent hospitals. Renewal of authorization for the COVID-era Acute [...]

Insurers Skirting Medicare Two-Midnight Rule?

Health care payers continue to classify large numbers of Medicare admissions as “observation status,” and while the recent extension of the two-midnight rule to Medicare Advantage plans has resulted in a decline in the use of observation status classifications among those plans, Medicare Advantage plans still use the observation status classification more than three times as often as traditional Medicare. According to a new study, Medicare Advantage plans used the observation rate classification for between 14.4 percent and 16.1 percent of their claims during the first half of 2024.  Traditional Medicare?  With a one-month exception, from 3.7 percent to 5.2 [...]

2024-10-30T11:41:07-04:00October 30, 2024|hospitals, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for October 24

The following is the latest health policy news from the federal government for October 18-24.  Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has issued new guidance outlining regulatory requirements for hospitals to report specific data on COVID-19, flu, and RSV.  The new weekly electronic reporting requirements will apply to short-term acute-care hospitals, long-term-care hospitals, critical access hospitals, Indian Health Service hospitals, children’s hospitals, and cancer hospitals, with other types of hospitals – psychiatric hospitals and distinct part units and inpatient rehabilitation hospitals and distinct part units – subject [...]

Federal Health Policy Update for October 17

The following is the latest health policy news from the federal government for October 11-17.  Some of the language used below is taken directly from government documents. Aftermath of Hurricanes Helene and Milton CMS has updated its waivers and flexibilities to help health care providers respond to the damage caused by Hurricane Helene in South Carolina, Tennessee, Georgia, North Carolina, and Florida and by Hurricane Milton in Florida.  Find the updated waivers and flexibilities here.  Please note that these waivers are not dated and therefore require individual attention by affected providers. HHS has initiated a series of steps to help restore [...]

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