Medicare reimbursement policy

Proposal Would Establish New “Essential Health System” Designation

The newly proposed “Reinforcing Essential Health Systems for Communities Act” would create a new federal hospital designation that would create a mechanism for directing more federal resources to safety-net hospitals that care for more low-income and uninsured patients. The bipartisan bill, sponsored by Representatives Lori Trahan (D-MA) and David Valadao (R-CA), would, according to Rep. Trahan, … provide federal lawmakers with the avenues necessary to target funding and resources to these critical facilities – just as we’ve done with other types of hospitals that serve specific populations or regions. Hospitals would qualify for “essential health system” status by meeting one [...]

Hospitals Rally Against Medicare Site-Neutral Payments

A proposal to save Medicare nearly $4 billion over a decade is running into stiff opposition. From hospitals. – and some members of Congress. Medicare has long paid more for outpatient services provided in hospital-based outpatient departments than it has for the same services delivered in private doctors’ offices.  Critics say this is unfair, that Medicare should pay the same no matter where the service is provided.  Defenders of the practice maintain that hospital-based outpatient departments share higher fixed costs, including for ERs and care for uninsured patients.  They also argue that reducing such Medicare outpatient payments could threaten the [...]

2024-02-15T13:42:15+00:00February 16, 2024|Medicare, Medicare reimbursement policy|

Federal Health Policy Update for February 15

The following is the latest health policy news from the federal government for February 9-15.  Some of the language used below is taken directly from government documents. Department of Health and Human Services HHS has released a 2023 update of its Equity Action Plan.  The plan outlines five priority areas to advance equity:  prevent neglect and improve care to help children thrive in their families and communities; promote accessible and welcoming health care for all; improve maternal health outcomes for rural, racial, and ethnic minority communities; prioritize the behavioral health of underserved populations; and increase clinical research and trial diversity [...]

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 [...]

Federal Health Policy Update for February 1

The following is the latest health policy news from the federal government for January 26 – February 1.  Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has released its calendar year (CY) 2025 Advance Notice for the Medicare Advantage and Medicare Part D Prescription Drug Programs that would update payment and other policies for these programs.  Under the notice, federal Medicare Advantage spending would increase an expected 3.7 percent, or more than $16 billion, but the agency also proposes reducing by 0.16 percent the program’s base rate.  CMS also detailed [...]

Federal Health Policy Update for January 25

The following is the latest health policy news from the federal government for January 12 - 25.  Some of the language used below is taken directly from government documents. Department of Health and Human Services – Funding Models HHS has announced a new model to test approaches for addressing the behavioral and physical health and health-related social needs of people with Medicaid and Medicare.  The goal of the Innovation in Behavioral Health Model (IBH) is to improve the overall quality of care and outcomes for adults with mental health conditions and/or substance use disorders by connecting them with the physical, behavioral, [...]

Federal Health Policy Update for January 18

The following is the latest health policy news from the federal government for January 12-16.  Some of the language used below is taken directly from government documents. Congress Medicaid DSH With a partial government shutdown looming on Friday, January 19, congressional leaders have agreed to extend the current stopgap legislation temporarily funding the federal government.  Under this agreement, the four spending bills scheduled to expire this Friday would be extended until March 1 and the eight bills set to expire on February 2 would be extended until March 8.  The appropriations bill that funds health and human services is included [...]

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 January 11

The following is the latest health policy news from the federal government for January 5 - 11.  Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS will establish 200 new Medicare-funded residency slots in FY 2025.  Learn more about the additional slots here and find information about how to apply for those slots here.  The deadline for applications is March 31. CMS released guidance for Medicare Part D plans that describes coverage and processing claims for COVID-19 therapeutics.  Medicare Part D plans must cover commercially available oral antivirals for COVID-19 [...]

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