Medicare reimbursement policy

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 [...]

joe2024-10-31T15:10:55-04:00October 31, 2024|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations, Medicare regulations, Medicare reimbursement policy, Telehealth|

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 [...]

joe2024-10-30T17:22:55-04:00October 31, 2024|COVID-19, hospitals, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare cuts, Medicare regulations, Medicare reimbursement policy, Telehealth|

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 [...]

joe2024-10-30T11:41:07-04:00October 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 [...]

joe2024-10-24T14:58:32-04:00October 24, 2024|Affordable Care Act, Centers for Medicare & Medicaid Services, COVID-19, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, post-acute care, Telehealth|

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 [...]

joe2024-10-17T15:58:08-04:00October 17, 2024|Centers for Medicare & Medicaid Services, hospitals, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, post-acute care, Telehealth|

MedPAC Meets

MedPAC’s commissioners held their latest public meetings last week, on Thursday, October 10 and Friday, October 11. The subjects on the meetings’ agenda were: Medicare beneficiaries in nursing homes findings from MedPAC’s annual beneficiary and provider focus groups supplemental benefits in Medicare Advantage work plan for a mandated final report on the impact of recent changes to the home health prospective payment system initial estimates of home health care use among Medicare Advantage enrollees Go here for summaries, key points, actions, and the presentations offered at the meetings about each agenda item and go here for a transcript of the [...]

joe2024-10-17T09:11:39-04:00October 17, 2024|Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for October 10

The following is the latest health policy news from the federal government for October 4-10. Some of the language used below is taken directly from government documents. Hurricane-Related Notices HHS Secretary Becerra has posted a letter to health care leaders and stakeholders outlining his department's response to Hurricane Helene and the shortage of IV solutions exacerbated by that storm and how providers can modify some of their practices in response to the shortage. Learn more from Secretary Becerra’s letter, which includes links to other HHS and external resources. In addition, the FDA has established a web page that addresses specific [...]

joe2024-10-10T16:36:12-04:00October 10, 2024|Centers for Medicare & Medicaid Services, COVID-19, Medicare, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for September 26

The following is the latest health policy news from the federal government for September 20-26. Some of the language used below is taken directly from government documents. Congress Yesterday, Congress passed a continuing resolution to fund the federal government when the new federal fiscal year begins on October 1. The continuing resolution will extend funding for federal agencies at current levels through December 20 of this year. The bill did not include other significant policy provisions. President Biden will sign the bill this week and avoid a shutdown of the federal government. Find the bill text here. Following passage of [...]

joe2024-09-26T16:49:25-04:00September 26, 2024|Accountable Care Organization, ACO, Affordable Care Act, Alternative payment models, Centers for Medicare & Medicaid Services, COVID-19, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for September 19

The following is the latest health policy news from the federal government for September 13-29. Some of the language used below is taken directly from government documents. Congress Energy and Commerce Committee. Yesterday the House Energy and Commerce Committee marked up 16 bills, including several that address health care. These bills are unlikely to proceed to votes in the full House until after Congress returns following the November elections. The committee passed a bill that would extend the current telehealth waivers, scheduled to expire on December 31, for two years and would extend the Medicare Hospital at Home program, also [...]

joe2024-09-19T14:56:55-04:00September 19, 2024|340b, Centers for Medicare & Medicaid Services, COVID-19, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare disproportionate share, Medicare DSH, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for September 12

The following is the latest health policy news from the federal government for September 6-12. Some of the language used below is taken directly from government documents. 340B A federal court has declined to issue a preliminary order to block implementation of a Maryland law that requires pharmaceutical companies to provide discounts on drugs dispensed by eligible 340B providers by contract pharmacies. The challenge to the Maryland law, filed by Pharmaceutical Research and Manufacturers of America (PhRMA) and several pharmaceutical companies, will be heard without a temporary order suspending the law’s implementation. Learn more from the court order. Centers for [...]

joe2024-09-12T15:22:15-04:00September 12, 2024|340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, COVID-19, hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare regulations, Medicare reimbursement policy, MedPAC|