Medicare

New Part D Limits on Target to Save Billions

By mid-2024, Medicare participants with Part D prescription drug plans had already saved nearly $1 billion in prescription drug costs as a result of a provision in the Inflation Reduction Act that capped Part D enrollees’ annual drug spending. For 2024 that limit is $3500 a year, and by the end of June nearly 1.5 million people had hit that limit and faced no more prescription drug costs for the rest of the year. 500,000 people hit that limit before mid-year and were already saving money – just shy of $1 billion over the same period of time. Nine of [...]

joe2024-10-22T17:15:20-04:00October 23, 2024|Medicare|

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 5

The following is the latest health policy news from the federal government for August 31 – September 5. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has posted a bulletin outlining changes coming in the FY 2025 inpatient and long-term-care hospital prospective payment system. Find that bulletin here. The changes it presents take effect on October 1. CMS has posted a bulletin about new waived laboratory tests that outlines Clinical Laboratory Improvement Amendments (CLIA) requirements, new CLIA-waived tests approved by the FDA, and use of the modifier QW for [...]

joe2024-09-05T15:20:05-04:00September 5, 2024|Centers for Medicare & Medicaid Services, COVID-19, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for August 30

The following is the latest health policy news from the federal government for August 23-30. Some of the language used below is taken directly from government documents. 340B Johnson & Johnson, the pharmaceutical, biotechnology, and medical technologies company, told health care providers this week that it would shift from the long-time 340B upfront discount approach to a rebate model for two of its drugs and that eligible 340B hospitals and other providers will need to purchase the prescription drugs Stelara and Xarelto at list price and then, after dispensing them to patients, will need to submit 340B rebate claims to [...]

joe2024-08-30T15:03:18-04:00August 30, 2024|340b, Centers for Medicare & Medicaid Services, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid long-term services and supports, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, social determinants of health|

States Stepping Into Prior Authorization Void

While federal lawmakers continue to weigh how to address the problem of prior authorization requirements that cause delays in the delivery of health care, many state governments are acting more decisively by implementing prior authorization reforms of their own. This year, 10 states have enacted 18 laws designed to facilitate prior authorization of medical services and in 2023, nine states and the District of Columbia did so. In all, 23 states have introduced prior authorization reforms in recent years. At the same time, some health insurers have reduced the number of medical services for which they require prior authorization. The [...]

joe2024-08-28T10:39:07-04:00August 29, 2024|Medicare|

ONC Takes Next Step in Advancing Interoperability

A proposed regulation that would require health care organizations that contract with the Department of Health and Human Services to comply with standards for data exchange adopted by HHS’s Office of the National Coordinator for Health Information Technology is the latter’s latest step toward fostering greater interoperability in the use and exchange of health care data. As ONC writes, By aligning on standards that enable interoperability, HHS is ensuring that federal investments do not contribute to the proliferation of proprietary modes of exchange and data silos that inhibit access, exchange, and use of data. Promoting interoperability through HHS investments can [...]

joe2024-08-15T16:14:43-04:00August 19, 2024|Medicare, Medicare regulations|

Federal Health Policy Update for August 15

The following is the latest health policy news from the federal government for August 9-15. Some of the language used below is taken directly from government documents. Department of Health and Human Services To advance its implementation of the 2009 Health Information Technology for Economic and Clinical Health Act (HITECH Act), HHS has published a proposed regulation that would amend and update its Health and Human Services Acquisition Regulation. The proposed regulation would require health care organizations that contract with HHS to comply with standards for data exchange adopted by the Office of the National Coordinator for Health Information Technology [...]

joe2024-08-15T16:35:34-04:00August 15, 2024|Accountable Care Organization, ACO, Alternative payment models, COVID-19, health equity, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, post-acute care|