post-acute care

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 [...]

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 December 14

The following is the latest health policy news from the federal government for December 8-14.  Some of the language used below is taken directly from government documents. MedPAC Rate Recommendations At their latest public meeting, members of the Medicare Payment Advisory Commission voted preliminary approval of the following rate updates for 2025 Medicare payments: Inpatient and outpatient services –update provided for in current law plus 1.5% and adoption of a safety-net index policy to pay safety-net hospitals another $4 billion. Physicians and other health professionals –update of 50% of the Medicare economic index and a new add-on payment for services [...]

MedPAC Meets, Makes 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 provisionally endorses 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 provided [...]

MedPAC Meets

The commissioners of the Medicare Payment Advisory Commission recently met virtually.  The subjects on the agenda of their two-day meeting were: rural emergency hospitals dual-eligible special needs plans MedPAC’s work plan for hospice issues Medicare coverage of and payment for software as a medical service favorable selection in Medicare Advantage network management and prior authorization and their impact on access in Medicare Advantage MedPAC is an independent congressional agency that advises Congress on issues involving Medicare.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find [...]

MedPAC Meets

The members of the Medicare Payment Advisory Commission held their latest public meeting last week. The issues addressed during the meeting were: Current legal updates to Medicare’s payment rates for clinician services. Staffing ratios and turnover rates in nursing facilities. An alternative method to establish Medicare payments for selected conditions treated in inpatient rehabilitation facilities. A staff work plan for examining prices of generic drugs under Part D For an overview of each of these issues and links to the presentations made by MedPAC’s staff during the discussions, go here.

Supply of Nursing Home Beds Declining

The number of nursing home beds in the U.S. is fast declining, according to a new analysis commissioned by the American Health Care Association, a nursing home trade group. According to the study, 21 percent of nursing home operators have downsized – dropped beds or units. 55 percent have turned away people seeking nursing home beds. 48 percent have waiting lists. 579 facilities have closed since 2020, and along with them, the supply of nursing home beds fell by more than 45,000. Nursing home operators cite a number of reasons for the decline, including current reimbursement practices – especially for [...]

2023-08-28T06:00:39+00:00August 28, 2023|hospitals, Medicaid, post-acute care|

Federal Health Policy Update for April 20

The following is the latest health policy news from the federal government for April 8 – 20.  Some of the language used below is taken directly from government documents. The White House The Biden administration has announced a plan to expand health coverage for Deferred Action for Childhood Arrivals (DACA) individuals.  To this end, it announced that HHS will soon propose a rule amending the definition of “lawful presence,” for purposes of Medicaid and Affordable Care Act coverage, to include DACA recipients.  If finalized, the rule would make DACA individuals eligible for these programs for the first time.  Under the proposed rule, [...]

MedPAC Meets

The government agency that advises Congress on Medicare payment matters met publicly in Washington, D.C. last week. During the virtual meeting, members of the Medicare Payment Advisory Commission discussed: reforming Medicare’s wage index system addressing the high prices of drugs covered under Medicare Part B a prototype design for a post-acute care prospective payment system favorable selection and future directions for Medicare Advantage payment policy aligning fee-for-service payment rates across ambulatory care settings MedPAC is an independent congressional agency that advises Congress on issues involving Medicare.  While its recommendations are not binding on either Congress or the administration, MedPAC is [...]

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