Policy Updates

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’ [...]

joe2024-12-05T17:14:33-05:00December 5, 2024|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, Federal Update, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, Pennsylvania Update|

Providers Winning Big on No Surprises Act Disputes

Health care providers are winning more than 86 percent of the emergency care payment disputes they take to adjudication through the Independent Dispute Resolution process established under the 2020 No Surprises Act. The abstract of the article “No Surprises Act independent dispute resolution outcomes for emergency services,” published by the journal Health Affairs Scholar, explains that The No Surprises Act banned surprise billing and established a final-offer arbitration system, independent dispute resolution (IDR), to resolve disagreements between health plans and providers. One factor that arbiters must consider in the IDR process is the qualifying payment amount (QPA), the median contracted [...]

joe2024-12-04T10:41:08-05:00December 5, 2024|hospitals|

Hospital Compliance With Price Transparency Rules Erodes

Hospitals’ compliance with federal price transparency regulations declined during 2024. According to the organization PatientRightsAdvocate.org, hospital compliance with the federal standard fell from 34.5 percent in February of this year to 21.1 percent in November. Under federal guidelines, hospitals are required to post payer-specific rates for their 300 most common procedures and those postings must be made in a consumer-friendly format. PatientRightsAdvocate.org reviewed the postings of 2000 hospitals and found that while all of them posted data in the appropriate format, the quality of that data varied greatly. While the objective of the requirement is to enable consumers to use [...]

joe2024-12-04T09:57:50-05:00December 4, 2024|hospitals|

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 [...]

joe2024-11-21T15:14:52-05:00November 21, 2024|Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

Medicaid Changes on the Agenda?

With a new administration 60 days from taking office and the same party to be controlling the White House, Senate, and House of Representatives, Medicaid changes are a common topic of conversation in Washington policy circles these days. One of the objectives of those conversations: reducing federal spending on Medicaid, which in federal fiscal year 2023 amounted to $860 billion. Among the means of reducing those expenditures that can be expected to be the subject of policy deliberations in the coming months are: Instituting Medicaid work requirements. Ending the supplemental federal Medicaid funding states receive for Medicaid enrollees covered under [...]

joe2024-11-19T16:26:24-05:00November 21, 2024|Affordable Care Act, Medicaid|

New Client

DeBrunner & Associates is pleased to welcome our newest client: Maxim Healthcare Services. Maxim’s team of nurses, behavioral health therapists, caregivers, and other clinicians help patients of all ages maintain their quality of life in the comfort of their homes. Maxim specializes in private duty nursing (PDN), also known as continuous skilled-nursing (CSN) home care, for medically-complex and vulnerable patients under Medicaid. Many patients require assistive technology such as ventilators and tracheostomies to sustain life. Maxim is a national provider of home health care services, serving clients in 39 states and the District of Columbia. DeBrunner will consult with Maxim [...]

joe2024-11-19T16:28:49-05:00November 20, 2024|DeBrunner & Associates, Uncategorized|

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 [...]

joe2024-11-14T16:54:24-05:00November 18, 2024|Alternative payment models, hospitals, Medicare, Medicare reimbursement policy, MedPAC|

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 [...]

joe2024-11-14T15:18:02-05:00November 14, 2024|ACO, Alternative payment models, Centers for Medicare & Medicaid Services, CMMI, COVID-19, health equity, hospitals, Medicaid, Medicaid DSH, Medicaid DSH allotments, Medicare reimbursement policy, MedPAC, Telehealth|

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 [...]

joe2024-11-07T16:26:47-05:00November 7, 2024|Centers for Medicare & Medicaid Services, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, Telehealth|

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|