Policy Updates

“Drivers of Health” Drive Most Health Outcomes

A recent analysis has found that newly coined “drivers of health” are the primary drivers of health outcomes. According to a Commonwealth Fund report, Research indicates that an estimated 20 percent of health outcomes are linked to medical care; the remaining 80 percent stem from socioeconomic, environmental, and behavioral factors referred to as social drivers of health (DOH). These factors – such as homelessness, food insecurity, and exposure to intimate partner violence – are associated with chronic illness, mental health issues, acute hospitalizations, and high health care costs and disproportionately impact communities of color. In its proposed 2023 Medicare physician [...]

joe2024-01-09T16:28:39-05:00January 9, 2024|Centers for Medicare & Medicaid Services, health equity, social determinants of health|

Federal Health Policy Update for January 4

The following is the latest health policy news from the federal government for December 21 to January 4. Some of the language used below is taken directly from government documents. No Surprises Act HHS, the departments of Labor and the Treasury, and the Office of Personnel Management intend to reopen the comment period for submitting comments on a proposed rule governing federal Independent Dispute Resolution (IDR) operations. They plan to publish a notice to this effect in the near future with further details on reopening the comment period. Department of Health and Human Services HHS’s Office of the National Coordinator [...]

joe2024-01-04T22:10:23-05:00January 4, 2024|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Federal Update, health equity, hospitals, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy|

Expanded Mental Health Options Coming to Medicare

Beginning on January 1, Medicare beneficiaries will have access to more varied types of mental health services. At that time, mental health counselors and marriage and family therapists will become eligible to accept Medicare payments, joining the limited number of psychiatrists, psychologists, and social workers who have been serving the Medicare population as part of the first expansion of Medicare-eligible mental health providers since 1989. With Medicare planning to pay its new provider types 75 percent of what it pays psychologists, it is not clear how many of those new providers will be interested in enrolling as eligible Medicare providers. [...]

joe2023-12-21T15:22:53-05:00December 26, 2023|Medicare, Medicare reimbursement policy|

Federal Health Policy Update for December 20

The following is the latest health policy news from the federal government December 14-20. Some of the language used below is taken directly from government documents. Congress The House is in recess until January 9. The Senate has delayed its recess to continue negotiations on a possible foreign aid and border policy deal. Democrats from the House Ways and Means Committee have published a report on the relationship between the U.S. health care system and climate change. View their report “Health Care and the Climate Crisis: Preparing America’s Health Care Infrastructure.” No Surprises Act The federal government has reopened the [...]

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C. The following is MACPAC’s own summary of the meeting. MACPAC’s December 2023 meeting opened with a session that highlighted findings related to sexual orientation and gender identity (SOGI) data collection as part of the Commission’s focus on the collection of primary language and limited English proficiency, SOGI, and disability data for the purposes of assessing and addressing health disparities. During this discussion, we reviewed the purpose of SOGI data and federal and state priorities for collecting these data, which includes an overview of [...]

joe2023-12-19T15:36:42-05:00December 19, 2023|Centers for Medicare & Medicaid Services, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicaid regulations|

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 [...]

joe2023-12-14T22:30:50-05:00December 14, 2023|340b, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, health equity, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care, Telehealth|

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 [...]

joe2023-12-12T17:52:27-05:00December 13, 2023|hospitals, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care|

Federal Health Policy Update for December 7

The following is the latest health policy news from the federal government for December 1-7. Some of the language used below is taken directly from government documents. Congress While Congress has more than a month before the next federal funding deadline of January 19, committees are working to prepare and pass health care legislation. On the House calendar for floor votes next week is H.R. 5378, the Lower Costs, More Transparency Act. This bill would eliminate the pending cuts to Medicaid DSH for two years (those cuts are temporarily suspended through January 19); introduce site-neutral payments for drug administration services [...]

joe2023-12-07T21:50:17-05:00December 7, 2023|340b, Centers for Medicare & Medicaid Services, Congress, COVID-19, health equity, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

Feds Tackles State Medicaid Redetermination Problems With Penalties

The Centers for Medicare & Medicaid Services has unveiled plans to penalize states that fail to comply with federal standards for redetermining the eligibility of individuals who enrolled in their Medicaid programs during the COVID-19 emergency. Under a new CMS regulation, states that fail to report on their Medicaid eligibility efforts and comply with current requirements face penalties that include civil penalties and reductions in the rate at which the federal government matches state Medicaid expenditures. According to a new interim final rule, CMS is implementing … reporting requirements and enforcement authorities in the Social Security Act (the Act) that [...]

joe2023-12-05T16:30:03-05:00December 6, 2023|COVID-19, Medicaid|

Medicaid Redeterminations Trigger Increase in Self-Pay Care

As states continue redetermining Medicaid eligibility for participants who were protected from disenrollment during the COVID-19 emergency, the number of patients telling providers they will pay for their own hospital, primary care, and emergency department visits has risen. The increase in self-pay has been greatest for emergency department visits, and overall, the increases occurred most often in states that began disenrolling Medicaid participants as soon as the continuous eligibility afforded by the Families First Coronavirus Response Act ended. The rise in self-pay patients suggests that many previous Medicaid participants have not obtained new health insurance since their Medicaid eligibility ended. [...]

joe2023-11-30T19:16:48-05:00December 4, 2023|COVID-19, Medicaid|