Policy Updates

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|

Federal Health Policy Update for November 30

The following is the latest health policy news from the federal government for November 17-30. Some of the language used below is taken directly from government documents. No Surprises Act CMS has released two new FAQs to provide guidance in advance of the Independent Dispute Resolution portal reopening for batched disputes and air ambulance disputes; that service remains temporarily suspended. These FAQs together explain how certified IDR entities may determine whether a dispute is appropriately batched in light of recent court rulings; provide information about policy for extending existing IDR deadlines once the federal IDR portal reopens to all batched [...]

joe2023-11-30T20:59:02-05:00November 30, 2023|Centers for Medicare & Medicaid Services, COVID-19, Federal Update, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for November 16

The following is the latest health policy news from the federal government for November 10-16. Some of the language used below is taken directly from government documents. Congress This week Congress passed another continuing resolution (CR) to fund the federal government beyond Friday, when the current CR expires. This bill establishes two separate deadlines for lawmakers to pass certain spending bills so they can avoid an omnibus bill that includes all 12 appropriations bills. Congress must pass four of the spending bills by January 19 and the other bills by February 2. The Labor, HHS, and Education bill, one of [...]

Senate Looks at Telehealth in Medicare

The Senate Finance Committee held a hearing this week on “Ensuring Medicare Beneficiary Access: A Path to Telehealth Permanency.” Go here for a video of the hearing and here for links to the testimony submitted to the committee.

iqtsupport2023-11-16T06:00:47-05:00November 16, 2023|Medicare, Telehealth|

Bill Would Halt Medicaid DSH Cuts, Bring Other Changes

A wide-ranging bill passed by the Senate Finance Committee would eliminate $16 billion in Medicaid disproportionate share (Medicaid DSH) payments over the next two years. The Better Mental Health Care, Lower-Cost Drugs, and Extenders Act, passed by the committee with unanimous, bipartisan support, also seeks to improve access to mental health care for Medicare patients living in rural and underserved areas; improve access to behavioral health services via telehealth for Medicaid and CHIP beneficiaries; reduce some of the recently adopted cuts in Medicare payments to physicians that will take effect in 2024; toughen federal regulations governing pharmacy benefit managers (PBMs); [...]

iqtsupport2023-11-15T13:00:58-05:00November 15, 2023|Congress, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicare reimbursement policy, Telehealth|

“Hospital at Home” Appears to be Working Well

The federal Acute Hospital Care at Home program introduced during the COVID-19 crisis appears to be working well, according to a new study. The program, intended to free hospital beds at the height of the COVID pandemic while protecting non-COVID patients from exposure to the virus, enabled hospitals meeting certain Centers for Medicare & Medicaid Services criteria to care for Medicare fee-for-service and non-managed care Medicaid patients in the home. Participating patients were chosen according to CMS-approved safety criteria built around an assessment of the acuity of their medical conditions and whether they might reasonably be treated at home. An [...]

iqtsupport2023-11-15T06:00:50-05:00November 15, 2023|hospitals, Medicare|