Policy Updates

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|

Looking Ahead to Lame Duck

When the dust clears after next week’s presidential election, Congress will return to Washington with numerous unfinished matters on its agenda – including many with implications for health care organizations. They include: Federal government funding, authorization for which expires on December 20. Medicare payments to physicians, which many in Congress want to increase if, as proposed, the Centers for Medicare & Medicaid Services reduces those payments for 2025. A potential temporary extension of the continued use of telehealth to prescribe Schedule 2 drugs such as Adderall. Payment adjustments for low-volume and Medicare-dependent hospitals. Renewal of authorization for the COVID-era Acute [...]

joe2024-10-30T17:22:55-04:00October 31, 2024|COVID-19, hospitals, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare cuts, Medicare regulations, Medicare reimbursement policy, Telehealth|

Insurers Skirting Medicare Two-Midnight Rule?

Health care payers continue to classify large numbers of Medicare admissions as “observation status,” and while the recent extension of the two-midnight rule to Medicare Advantage plans has resulted in a decline in the use of observation status classifications among those plans, Medicare Advantage plans still use the observation status classification more than three times as often as traditional Medicare. According to a new study, Medicare Advantage plans used the observation rate classification for between 14.4 percent and 16.1 percent of their claims during the first half of 2024. Traditional Medicare? With a one-month exception, from 3.7 percent to 5.2 [...]

joe2024-10-30T11:41:07-04:00October 30, 2024|hospitals, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for October 24

The following is the latest health policy news from the federal government for October 18-24. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has issued new guidance outlining regulatory requirements for hospitals to report specific data on COVID-19, flu, and RSV. The new weekly electronic reporting requirements will apply to short-term acute-care hospitals, long-term-care hospitals, critical access hospitals, Indian Health Service hospitals, children’s hospitals, and cancer hospitals, with other types of hospitals – psychiatric hospitals and distinct part units and inpatient rehabilitation hospitals and distinct part units – subject [...]

joe2024-10-24T14:58:32-04:00October 24, 2024|Affordable Care Act, Centers for Medicare & Medicaid Services, COVID-19, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, post-acute care, Telehealth|

Hospital Margins Expected to Remain Low Next Year

Labor costs that outstrip increases in reimbursements will lead hospitals to continue to have low operating margins through 2025, according to Moody’s, the bond and credit rating company. While the growth of hospital labor costs is no longer as great as it was during the COVID-19 pandemic, Moody’s reports, labor costs continue to grow – as do supply costs. Meanwhile, reimbursements are not keeping pace, with government payments especially lagging. As a result of these factors, hospital margins and operating cash flow margins are down and prospects for recovery in the coming year are only modest. Learn more about how [...]

joe2024-10-23T10:59:15-04:00October 23, 2024|hospitals|

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|

Federal Health Policy Update for October 17

The following is the latest health policy news from the federal government for October 11-17. Some of the language used below is taken directly from government documents. Aftermath of Hurricanes Helene and Milton CMS has updated its waivers and flexibilities to help health care providers respond to the damage caused by Hurricane Helene in South Carolina, Tennessee, Georgia, North Carolina, and Florida and by Hurricane Milton in Florida. Find the updated waivers and flexibilities here. Please note that these waivers are not dated and therefore require individual attention by affected providers. HHS has initiated a series of steps to help restore [...]

joe2024-10-17T15:58:08-04:00October 17, 2024|Centers for Medicare & Medicaid Services, hospitals, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, post-acute care, Telehealth|

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|

HHS Acts on IV Shortage

The Department of Health and Human Services has initiated a series of steps to help restore the supply of IV solution that was greatly reduced by damage to a Baxter International Inc.’s facility in North Carolina during Hurricane Helene. Among those steps are: posting FDA guidance providing flexibility for compounding IV solution alternatives; extending the expiration dates of existing IV products; airlifting new supplies into and around the country; working with other manufacturers to increase production capacity; helping Baxter clean up and restore its North Carolina plant and invoking the Defense Production Act toward that end; and more. Learn more [...]

joe2024-10-15T17:30:39-04:00October 16, 2024|Uncategorized|

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|