Policy Updates

Federal Health Policy Update for July 12

The following is the latest health policy news from the federal government for July 6-12. Some of the language used below is taken directly from government documents. The Courts A federal court has blocked implementation of the FTC’s rule banning non-compete clauses in most employment contracts, a regulatory development with potentially significant implications for the health care industry. The temporary ban affects only the five plaintiffs in the case and it is not yet clear whether the ruling will have broader implications in the wake of the recent reversal of the Chevron decision that could potentially curtail the rulemaking authority [...]

joe2024-07-12T18:46:49-04:00July 12, 2024|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, health equity, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for July 5

The following is the latest health policy news from the federal government for June 29-July 5. Some of the language used below is taken directly from government documents. Department of Health and Human Services Because it has found that Medicare Advantage organizations sometimes deny prior authorization requests for post-acute care after a qualifying hospital stay even though the requests met Medicare coverage rules, HHS’s Office of the Inspector General will examine selected Medicare Advantage plans’ processes for reviewing prior authorization requests for post-acute care in long-term acute-care hospitals, inpatient rehabilitation facilities, and skilled nursing facilities. It also will review the [...]

joe2024-07-05T17:44:35-04:00July 5, 2024|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare reimbursement policy, post-acute care|

The “Other” Supreme Court Decision

While much attention has focused on recent Supreme Court decisions involving reproductive care rights and presidential immunity, a less-noticed case has potential implications for the health care industry. In the case of Securities and Exchange Commission v. Jarkesy, the Supreme Court ruled last week that the SEC’s use of administrative proceedings to levy a fine against a hedge fund manager for misleading investors deprived that manager of the right to a court trial. While the immediate ruling addresses only the SEC case, the underlying rationale has implications across the federal government – including health care agencies. Currently, the Department of [...]

joe2024-07-03T16:18:15-04:00July 5, 2024|Uncategorized|

Court’s Chevron Decision to Affect Health Care

A Supreme Court decision last week could have a profound effect on the regulation of many aspects of the health care industry. The Chevron decision, issued by the court in 1984, called for courts to defer to federal agency interpretation of ambiguous statutes if they found those interpretations to be reasonable. The latest Supreme Court ruling, however, overturns that approach, calling for the courts to act independently when evaluating the appropriateness of agency interpretations and the regulations federal agencies implement in support of those interpretations. The Washington Post explains that Legal experts and health officials expect a gusher of litigation [...]

joe2024-07-02T17:26:48-04:00July 2, 2024|Medicaid, Medicaid regulations, Medicare, Medicare regulations|

Federal Health Policy Update for June 28

The following is the latest health policy news from the federal government for June 21-28. Some of the language used below is taken directly from government documents. The Courts The Supreme Court has overturned the court’s own decision in the 1984 case of Chevron U. S. A. Inc. v. Natural Resources Defense Council, Inc. that gave federal agencies considerable leeway to interpret ambiguous laws enacted by Congress. While the Chevron decision called for the courts to defer to federal agency interpretation of ambiguous statutes if they found them to be reasonable, the latest Supreme Court decision calls for the courts [...]

joe2024-06-28T20:03:06-04:00June 28, 2024|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

Little Progress So Far on Health Inequity, Report Says

The past 20 years have seen little progress in addressing health care inequity, according to a new report from the National Academies of Sciences, Engineering, and Medicine. According to the report, Despite spending the most on health care among high-income countries, the U.S. has some of the worst population health outcomes… The U.S. health care system is highly influenced by societal factors, and delivers different outcomes for different populations by its very design. The system’s inadequacies disproportionately affect minoritized populations, with stark racial and ethnic inequities in life expectancy, maternal and infant mortality, and many chronic diseases. The report goes [...]

joe2024-06-27T21:10:37-04:00June 28, 2024|health equity|

The Times Looks at PBMs

The New York Times this week began an in-depth look at pharmacy benefit managers: the companies that administer the prescription drug benefits of more than 200 million Americans. As the Times notes, only three companies dominate the market, and its report examines when, how, and if PBMs save money for insurers and consumers; how they charge for prescription drugs; how they influence consumer access to prescription drugs – and the timeliness of that access; the effect they are having on independent pharmacies; how they make money; the influence they have on the price of prescription drugs; and more. Learn more [...]

joe2024-06-25T19:58:47-04:00June 26, 2024|Uncategorized|

Federal Health Policy Update for June 20

The following is the latest health policy news from the federal government for June 14-20. Some of the language used below is taken directly from government documents. No Surprises Act HHS and the departments of Labor and the Treasury have announced a policy that offers extra time to health care providers whose desire to engage in No Surprises Act adjudication of payment disagreements with payers was affected by the Change Healthcare cybersecurity attack. Under this temporary policy, providers, facilities, and providers of air ambulance services whose ability to initiate timely No Surprises Act open negotiation for any item or service [...]

joe2024-06-20T19:22:28-04:00June 20, 2024|340b, Alternative payment models, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for June 13

The following is the latest health policy news from the federal government for June 7-13. Some of the language used below is taken directly from government document. Supreme Court The Supreme Court has agreed to hear a challenge to how the Department of Health and Human Services calculates hospitals’ Medicare disproportionate share (Medicare DSH) payments. The case was added to the court’s 2024-2025 schedule. Congress Individual members and key committees in Congress continue to introduce and mark up health care-related legislation with an eye toward including these initiatives in an end-of-year package. This work is expected to continue through the [...]

joe2024-06-13T20:15:06-04:00June 13, 2024|Alternative payment models, Centers for Medicare & Medicaid Services, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy, MedPAC, Telehealth|

Supreme Court to Review Medicare DSH Case

The Supreme Court will hear a challenge to how the federal government calculates Medicare disproportionate share hospital payments (Medicare DSH) for hospitals that serve especially large numbers of low-income patients. At the heart of the issue is the Department of Health and Human Services’ contention that patients who are enrolled in Social Security’s Supplemental Security Income program but are not receiving supplemental payments at the time of their admission to a hospital should not count toward a hospital’s percentage of low-income patients in the calculation of Medicare DSH payments. A 2022 federal appeals court decision supported HHS’s approach. Learn more [...]

joe2024-06-12T15:01:06-04:00June 12, 2024|Medicare disproportionate share, Medicare DSH|