Policy Updates

MedPAC Offers 2021 Medicare Rate Recommendations

MedPAC has recommended to Congress changes in Medicare payment rates in the coming year. In its annual report to Congress, the Medicare Payment Advisory Commission recommended the following rate changes: acute-care hospitals – a two percent rate increase and a suggestion that the difference between this two percent increase and the payment increase specified by law be used to increase the rewards hospitals may earn under Medicare’s hospital value incentive program.  As a result, the value incentive program would offer a possible 0.8 percent in bonus payments, and with the recommended elimination of the 0.5 percent penalty for which hospitals [...]

2020-03-26T11:48:02-04:00March 26, 2020|Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy, MedPAC|
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CMS Posts COVID-19 FAQ for State Medicaid and CHIP Agencies

State Medicaid agencies and CHIP programs have received new guidance on the federal resources available to them to fight the COVID-19 national health emergency through a new FAQ published by the Centers for Medicare & Medicaid Services last week. Among the issues addressed in the FAQ are eligibility, enrollment, benefits, cost sharing, workforce issues, telehealth, and more.  Health care providers may find this information useful when serving their patients. See CMS’s news release describing the FAQ here and the FAQ itself here.

2020-03-16T06:00:32-04:00March 16, 2020|Centers for Medicare & Medicaid Services, Medicaid|
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CMS Authorizes Waiving of Some Medicare Coronavirus Fees

Medicare Advantage organizations, Medicare Part D plans, and Medicare-Medicaid managed care plans have been directed by the Centers for Medicare & Medicaid Services to waive cost-sharing for testing and treatment of the novel coronavirus. This news was transmitted to those payers in a March 10 letter from CMS. The directive also authorizes Medicare Advantage plans to waive coronavirus-related telehealth fees and authorizes Part D plans to relax refill-too-soon limits, provide maximum expended day supplies of prescription drugs, reimburse enrollees for prescription drugs obtained from out-of-network pharmacies, ease prior authorization limits on drugs prescribed to treat patients with the disease, and [...]

2020-03-12T06:00:10-04:00March 12, 2020|Medicare, Medicare reimbursement policy|
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Block Grants Could Hurt Medicaid, Study Finds

A switch to block grants to fund state Medicaid programs “…would require states to cut coverage, reduce benefits, increase cost-sharing, lower provider payment rates, or otherwise reduce Medicaid expenditures as compared to current law spending levels” according to a new Commonwealth Fund study. The study, conducted in the wake of the Trump administration’s new guidance on how states can transform their Medicaid programs into block grants and its encouragement that they do so, suggests that such efforts could result in considerable harm to Medicaid beneficiaries, providers of Medicaid-covered services, and state government finances.  Meanwhile, the federal government’s share of state [...]

2020-03-11T11:34:50-04:00March 11, 2020|Medicaid|
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MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s March agenda were: Addressing Medicare Shared Savings Program vulnerabilities The role of specialists in alternative payment models and accountable care organizations Realigning incentives in Medicare Part D Redesigning the Medicare Advantage quality bonus program Mandated report: Impact of changes in the 21st Century Cures Act to risk adjustment for Medicare Advantage enrollees Improving Medicare’s end-stage renal disease prospective payment system Separately payable drugs in the hospital outpatient prospective payment system MedPAC is an independent congressional agency that advises [...]

2020-03-09T09:40:54-04:00March 9, 2020|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|
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U.S. May Pick Up Tab for Coronavirus Care for the Uninsured

Care for the uninsured who contract the coronavirus may be paid for by the federal government under the National Disaster Medical System program. That program, activated during national disasters, pays hospitals, doctors, and other medical facilities approximately 110 percent of Medicare rates for hospital and doctor care, home health services, primary care, and rehabilitation services. The possibility of using the program for this purpose is being discussed within the Trump administration and was raised during a congressional hearing earlier this week by the Department of Health and Human Services’ assistant secretary for preparedness. Learn more about the National Disaster Medical [...]

2020-03-06T06:00:28-05:00March 6, 2020|Uncategorized|
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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 sessions. The February 2020 MACPAC meeting opened with a continuation of MACPAC’s examination of Medicaid’s role in maternal health, when Medicaid officials from Michigan, New Jersey, and North Carolina joined the Commission to discuss how their states are addressing maternal morbidity and mortality.* The Commission plans to include a chapter on maternal health in its June 2020 report to Congress. Commissioners later turned their attention to policy options for improving enrollment in the Medicare Savings Program. [...]

2020-03-06T06:00:04-05:00March 6, 2020|hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare|
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Comfort, Not Quality, Woos Patients

People are more likely to recommend a hospital based on the comfort they felt when hospitalized rather than on the quality of the care they received, a new study has found. Good food, rooms with a view, friendly nurses, peace and quiet, more television channels, and other amenities impress patients more than higher survival rates and lower hospital-acquired conditions rates. These are among the findings from an analysis of patient satisfaction data from 3000 hospitals between 2007 and 2010. Learn more about how inpatients view their hospital experiences and how those experiences shape how they rate hospitals in Oxford Academic’s [...]

2020-03-04T06:00:37-05:00March 4, 2020|hospitals|
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Number of Medicare-Dependent Hospitals Declines

The number of Medicare-dependent hospitals in the U.S. fell 28 percent between 2011 and 2017, the U.S. Government Accountability Office reports. Medicare-dependent hospitals receive additional payments from Medicare if at least 60 percent of their discharges or inpatient days are associated with Medicare patients, if they have 100 or fewer beds, and if their historic costs in one of three base years are greater than what they would have been paid through Medicare’s inpatient prospective payment system.  The Medicare-dependent program was created in 1989 to protect vulnerable small, mostly rural hospitals, and in any given year not all eligible hospitals [...]

2020-03-03T06:00:53-05:00March 3, 2020|Medicare, Medicare reimbursement policy|
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