Policy Updates

Federal Health Policy Update for May 23

The following is the latest health policy news from the federal government for May 18-23. Some of the language used below is taken directly from government documents. Congress Leaders of the Senate Finance Committee have released a white paper outlining potential reforms of how Medicare pays physicians and how Medicare might better meet the needs of those with chronic illnesses. The white paper notes areas of interest the committee sees as opportunities for reform, including: Creating sustainable payment updates to ensure clinicians can own and operate their practices. Creating incentives for alternative payment models that reward providing better care at [...]

joe2024-05-23T18:28:33-04:00May 23, 2024|340b, Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC, Telehealth|

Federal Health Policy Update for May 17

The following is the latest health policy news from the federal government for May 10-17. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has announced a further extension of deadlines for fulfilling certain Medicaid unwinding requirements. Some current deadlines will be extended to December 31, 2024 and others through June 30, 2025. States also may seek to extend selected COVID-19-related flexibilities through June 30, 2025. Among the deadlines affected by this announcement are those for using ex parte information to determine eligibility; permitting Medicaid managed care organizations to help [...]

joe2024-05-17T20:18:34-04:00May 17, 2024|Centers for Medicare & Medicaid Services, health equity, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, social determinants of health|

Medicaid Unwinding Extended

The federal government is giving states more time to complete their Medicaid unwinding process – and people still on the Medicaid rolls more time to apply to retain their Medicaid eligibility. In a memo to state Medicaid programs, the Centers for Medicare & Medicaid Services wrote that To continue supporting states’ efforts to establish and update income and eligibility determination systems that maximize states’ ability to ensure that eligible individuals retain coverage, CMS is further extending these unwinding-related…waivers through June 30, 2025. When the Families First Coronavirus Response Act’s prohibition against removing people from state Medicaid rolls ended with the [...]

joe2024-05-15T17:07:11-04:00May 15, 2024|COVID-19, Medicaid|

Federal Health Policy Update for May 9

The following is the latest health policy news from the federal government for May 3-9. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services HHS and CMS have announced the Increasing Organ Transplant Access Model, which seeks to increase access to kidney transplants for people living with end-stage renal disease (ESRD), improve the quality of care for people seeking kidney transplants, reduce disparities among individuals undergoing the process of receiving a kidney transplant, and increase the efficiency and capability of transplant hospitals selected to participate. Hospitals eligible to be selected for [...]

joe2024-05-09T20:32:32-04:00May 9, 2024|Affordable Care Act, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, health equity, hospitals, Medicaid, Medicare, social determinants of health|

Hospitals Looking for More Skilled Nursing Options

After years of divesting skilled nursing facilities, hospitals are responding to the growing challenge of finding skilled nursing beds into which to discharge their patients by looking to get back into the skilled nursing business. Sort of. In general, acute-care hospitals are no longer interested in owning nursing homes but they are interested in securing access to the skilled nursing beds they need for their patients through bed reservation contracts, management and lease agreements, sharing their clinicians with nursing facilities, and more while also expanding their hospital at-home programs because they see their average length of stay increasing not because [...]

joe2024-05-08T15:49:28-04:00May 9, 2024|hospitals, post-acute care|

Study Finds Disparities in Medicare Advantage

The quality of care Medicare Advantage participants receive varies based on their race, gender, and ethnicity according to a new report from the Centers for Medicare & Medicaid Services’ Office of Minority Health. The report, based on data from Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys and the Healthcare Effectiveness Data and Information Set (HEDIS), presents the following findings: Some disparities exist between patient experiences; most groups—except for Asian American and Native Hawaiian or other Pacific Islander (AA and NHPI) MA enrollees—showed disparities in 1 or 2 of 7 total measures. Scores for AA and NHPI MA [...]

joe2024-05-07T20:10:26-04:00May 8, 2024|health equity, Medicare|

Federal Health Policy Update for May 2

The following is the latest health policy news from the federal government for April 26 – May 2. Some of the language used below is taken directly from government documents. No Surprises Act – Independent Dispute Resolution Process CMS has announced a new process for resubmitting Independent Dispute Resolution (IDR) disputes that were originally improperly batched or bundled.This new resubmission process is automated in the federal IDR portal and seeks to streamline federal IDR operations. For further information about this new process and an implementation timetable, see this CMS announcement. CMS also has posted a user guide for the IDR [...]

joe2024-05-02T19:49:55-04:00May 2, 2024|Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for April 25

The following is the latest health policy news from the federal government for April 9-25. Some of the language used below is taken directly from government documents. Updated 340B Arbitration Process Last week HHS’s Health Resources and Services Administration (HRSA) published a regulation modifying the administrative dispute resolution (ADR) process it uses to adjudicate payment disputes between 340B-eligible providers and pharmaceutical companies. The major changes in the ADR process include the use of HRSA experts to serve on ADR panels; elimination of the $25,000 damage threshold for filing a claim; 340B-eligible providers may now challenge manufacturers that seek to prevent [...]

joe2024-04-25T20:25:44-04:00April 25, 2024|340b, Accountable Care Organization, ACO, Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid long-term services and supports, Medicaid managed care, Medicaid regulations, Medicaid regulations for long-term care, Medicaid regulations for the disabled, Medicare, Medicare post-acute care, Medicare regulations, post-acute care|

Racial, Ethnic Health Care Disparities Remain Widespread

Racial and ethnic health disparities are pervasive across all states, according to a new report from the Commonwealth Fund. According to “The Commonwealth Fund 2024 State Health Disparities Report,” Racial and ethnic disparities are pervasive across all states. Death rates and prevalence of health problems vary significantly by race and ethnicity in every state. Racial and ethnic health disparities are perpetuated by less insurance coverage and unequal access to high-quality care. Lack of comprehensive insurance coverage is a key contributor to disparities in access. Being uninsured or underinsured has consequences. Racial and ethnic disparities in care quality are driven by [...]

joe2024-04-18T20:47:43-04:00April 23, 2024|health equity|

Self-Employed Docs Increasingly Uncommon

The number of self-employed and independent practice physicians has fallen from three out of every four in 2012 to just one out of four today, according to a new study. The drastic change in just a dozen years is the result of hospitals and corporate entities purchasing physician practices. Hospital and corporate ownership are now greatest in the south and currently growing fastest in the northeast. For the first time, moreover, corporate ownership has surpassed hospitals as the largest owners of physician practices. Learn more about the changing nature of medical practice from the Fierce Healthcare article “Nearly 80% of [...]

joe2024-04-18T19:59:04-04:00April 22, 2024|hospitals|