Policy Updates

MedPAC Meets

Members of the Medicare Payment Advisory Commission met publicly last week in Washington, D.C. Their agenda consisted of the following issues: Rural hospital and clinician payment policy: A workplan for 2024–2025 Assessing data sources for measuring health care utilization by Medicare Advantage enrollees: Encounter data and other sources Preliminary analysis of Medicare Advantage quality Medicare’s Acute Hospital Care at Home program Update on trends and issues in Medicare inpatient psychiatric services Go here for a brief overview of each agenda item and links to the staff presentations on those issues and here for a transcript of the two-day meeting. MedPAC [...]

joe2024-03-13T16:10:33-04:00March 14, 2024|Medicare, Medicare reimbursement policy, MedPAC|

Rural Hospitals Losing Money, Slashing Services, Mulling Future

Roughly half of rural hospitals lost money last year, according to a new report. Those struggles, moreover, are not a one-time thing: more than 40 percent were in the same position a year ago and more such hospitals are expected to be in this position a year from now. The problem is worse, moreover, for hospitals in states that did not take advantage of the Affordable Care Act option of expanding their Medicaid programs. In response to these challenges, some rural hospitals are discontinuing services like obstetrics – a serious challenge for hospitals located in isolated communities; exploring Medicare’s new [...]

joe2024-03-13T14:54:41-04:00March 13, 2024|hospitals, Medicaid, Medicare|

Federal Health Policy Update for March 7

The following is the latest health policy news from the federal government for March 1-7. Some of the language used below is taken directly from government documents. Congress On Wednesday, March 16 the House passed, by a vote of 339-85, the first package of spending bills to fund some federal agencies through the remainder of the 2024 federal fiscal year. The House bills include several health care provisions extending programs that were set to expire on Friday, March 8. The bills would extend the following provisions and programs through December 31, 2024: The continued delay of cuts to Medicaid disproportionate [...]

joe2024-03-07T21:42:53-05:00March 7, 2024|Alternative payment models, Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care|

Federal Health Policy Update for February 29

The following is the latest health policy news from the federal government for February 23-29. Some of the language used below is taken directly from government documents. Congress This afternoon the House passed H.R. 7463, which changed the dates for the March 1 and March 8 funding deadlines to March 8 and March 22 and includes no new health care policies. Health care extenders included in the current continuing resolution, including the delay to Medicaid DSH cuts, are not included in the bill that passed the House; the March 8 expiration date still applies to those extenders. The new continuing [...]

joe2024-02-29T22:41:47-05:00February 29, 2024|Centers for Medicare & Medicaid Services, COVID-19, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare reimbursement policy|

Medicaid DSH Cut In, Medicare Site-Neutral Payments Out of Health Bill?

With Congress at a stalemate on spending legislation, lawmakers are considering a narrower scope of issues to address in near-term health care legislation. According to published reports, scheduled cuts in Medicaid disproportionate share allotments to states (Medicaid DSH), already delayed several times, could be delayed once again. In addition, a proposal to require Medicare to pay for outpatient services on a site-neutral basis, rather than paying higher rates to hospital-based outpatient departments higher rates, might not be included. Also under consideration: restoring some cuts in Medicare’s payments to physicians and additional funding for community health centers. Also in jeopardy at [...]

joe2024-02-27T18:53:55-05:00February 28, 2024|Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare cuts, Medicare reimbursement policy|

New Way of Calculating Medicaid DSH

Hospitals will soon see federal regulators take a new approach to calculating their Medicaid DSH payments. Specifically, their Medicaid disproportionate share hospital-specific payment limit. A new CMS regulation changes how third-party payments are factored into the calculation of hospitals’ Medicaid disproportionate share hospital-specific payment limit. That limit, in turn, affects hospitals’ Medicaid DSH payments. This final rule implements changes CMS proposed last year to comply with a congressional mandate to include in the calculation of hospitals’ Medicaid disproportionate share hospital-specific payment limits only costs and payments for services furnished to beneficiaries for whom Medicaid is the primary payer; this means [...]

joe2024-02-23T16:37:23-05:00February 26, 2024|Centers for Medicare & Medicaid Services, Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH|

Federal Health Policy Update for February 22

The following is the latest health policy news from the federal government for February 16-22. Some of the language used below is taken directly from government documents. CMS and Medicaid DSH Payments CMS has published a final rule governing how third-party payers are factored into the calculation of hospitals’ Medicaid disproportionate share hospital-specific payment limit. This change requires that the calculation be based solely on Medicaid costs and payments and that costs and payments associated with dually eligible (Medicare and Medicaid) patients be excluded from the calculation of that limit. The effect of this change is that hospitals that are [...]

joe2024-02-22T22:00:03-05:00February 22, 2024|Alternative payment models, Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid regulations, Medicaid upper-payment limit, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

Providers Faring Well in Surprisingly Busy Dispute Resolution Process

Health care providers are winning more than three-quarters of all payment disputes being brought through an unexpectedly active federal Independent Dispute Resolution process. The process, created under the 2020 No Surprises Act to settle payment disagreements between providers and payers and to spare consumers surprise medical bills – especially for receiving emergency care from providers outside of their insurer’s network. 2023 saw 13 times more disputes during the first half of 2023 – nearly 300,000 cases in all – than federal officials anticipated. With more than 20 percent of the disputes submitted for resolution rejected as ineligible for the process, [...]

joe2024-02-20T21:23:48-05:00February 21, 2024|Uncategorized|

Proposal Would Establish New “Essential Health System” Designation

The newly proposed “Reinforcing Essential Health Systems for Communities Act” would create a new federal hospital designation that would create a mechanism for directing more federal resources to safety-net hospitals that care for more low-income and uninsured patients. The bipartisan bill, sponsored by Representatives Lori Trahan (D-MA) and David Valadao (R-CA), would, according to Rep. Trahan, … provide federal lawmakers with the avenues necessary to target funding and resources to these critical facilities – just as we’ve done with other types of hospitals that serve specific populations or regions. Hospitals would qualify for “essential health system” status by meeting one [...]

joe2024-02-20T17:02:55-05:00February 20, 2024|Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicare, Medicare reimbursement policy|

Hospitals Rally Against Medicare Site-Neutral Payments

A proposal to save Medicare nearly $4 billion over a decade is running into stiff opposition. From hospitals. – and some members of Congress. Medicare has long paid more for outpatient services provided in hospital-based outpatient departments than it has for the same services delivered in private doctors’ offices. Critics say this is unfair, that Medicare should pay the same no matter where the service is provided. Defenders of the practice maintain that hospital-based outpatient departments share higher fixed costs, including for ERs and care for uninsured patients. They also argue that reducing such Medicare outpatient payments could threaten the [...]

joe2024-02-15T13:42:15-05:00February 16, 2024|Medicare, Medicare reimbursement policy|