Center for Medicare and Medicaid Innovation

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+00:00July 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|

Federal Health Policy Update for February 1

The following is the latest health policy news from the federal government for January 26 – February 1. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has released its calendar year (CY) 2025 Advance Notice for the Medicare Advantage and Medicare Part D Prescription Drug Programs that would update payment and other policies for these programs. Under the notice, federal Medicare Advantage spending would increase an expected 3.7 percent, or more than $16 billion, but the agency also proposes reducing by 0.16 percent the program’s base rate. CMS also detailed [...]

joe2024-02-01T21:47:38+00:00February 1, 2024|Accountable Care Organization, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, Federal Update, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for November 16

The following is the latest health policy news from the federal government for November 10-16. Some of the language used below is taken directly from government documents. Congress This week Congress passed another continuing resolution (CR) to fund the federal government beyond Friday, when the current CR expires. This bill establishes two separate deadlines for lawmakers to pass certain spending bills so they can avoid an omnibus bill that includes all 12 appropriations bills. Congress must pass four of the spending bills by January 19 and the other bills by February 2. The Labor, HHS, and Education bill, one of [...]

Inadequate Data Hinders Federal Approach to Health Equity

Federal efforts to develop and improve payment models and other programs designed to foster health equity are often hamstrung by poor data: inconsistent data requests from program to program and flawed and incomplete data reporting by those participating in those programs. As a result, federal policymakers often are unable to tell whether programs – both those developed specifically to address health equity and those that are not – are having the desired effect on health equity. The result, according to a new study from the Centers for Medicare & Medicaid Services’ Center for Medicare and Medicaid Innovation, is that 1) [...]

admin2023-07-19T10:50:34+00:00July 19, 2023|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, health equity|

Federal Health Policy Update for July 13

The following is the latest health policy news from the federal government for June 30 – July 13. Some of the language used below is taken directly from government documents. 340B CMS has published a proposed regulation outlining how it plans to reimburse hospitals for reductions in 340B prescription drug payments that it implemented from 2018 to 2022 but that a federal court found to be illegal. The agency calculates that it owes participating 340B providers $9 billion, which it proposes paying to those providers in single lump-sum payments. CMS also proposes offsetting these payments through reductions in future non-drug [...]

admin2023-07-13T15:50:46+00:00July 13, 2023|340b, Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for June 22

The following is the latest health policy news from the federal government for June 9-22. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has announced new flexibilities to help keep Americans insured as states resume Medicaid and Children’s Health Insurance Program (CHIP) renewals. The new flexibilities were announced in a letter sent by HHS Secretary Xavier Becerra to the nation’s governors urging them to adopt all available flexibilities to minimize avoidable coverage losses among children and families. The new flexibilities include permitting managed care plans to assist people currently [...]

admin2023-06-22T16:04:30+00:00June 22, 2023|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, COVID-19, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC, Telehealth|

Health Policy Update for June 8

The following is the latest health policy news from the federal government for May 28 – June 8. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has announced a new primary care model – the Making Care Primary Model – that will be tested by the Center for Medicare and Medicaid Innovation in eight states. The model seeks to improve care for patients by expanding and enhancing care management and care coordination, equipping primary care clinicians with tools to form partnerships with health care specialists, and leveraging community-based connections [...]

admin2023-06-08T16:41:06+00:00June 8, 2023|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for February 16

The following is the latest health policy news from the federal government for February 6-16. Some of the language used below is taken directly from government documents. No Surprises Act A federal judge in Texas has vacated parts of a regulation governing the arbitration process that is a major aspect of implementation of the No Surprises Act. In his ruling, the judge found that the arbitration process unfairly favored payers over providers, most notably by placing undue emphasis on the qualified payment amount (QPA) that is a major part of the arbitration process. The decision explains that “The Court first [...]

admin2023-02-16T17:02:31+00:00February 16, 2023|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, health equity, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations|

Federal Health Policy Update for November 10

The following is the latest health policy news from the federal government for the week of November 7 to 10. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has published a notice advising teaching hospitals that they have until November 18 to ask Medicare to reconsider their per resident amounts or resident caps as shown in the Hospital Cost Report Information System (HCRIS) associated with cost reports that, as of July 1, 2022, were not reopenable. Learn more from this CMS notice. Due to an unplanned system outage of [...]

admin2022-11-10T16:23:21+00:00November 10, 2022|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare reimbursement policy, MedPAC|

Innovation Center Updates Strategy

The Center for Medicare and Medicaid Innovation has updated its strategy for person-centered innovation. The Innovation Center’s new strategy document, “Person-Centered Innovation – An Update on the Implementation of the CMS Innovation Center’s Strategy,” outlines steps the agency hopes will foster greater coordination and cooperation between primary care providers and medical specialists through the introduction and refinement of new payment models. The new document outlines five strategic objectives: drive accountable care advance health equity support innovation address affordability partner to achieve system transformation In support of these objectives, the Innovation Center describes recent accomplishments – most them process measures rather [...]

admin2022-11-09T06:00:32+00:00November 9, 2022|Center for Medicare and Medicaid Innovation, CMMI|