GAO – DeBrunner & Associates

Federal Health Policy Update for February 6

The following is the latest health policy news from the federal government for the week of January 23 to February 6. Some of the language used below is taken directly from government documents. 340B Pharmaceutical companies may restrict the ability of providers to use specialty and community pharmacies to distribute 340B-covered drugs, a federal appeals court has decided. See the court’s ruling here. Centers for Medicare & Medicaid Services CMS has revised its fact sheets about COVID-19 public health emergency waivers and flexibilities for different types of providers, updating which waivers and flexibilities have already been terminated, which have been [...]

admin2023-02-06T17:03:31+00:00February 6, 2023|340b, Centers for Medicare & Medicaid Services, COVID-19, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for October 27

The following is the latest health policy news from the federal government for the week of October 21 to October 27. Some of the language used below is taken directly from government documents. 340B Responding to a federal court ruling that the federal government has shortchanged hospitals in its payments for 340B-covered prescription drugs, CMS has announced how it will compensate hospitals for its underpayments – at least for the 2023 fiscal year. According to CMS, it “…will apply the default rate (generally ASP plus 6%) to 340B-acquired drugs for the rest of the year. CMS also will reprocess claims [...]

admin2022-10-27T17:06:24+00:00October 27, 2022|340b, Center for Medicare and Medicaid Innovation, CMMI, COVID-19, Medicaid, Medicaid regulations for long-term care, Medicare, Medicare reimbursement policy, MedPAC, post-acute care|

FEDERAL HEALTH POLICY UPDATE FOR OCTOBER 20

The following is the latest health policy news from the federal government for the week of October 14 to October 20. Some of the language used below is taken directly from government documents. White House President Biden has signed an executive order on lowering prescription drug costs. The order directs HHS to consider additional actions to further drive down prescription drug costs, encourages it to pursue such actions through its Center for Medicare and Medicaid Innovation (CMMI), and directs HHS to submit a formal report within 90 days outlining any plans to use CMMI’s authority to lower drug costs and [...]

admin2022-10-20T17:01:23+00:00October 20, 2022|Centers for Medicare & Medicaid Services, CMMI, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid and housing, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for Thursday, April 21

The following is the latest health policy news from the federal government as of 2:45 p.m. on Thursday, April 21. Some of the language used below is taken directly from government documents. Proposed FY 2023 Medicare Inpatient Prospective Payment System Regulation CMS has published its proposed FY 2023 Medicare inpatient prospective payment system regulation outlining how it envisions paying hospitals for the inpatient care they provide to Medicare patients in the coming fiscal year. Highlights of the proposed regulation include: A proposed 3.2 percent increase in inpatient rates and a 0.7 percent increase in LTCH rates. A $654 million cut [...]

admin2022-04-21T17:30:19+00:00April 21, 2022|Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for Thursday, March 10

The following is the latest health policy news from the federal government as of 2:30 p.m. on Thursday, March 10. Some of the language used below is taken directly from government documents. White House The White House has posted a transcript of the March 2 press briefing given by its COVID-19 response team to outline the administration’s National COVID-19 Preparedness Plan. 340B Eligibility Protection and Telehealth Extensions in the Omnibus Spending Bill Providers that feared they might lose their eligibility to continue participating in the 340B prescription drug discount program because they have fallen below that program’s Medicare disproportionate share [...]

admin2022-03-10T17:37:25+00:00March 10, 2022|Centers for Medicare & Medicaid Services, Congress, Coronavirus, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid managed care, Medicare, Medicare disproportionate share, Medicare DSH, Medicare reimbursement policy, MedPAC, Telehealth|

Federal Health Policy Update for Friday, November 19

The following is the latest health policy news from the federal government as of 2:45 p.m. on Friday, November 19. Some of the language used below is taken directly from government documents. Congress On Friday the House passed a $1.7 trillion social spending bill, H.R. 5376 - Build Back Better Act, with no Republican votes and all but one Democratic vote. The Congressional Budget Office score indicates that the health care policies in the bill are paid for by cuts in other health care programs. The bill includes nearly $300 billion in health care provisions, including: $57 billion to provide [...]

admin2021-11-19T17:30:27+00:00November 19, 2021|Centers for Medicare & Medicaid Services, Congress, Coronavirus, COVID-19, Medicare reimbursement policy|

Federal Health Policy Update for Monday, June 28

The following is the latest health policy news from the federal government as of 2:30 p.m. on Monday, June 28. Some of the language used below is taken directly from government documents. Supreme Court Decision in Affordable Care Act Case The Supreme Court has declined to hear an appeal of a case in which insurers unsuccessfully sued to recover reductions in their Affordable Care Act federal cost-sharing reduction payments. White House The White House has posted a transcript of the June 22 press briefing given by its COVID-19 response team and public health officials. Department of Health and Human Services [...]

admin2021-06-28T17:33:25+00:00June 28, 2021|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Coronavirus, COVID-19, MACPAC, Medicaid, Medicaid managed care, Medicare, MedPAC|

Federal Health Policy Update for Wednesday, May 19

The following is the latest health policy news from the federal government as of 2:15 p.m. on Wednesday, May 19. Some of the language used below is taken directly from government documents. NASH Advocacy NASH has written to all members of Congress urging them to contact Health and Human Services Secretary Xavier Becerra about directing more of its remaining CARES Act Provider Relief Fund money to private safety-net hospitals to help them serve their diverse, predominantly low-income communities during the COVID-19 emergency. Go here to see NASH’s message to Congress. The White House COVID-19 The White House has posted a [...]

admin2021-05-19T18:01:19+00:00May 19, 2021|Centers for Medicare & Medicaid Services, Congress, Coronavirus, hospitals, Medicare, Medicare reimbursement policy, MedPAC, Telehealth|

Medicaid Waiver Process Often Lacks Transparency, GAO Finds

States’ applications for federal Medicaid waivers often lack transparency, according to a new report by the U.S. Government Accountability Office. According to the GAO, the chief problem with the transparency of state applications for Medicaid waivers arises when states either seek to amend waivers they have already obtained or amend waiver applications currently under review by the Centers for Medicare & Medicaid Services. Too often, the GAO found, states neither subject such amendments to public review and comment nor adequately explain to stakeholders the implications of the amendments they are proposing. To address this problem, the GAO recommends that CMS [...]

admin2019-05-23T09:52:40+00:00May 23, 2019|Medicaid|

Hospitals Flee Downside Risk in Medicare Bundled Programs

More than half of the hospitals that voluntary participate in Medicare bundled payment model programs leave those programs when faced with the possibility of financial penalties based on their performance. So concludes a new report by the U.S. Government Accountability Office. Some of these models feature both “upside” and “downside” risk. Upside risk offers financial incentives to participants that keep their costs below targeted amounts; they share those savings with Medicare. Downside risk occurs when hospitals are penalized when their costs exceed agreed-upon targets. Some of the model programs begin with only upside risk and later move into both upside [...]

admin2019-01-29T06:00:06+00:00January 29, 2019|Alternative payment models, hospitals, Medicare|