Medicaid and prior authorization

MACPAC Meets

Members of the Medicaid and CHIP Payment and Access Commission met publicly last week in Washington, D.C. The following is MACPAC’s own summary of its meeting. During MACPAC’s February 2025 meeting, staff presented four draft policy recommendations to address challenges related to transitions from pediatric to adult care for children and youth with special health care needs (CYSHCN). The draft recommendations reflect the Commission’s feedback from the December and January meetings. The recommendations include requiring states to develop a strategy for transitions of care for CYSHCN, which includes developing an individualized transition of care plan and making the strategy publicly [...]

joe2025-03-05T09:14:32-05:00March 5, 2025|MACPAC, Medicaid and CHIP Payment and Access Commission, Medicaid regulations|

Federal Health Policy Update for August 5

The following is the latest health policy news from the federal government for July 19 – August 5. Some of the language used below is taken directly from government documents. CMS – Medicare Payment Regulations Final FY 2025 Inpatient Prospective Payment System Regulation CMS has finalized its hospital inpatient prospective payment system rule for FY 2025. In the next fiscal year CMS will increase Medicare inpatient payments 2.9% while cutting Medicare disproportionate share hospital payments (Medicare DSH) $200 million. It also has: finalized its use of new core-based statistical area (CBSA) delineations for use in Medicare wage index calculations; established [...]

joe2024-08-06T14:25:10-04:00August 6, 2024|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, health equity, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care|

Federal Health Policy Update for January 25

The following is the latest health policy news from the federal government for January 12 - 25. Some of the language used below is taken directly from government documents. Department of Health and Human Services – Funding Models HHS has announced a new model to test approaches for addressing the behavioral and physical health and health-related social needs of people with Medicaid and Medicare. The goal of the Innovation in Behavioral Health Model (IBH) is to improve the overall quality of care and outcomes for adults with mental health conditions and/or substance use disorders by connecting them with the physical, behavioral, [...]

joe2024-01-25T22:30:26-05:00January 25, 2024|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC, social determinants of health, Telehealth|