Medicare

Federal Health Policy Update for February 20

The following is the latest health policy news from the federal government for February 14-20. Some of the language used below is taken directly from government documents. Congress The current continuing resolution funding the federal government expires on March 14 and a number of health care extenders, including preventing cuts to Medicaid disproportionate share (Medicaid DSH), an extension of telehealth flexibilities, an extension of the Acute Hospital Care at Home program, and other rural programs will expire on March 31. It is yet unclear how Congress will meet either of those deadlines. Provisions that had been included in the bipartisan [...]

joe2025-02-20T16:09:51-05:00February 20, 2025|Affordable Care Act, Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Telehealth|

Federal Health Policy Update for February 13

The following is the latest health policy news from the federal government for February 7 - 13. Some of the language used below is taken directly from government documents. Introduction With the pause in external communication that the new administration imposed on HHS three weeks ago, including announcements, advisories, regular publications, and web site updates, there has been very little public communication from or activity involving HHS in the past week. While an HHS spokesperson explained that the moratorium has been eased and agencies are now permitted to engage in some public communication, subject to review, such activity remains very [...]

Hospitals Chart 2025 Public Policy Objectives

The hospital industry has an ambitious public policy agenda for 2025 – most of it involving defending the status quo against proposed changes. Hospitals’ advocacy in 2025 will focus on: Fighting off Medicaid cuts, work requirements, reductions in the federal Medicaid matching rate, eliminating scheduled cuts in Medicaid disproportionate share (Medicaid DSH) allotments to the states, and protecting state-directed Medicaid payments and the ability of states to raise Medicaid funding through provider taxes. Preventing a transition to site-neutral payments for Medicare-covered outpatient services. Ensuring the continuation of current section 340B prescription drug discount program practices. Preserving and even extending current [...]

joe2025-02-12T11:11:23-05:00February 13, 2025|340b, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicaid regulations, Medicare, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for November 21

The following is the latest health policy news from the federal government for November 15-21. Some of the language used below is taken directly from government documents. The Incoming Administration President Trump has nominated Robert F. Kennedy, Jr. for Secretary of Health and Human Services and Dr. Mehmet Oz for Administrator of the Centers for Medicare & Medicaid Services (CMS). Both positions require confirmation by the Senate. Senators will start the process of confirming the President-elect’s cabinet nominees when the new Congress convenes in January. Congress Funding for the federal government will expire on December 20 and it is still [...]

joe2024-11-21T15:14:52-05:00November 21, 2024|Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

MedPAC Meets

MedPAC’s commissioners held their latest public meetings on Thursday, November 7 and Friday, November 8. The subjects on the meetings’ agenda were: reforming physician fee schedule updates and improving the accuracy of payments considering the participation bonus for clinicians in advanced alternative payment models structural differences between the prescription drug plan and Medicare Advantage prescription drug plan markets assessing Medicare Advantage provider networks Medicare’s coverage limits on stays in freestanding inpatient psychiatric facilities Go here for summaries of the issues and key points and links to the presentations delivered by MedPAC staff and find a transcript of the two-day session [...]

joe2024-11-14T16:54:24-05:00November 18, 2024|Alternative payment models, hospitals, Medicare, Medicare reimbursement policy, MedPAC|

Insurers Skirting Medicare Two-Midnight Rule?

Health care payers continue to classify large numbers of Medicare admissions as “observation status,” and while the recent extension of the two-midnight rule to Medicare Advantage plans has resulted in a decline in the use of observation status classifications among those plans, Medicare Advantage plans still use the observation status classification more than three times as often as traditional Medicare. According to a new study, Medicare Advantage plans used the observation rate classification for between 14.4 percent and 16.1 percent of their claims during the first half of 2024. Traditional Medicare? With a one-month exception, from 3.7 percent to 5.2 [...]

joe2024-10-30T11:41:07-04:00October 30, 2024|hospitals, Medicare, Medicare reimbursement policy|

CMS Tinkers With ACO REACH Model

Medicare’s ACO REACH Model will undergo some changes when it heads into its 2025 performance year. To help ensure that the program controls costs and saves money, the Centers for Medicare & Medicaid Services will implement a series of changes in its voluntary Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. According to the agency, it is: adjusting the financial methodology to improve model sustainability based on the findings in the PY [performance year] 2022 Evaluation Report; responding to feedback from interested parties on improvements to the accuracy of benchmarks; and strengthening operational flexibility and [...]

joe2024-08-13T15:57:16-04:00August 14, 2024|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicare, Medicare reimbursement policy|

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|

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|

MedPAC to Talk Telemedicine, Doc Payments, 340B, More

Members of the Medicare Payment Advisory Commission will meet publicly on Thursday, April 11 and Friday, April 12. Medicare reimbursement subjects on the two-day session’s agenda include: telehealth inpatient rehabilitation hospital payments the physician fee schedule Medicare Advantage Part D generic drug pricing Part B rate and 340B ceilings Go here for a more detailed look at the MedPAC agenda and for information about how to participate in the meeting.

joe2024-04-09T17:14:42-04:00April 9, 2024|340b, Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC, Telehealth|