Medicare

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 [...]

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 [...]

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 [...]

2024-10-30T11:41:07-04:00October 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 [...]

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 [...]

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 [...]

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.

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 [...]

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

CMS Clarifies Medicare Advantage Rule

To help clarify its final Medicare Advantage rule for 2024, the Centers for Medicare & Medicaid Services has published an FAQ providing additional guidance to Medicare Advantage plans and Medicare-Medicaid plans about prior authorization for admission to post-acute-care facilities and plans’ future use of artificial intelligence (AI), algorithms, and other software tools in their coverage criteria and utilization management practices. The rule has broad implications for most health care providers but especially for post-acute-care providers, which the FAQ reflects by addressing major issues and long-running challenges for such providers, including prior authorization for discharge from acute-care hospitals into post-acute care, [...]

Acute Hospital Care at Home Shows Promise

The Acute Hospital Care at Home program, launched by the Centers for Medicare & Medicaid Services during the COVID-19 pandemic to free hospital beds for COVID and other sick patients, is showing promise as an alternative to hospital care for at least some patients. In an analysis of more than 5000 Medicare patients participating in the Acute Hospital Care at Home program from mid-2022 through mid-2023, only 0.5 percent of participants passed away while being served by the program at home and only 6.2 percent required a return to a hospital for more than 24 hours. With the waiver enacted [...]

2024-01-16T14:21:27-05:00January 17, 2024|Centers for Medicare & Medicaid Services, Medicare|
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