Medicare Advantage

Study Finds Differences in Medicare Advantage Hospitalization Trends

Patients who participate in Medicare Advantage plans spend more time as hospital inpatients but receive less post-acute care than those in traditional Medicare, a new study has found. According to NORC, a non-partisan research organization at the University of Chicago, Medicare Advantage patients had hospital stays that were 40% longer on average than those with Traditional Medicare, which comes to seven days versus five. In 2022, Medicare Advantage plans discharged fewer patients to post-acute care settings such as skilled nursing or home health compared to patients covered by Traditional Medicare. According to NORC, “These disparities suggest that Medicare Advantage beneficiaries [...]

joe2025-06-24T16:21:34-04:00June 25, 2025|Medicare, Medicare post-acute care|

Federal Health Policy Update for June 12

The following is the latest health policy news from the federal government for June 6-12. Some of the language used below is taken directly from government documents. Congress Republican senators continue to work on their version of a reconciliation bill with a goal of passage by July 4, although that deadline may slip. Some Senate committees have begun releasing their portions of the bill but the Finance Committee’s bill, with its tax and Medicaid provisions, has not yet been released. Among the majority party in the Senate, fault lines around the House-passed reconciliation bill remain around Medicaid provider taxes, state [...]

joe2025-06-12T16:32:26-04:00June 12, 2025|Centers for Medicare & Medicaid Services, hospitals, MACPAC, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, Telehealth|

Federal Health Policy Update for May 22

The following is the latest health policy news from the federal government for May 16-22. Some of the language used below is taken directly from government documents. Congress: Reconciliation Early Thursday morning the House of Representatives passed its version of an FY 2025 budget reconciliation bill by a vote of 215-214. The bill underwent a number of changes during the hours before its passage and its health care provisions now include $800 billion in Medicaid cuts over the next ten years. The Congressional Budget Office projects that the bill, mostly because of the Medicaid cuts, will lead to 8.6 million [...]

joe2025-05-23T10:22:33-04:00May 23, 2025|340b, Affordable Care Act, Centers for Medicare & Medicaid Services, COVID-19, deficit reduction, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid managed care, Medicaid regulations, Medicare, Medicare reimbursement policy|

Federal Health Policy Update for April 10

The following is the latest health policy news from the federal government for April 4-10. Some of the language used below is taken directly from government documents. Congress The House today passed the budget resolution passed by the Senate last week. Passage of the same budget resolution by both chambers now enables Congress to begin work on a reconciliation bill to enact President Trump’s priorities on tax cuts, border security, and energy policies. Until this morning, more than a dozen Republican House members had opposed the Senate-passed budget resolution because they believed the Senate’s budget did not require enough spending [...]

joe2025-04-10T16:05:02-04:00April 10, 2025|Centers for Medicare & Medicaid Services, hospitals, Medicaid, Medicaid managed care, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy|

MedPAC Meets

MedPAC’s commissioners held their latest public meetings on Thursday, January 13 and Friday, January 14. The subjects on the meetings’ agenda were: assessing payment adequacy and updating payments: physician and other health professional services assessing payment adequacy and updating payments: hospital inpatient and outpatient services assessing payment adequacy and updating payments: skilled nursing facility services; home health agency services; inpatient rehabilitation facility services; outpatient dialysis services; and hospice services eliminating Medicare’s coverage limits on stays in freestanding inpatient psychiatric facilities Medicare prescription drug program (Part D): status report ambulatory surgical center services: status report the Medicare Advantage program: status report [...]

joe2025-01-21T17:23:04-05:00January 22, 2025|Centers for Medicare & Medicaid Services, Federal Update, hospitals, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for January 16

The following is the latest health policy news from the federal government for January 11-17. Some of the language used below is taken directly from government documents. Congress House Budget Committee Republican members of the House Budget Committee have circulated a list of possible policy changes that would reduce federal spending by between $5.3 trillion and $5.7 trillion over a period of ten years. Up to $3.4 trillion of those possible cuts could include reductions in federal health care spending. The health care cuts the document lists (all figures are ten-year reductions) are: Medicare introducing Medicare site-neutral outpatient payments - [...]

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. The MACPAC December 2024 meeting began with a discussion on accountability in Medicaid managed care, which is the predominant delivery system in Medicaid. MACPAC will examine the tools the Centers for Medicare & Medicaid Services (CMS) and state Medicaid agencies use to manage managed care organizations’ (MCOs) performance and hold plans accountable to contractual obligations. Staff presented findings from MACPAC’s review of federal policy and a 40-state review of accountability tools as described in [...]

joe2024-12-17T15:23:53-05:00December 18, 2024|Centers for Medicare & Medicaid Services, Congress, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations|

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|

Federal Health Policy Update for November 14

The following is the latest health policy news from the federal government for November 8-14. Some of the language used below is taken directly from government documents. Election Update House of Representatives Though the outcome of nine races for seats in the House remains undecided, Republicans have won enough seats to control the House in the new Congress. Yesterday, Republicans voted to nominate the current Speaker of the House, Mike Johnson (LA), for Speaker in the new Congress and will hold the vote for that position when the 119th Congress convenes in Washington, D.C. on January 3. It is expected, after [...]

joe2024-11-14T15:18:02-05:00November 14, 2024|ACO, Alternative payment models, Centers for Medicare & Medicaid Services, CMMI, COVID-19, health equity, hospitals, Medicaid, Medicaid DSH, Medicaid DSH allotments, Medicare reimbursement policy, MedPAC, Telehealth|

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|