Medicare alternative payment models

Federal Health Policy Update for June 13

The following is the latest health policy news from the federal government for June 7-13. Some of the language used below is taken directly from government document. Supreme Court The Supreme Court has agreed to hear a challenge to how the Department of Health and Human Services calculates hospitals’ Medicare disproportionate share (Medicare DSH) payments. The case was added to the court’s 2024-2025 schedule. Congress Individual members and key committees in Congress continue to introduce and mark up health care-related legislation with an eye toward including these initiatives in an end-of-year package. This work is expected to continue through the [...]

joe2024-06-13T20:15:06+00:00June 13, 2024|Alternative payment models, Centers for Medicare & Medicaid Services, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid regulations, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy, MedPAC, Telehealth|

MedPAC Meets

The government agency that advises Congress on Medicare payment matters met publicly in Washington, D.C. last week. During the virtual meeting, members of the Medicare Payment Advisory Commission discussed: addressing high prices of drugs covered under Medicare Part B initial findings from MedPAC's analysis of Part D data on drug rebates and discounts segmentation in the stand-alone Part D prescription drug plan market leveraging Medicare policies to address social determinants of health an approach to streamline and harmonize Medicare’s portfolio of alternative payment models aligning fee-for-service payment rates across ambulatory settings MedPAC is an independent congressional agency that advises Congress [...]

admin2022-04-12T06:00:14+00:00April 12, 2022|Alternative payment models, Medicare, MedPAC|

Changes Coming in Innovation Center Payment Models

Future Medicare payment models will probably feature less risk for participants and a greater emphasis on health equity. At least that is the vision shared by Centers for Medicare & Medicaid Services chief operating officer Jon Blum during a recent conference. While not backing away from including risk in future value-based purchasing models, CMS and the Center for Medicare and Medicaid Innovation Center will probably propose fewer full-risk models, which the agency fears favor wealthier providers that can afford to shoulder more risk to begin with, and a greater focus on reporting race and ethnicity data among future model participants [...]

admin2021-10-05T06:00:24+00:00October 5, 2021|Alternative payment models, Center for Medicare and Medicaid Innovation, CMMI|

Federal Health Policy Update for Thursday, July 22

The following is the latest health policy news from the federal government as of 2:45 p.m. on Thursday, July 22. Some of the language used below is taken directly from government documents. White House The White House has posted a transcript of the July 22 press briefing given by its COVID-19 response team and public health officials. Centers for Medicare & Medicaid Services Health Policy News CMS has published its proposed calendar year 2022 Medicare outpatient prospective payment system regulation. Among other subjects, the proposed regulation addresses hospital outpatient and ambulatory surgery center payment rates, hospital price transparency, the section 340B [...]

admin2021-07-22T17:21:47+00:00July 22, 2021|340b, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Coronavirus, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare regulations, Medicare reimbursement policy|

CMS Reconsidering Medicare Payment Models

Five Medicare alternative payment models previously slated for implementation are being delayed, cancelled, or reconsidered. The five APMs whose futures are not clear are: The Community Health Access and Rural Transformation Model ACO Track Primary Care First Kidney Care Choices Geographic Direct Contracting Part D Payment Modernization Model Learn more about the Centers for Medicare & Medicaid Services’ latest actions on these models in the Becker’s Hospital Review article “5 CMS payment models that are under review, delayed.”

admin2021-04-26T06:00:47+00:00April 26, 2021|ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy|

MedPAC Meets

The Medicare Payment Advisory Commission met in Washington, D.C. last week to discuss various Medicare payment issues. Among the issues discussed at MedPAC’s April meeting were: Medicare skilled nursing facility value-based purchased program. Medicare alternative payment models (APMs). Medicare Advantage benchmark policy. Medicare indirect medical education (Medicare IME) payments. Medicare vaccine coverage and payments. Medicare payment for prescription drugs prescribed on an outpatient basis. Private equity and Medicare. Medicare clinical laboratory fee schedule. MedPAC is an independent congressional agency that advises Congress on issues involving Medicare. While its recommendations are not binding on either Congress or the administration, MedPAC is [...]

admin2021-04-07T06:00:07+00:00April 7, 2021|Alternative payment models, Center for Medicare and Medicaid Innovation, CMMI, Medicare regulations, Medicare reimbursement policy, MedPAC|

Too Many Medicare APMs?

MedPAC thinks maybe that’s the case. At the recent meeting of the Medicare Payment Advisory Commission, the agency’s commissioners suggested that they may recommend that the Centers for Medicare & Medicaid Services reduce its assortment of alternative payment model programs. As reported by MedPage Today, a draft of MedPAC’s June report to Congress states that The [Health and Human Services] Secretary should implement a more coordinated portfolio of fewer alternative payment models (APMs) that support the strategic objectives of reducing spending and improving quality. In recent years CMS’s Center for Medicare and Medicaid Innovation has tested 54 different APMs; few [...]

admin2021-03-11T06:00:58+00:00March 11, 2021|Alternative payment models, MedPAC|

MedPAC Meets

The Medicare Payment Advisory Commission met in Washington, D.C. last week to discuss various Medicare payment issues. Among the issues discussed at MedPAC’s March meeting were: Medicare beneficiary access to care in rural areas skilled nursing facility value-based purchasing program and proposed replacement streamlining CMS’s portfolio of alternative payment models balancing efficiency with equity in Medicare Advantage benchmark policy relationship between clinician services and other Medicare services revising Medicare’s indirect medical education payments to better reflect teaching hospitals’ costs Medicare’s vaccine coverage and payment separately payable drugs in the hospital outpatient prospective payment system MedPAC is an independent congressional agency [...]

admin2021-03-10T06:00:08+00:00March 10, 2021|Medicare, MedPAC|

MedPAC Meets

The Medicare Payment Advisory Commission met in Washington, D.C. recently to discuss various Medicare payment issues. Among the issues discussed at MedPAC’s January meeting were: hospital inpatient and outpatient payments physician and health professionals payments the possible expansion of the post-acute transfer policy to hospice ambulatory surgical center, outpatient dialysis, and hospice payments Medicare payments for skilled nursing facilities, long-term hospitals, inpatient rehabilitation facilities, and home health services the Center for Medicare and Medicaid Innovation’s development and implementation of alternative payment models the future of telehealth after the COVID-19 public health emergency ends a status report on the Medicare Part [...]

admin2021-01-25T06:00:58+00:00January 25, 2021|Alternative payment models, Center for Medicare and Medicaid Innovation, CMMI, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s October agenda were: the skilled nursing facility value-based payment system future research directions in hospice payments Medicare Advantage benchmark policy indirect medical education: current Medicare policy, concerns, and principles for revising the evolution of Medicare’s advanced alternative payment models vertical integration and Medicare payment policy MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program. While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in [...]

admin2020-10-09T06:00:26+00:00October 9, 2020|Alternative payment models, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|