Medicare Part D

Federal Health Policy Update for December 5

The following is the latest health policy news from the federal government for November 22 – December 5. Some of the language used below is taken directly from government documents. Congress The House has posted its session calendar for 2025. Find that calendar here. Yesterday, House Republicans made an offer to House Democrats regarding health care provisions to be included in the continuing resolution (CR) that must pass before December 20. The offer is a conversation-opener and very few details are available. Although most of the proposed policies have bipartisan support, there are some tangible policy differences, including House Democrats’ [...]

joe2024-12-05T17:14:33-05:00December 5, 2024|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, Federal Update, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, Pennsylvania Update|

New Part D Limits on Target to Save Billions

By mid-2024, Medicare participants with Part D prescription drug plans had already saved nearly $1 billion in prescription drug costs as a result of a provision in the Inflation Reduction Act that capped Part D enrollees’ annual drug spending. For 2024 that limit is $3500 a year, and by the end of June nearly 1.5 million people had hit that limit and faced no more prescription drug costs for the rest of the year. 500,000 people hit that limit before mid-year and were already saving money – just shy of $1 billion over the same period of time. Nine of [...]

joe2024-10-22T17:15:20-04:00October 23, 2024|Medicare|

Federal Health Policy Update for October 17

The following is the latest health policy news from the federal government for October 11-17. Some of the language used below is taken directly from government documents. Aftermath of Hurricanes Helene and Milton CMS has updated its waivers and flexibilities to help health care providers respond to the damage caused by Hurricane Helene in South Carolina, Tennessee, Georgia, North Carolina, and Florida and by Hurricane Milton in Florida. Find the updated waivers and flexibilities here. Please note that these waivers are not dated and therefore require individual attention by affected providers. HHS has initiated a series of steps to help restore [...]

joe2024-10-17T15:58:08-04:00October 17, 2024|Centers for Medicare & Medicaid Services, hospitals, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, post-acute care, Telehealth|

Federal Health Policy Update for June 6

The following is the latest health policy news from the federal government for May 31-June 6. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services The deadline for stakeholders to submit comments on CMS’s proposed FY 2025 Medicare inpatient prospective payment system and long-term-care hospital prospective payment system regulation is Monday, June 10. Go here for further information about the proposed rule and how to submit comments. CMS has posted a bulletin describing billing changes in the Medicare hospital outpatient prospective payment system that will take effect on July 1. Find [...]

joe2024-06-06T20:37:05-04:00June 6, 2024|Accountable Care Organization, ACO, Centers for Medicare & Medicaid Services, COVID-19, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|

MedPAC Meets

Members of the Medicare Payment Advisory Commission met publicly last week in Washington, D.C. Their agenda consisted of the following issues: telehealth in Medicare alternative approaches to lowering Medicare payments for selected conditions in inpatient rehabilitation facilities considering approaches for updating the Medicare physician fee schedule assessing consistency between plan-submitted data sources for Medicare Advantage enrollees generic drug pricing under Part D initial findings from analysis of Medicare Part B payment rates and 340B ceiling prices Go here for a brief overview of each agenda item and links to the staff presentations on those issues. MedPAC is an independent congressional [...]

joe2024-04-16T15:35:18-04:00April 16, 2024|340b, Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for April 12

The following is the latest health policy news from the federal government for April 5-11. Some of the language used below is taken directly from government documents. CMS – Proposed FY 2025 Medicare Inpatient Prospective Payment System Regulation Earlier this week CMS issued its proposed FY 2025 Medicare inpatient prospective payment system regulation – the rule under which it envisions paying acute-care hospitals, critical access hospitals, and long-term care hospitals for inpatient care in the coming fiscal year. Highlights of the proposed rule include: Rate increases of 2.6 percent for acute-care and critical access hospitals and 2.8 percent for LTCHs. [...]

Federal Health Policy Update for February 1

The following is the latest health policy news from the federal government for January 26 – February 1. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has released its calendar year (CY) 2025 Advance Notice for the Medicare Advantage and Medicare Part D Prescription Drug Programs that would update payment and other policies for these programs. Under the notice, federal Medicare Advantage spending would increase an expected 3.7 percent, or more than $16 billion, but the agency also proposes reducing by 0.16 percent the program’s base rate. CMS also detailed [...]

joe2024-02-01T21:47:38-05:00February 1, 2024|Accountable Care Organization, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, Federal Update, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

MedPAC Outlines Plans for the Coming Year

The Medicare Payment Advisory Commission has shared its agenda for its 2023-2024 public meeting cycle. According to MedPAC, it will engage in its regular work of offering recommendations to Congress on the adequacy of Medicare payments to providers and, as needed, suggest changes in those payments. In addition, it will fulfill two statutory requirements in the coming year: to evaluate Medicare Advantage special needs plans for individuals eligible for both Medicare and Medicaid and to review the new “Rural Emergency Hospital” designation. In addition, MedPAC writes that We are working on several other issues in the Medicare program as well, [...]

iqtsupport2023-10-24T16:43:49-04:00October 24, 2023|Centers for Medicare & Medicaid Services, Congress, Medicare, Medicare reimbursement policy, MedPAC, Telehealth|

Federal Health Policy Update for February 6

The following is the latest health policy news from the federal government for the week of January 23 to February 6. Some of the language used below is taken directly from government documents. 340B Pharmaceutical companies may restrict the ability of providers to use specialty and community pharmacies to distribute 340B-covered drugs, a federal appeals court has decided. See the court’s ruling here. Centers for Medicare & Medicaid Services CMS has revised its fact sheets about COVID-19 public health emergency waivers and flexibilities for different types of providers, updating which waivers and flexibilities have already been terminated, which have been [...]

iqtsupport2023-02-06T17:03:31-05:00February 6, 2023|340b, Centers for Medicare & Medicaid Services, COVID-19, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare reimbursement policy, MedPAC|

Federal Health Policy Update for December 15

The following is the latest health policy news from the federal government for the week of December 12-15. Some of the language used below is taken directly from government documents. White House The White House has unveiled its “COVID-19 Winter Preparedness Plan,” the major components of which are expanding easy access to free COVID-19 testing options in the winter; making vaccinations and treatments readily available as cases rise; preparing personnel and resources; and focusing on protecting the highest-risk Americans. Learn more about the plan from this White House fact sheet and go here for a transcript of the White House [...]