Medicare Part D

Federal Health Policy Update for January 23

The Administration Public Communication The new administration has directed HHS to pause all external communications, including announcements, advisories, regular publications, and web site updates.  According to a published report, "HHS has issued a pause on mass communications and public appearances that are not directly related to emergencies or critical to preserving health," a spokesperson wrote in an email.  "This is a short pause to allow the new team to set up a process for review and prioritization.  There are exceptions for announcements that HHS divisions believe are mission critical, but they will be made on a case-by-case basis."  The directive [...]

2025-01-23T14:37:57-05:00January 23, 2025|Affordable Care Act, Centers for Medicare & Medicaid Services, Congress, COVID-19, Federal Update, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations, Medicare, Medicare bad debt reimbursement, Medicare cuts, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, Pennsylvania Update|
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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 [...]

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

2025-01-16T16:45:18-05:00January 16, 2025|Accountable Care Organization, ACO, Affordable Care Act, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, COVID-19, Federal Update, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicaid regulations, Medicare, Medicare bad debt reimbursement, Medicare cuts, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy, Pennsylvania Update, Telehealth|
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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’ [...]

2024-12-05T17:14:33-05:00December 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|
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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 [...]

2024-10-22T17:15:20-04:00October 23, 2024|Medicare|
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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 [...]

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

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

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

2024-04-12T18:35:42-04:00April 12, 2024|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, social determinants of health|
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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 [...]

2024-02-01T21:47:38-05:00February 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|
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