Medicare regulations

Jury Still Out on Revised 2-Midnight Rule

A regulation that requires Medicare Advantage plans to comply with Medicare’s 2-midnight rule in the same manner as traditional Medicare as of 2024 is bringing mixed results for hospitals. Some hospitals report increased admissions – and inpatient revenue – as they admit Medicare patients previously kept under observation status. Others, though, report that with those increased admissions has come a reduction of case-mix index because these newly admitted patients are not as acutely ill as the typical hospital patient. Still others report no clear impact yet of the requirement that Medicare Advantage plans treat the 2-midnight rule the same as [...]

joe2024-08-21T12:30:42-04:00August 22, 2024|Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for July 12

The following is the latest health policy news from the federal government for July 6-12. Some of the language used below is taken directly from government documents. The Courts A federal court has blocked implementation of the FTC’s rule banning non-compete clauses in most employment contracts, a regulatory development with potentially significant implications for the health care industry. The temporary ban affects only the five plaintiffs in the case and it is not yet clear whether the ruling will have broader implications in the wake of the recent reversal of the Chevron decision that could potentially curtail the rulemaking authority [...]

joe2024-07-12T18:46:49-04:00July 12, 2024|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, health equity, hospitals, Medicaid, Medicaid regulations, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for June 28

The following is the latest health policy news from the federal government for June 21-28. Some of the language used below is taken directly from government documents. The Courts The Supreme Court has overturned the court’s own decision in the 1984 case of Chevron U. S. A. Inc. v. Natural Resources Defense Council, Inc. that gave federal agencies considerable leeway to interpret ambiguous laws enacted by Congress. While the Chevron decision called for the courts to defer to federal agency interpretation of ambiguous statutes if they found them to be reasonable, the latest Supreme Court decision calls for the courts [...]

joe2024-06-28T20:03:06-04:00June 28, 2024|Affordable Care Act, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy|

Hospitals Continue to Protest Medicare DSH Cut

The regulation has already been finalized but hospitals continue to protest Medicare’s intention to reduce their Medicare disproportionate share (Medicare DSH) uncompensated care payments. The cut, proposed at $115 million in April, when the Centers for Medicare & Medicaid Services proposed it, ended up just shy of $1 billion in the final regulation. The major change, according to CMS, comes because the agency’s actuaries have projected a lower uninsured rate than when CMS proposed the $115 million cut in the spring. Medicare DSH payments are intended to help hospitals that care for especially large numbers of uninsured patients with the [...]

iqtsupport2023-08-17T06:00:38-04:00August 17, 2023|Centers for Medicare & Medicaid Services, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy|

CMS Proposes Regulation Governing Medicare DSH

The Centers for Medicare & Medicaid Services has proposed altering its regulations governing the calculation of eligible hospitals’ Medicare disproportionate share payments (Medicare DSH). According to CMS, This proposed rule would revise our regulations on the counting of days associated with individuals eligible for certain benefits provided by section 1115 demonstrations in the Medicaid fraction of a hospital's disproportionate patient percentage. This is essentially the same change CMS included in its proposed FY 2022 and FY 2023 inpatient prospective payment system rules and then did not adopt in the final rule. In proposing this change again CMS suggests that this [...]

iqtsupport2023-03-01T06:00:58-05:00March 1, 2023|Centers for Medicare & Medicaid Services, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations|

Federal Health Policy Update for Thursday, November 4

The following is the latest health policy news from the federal government as of 2:45 p.m. on Thursday, November 4. Some of the language used below is taken directly from government documents. New Federal Vaccination Requirements CMS has unveiled its new COVID-19 vaccine requirements for health care providers that receive reimbursement from the federal government. The highlights include: CMS is requiring COVID-19 vaccination of eligible staff at health care facilities that participate in the Medicare and Medicaid programs. The staff vaccination requirement applies to the following Medicare and Medicaid-certified provider and supplier types: ambulatory surgery centers, community mental health centers, [...]

iqtsupport2021-11-04T17:17:11-04:00November 4, 2021|340b, Alternative payment models, Centers for Medicare & Medicaid Services, Congress, Coronavirus, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid upper-payment limit, Medicare post-acute care, Medicare regulations, MedPAC, Telehealth|

Federal Health Policy Update for Thursday, April 22

The following is the latest health policy news from the federal government as of 2:30 p.m. on Thursday, April 22. Department of Health and Human Services COVID-19 HHS’s Office of the Assistant Secretary for Preparedness and Response has published a new edition of its online publication The Exchange. The issue focuses on the work of hospital allied and supportive care providers during COVID-19 and is divided into three subjects: COVID-19 and acute hospital care, home care, and hospice; the role of allied health care professionals; and engineering and environmental support during COVID-19. For each subject the issue directs readers to [...]

iqtsupport2021-04-22T17:30:26-04:00April 22, 2021|Coronavirus, COVID-19, Medicare, Medicare regulations|

Feds Propose Changing Medicare DSH Calculation

Medicare DSH payments would reflect hospitals’ Medicare Advantage inpatient days under a new regulation proposed by the Centers for Medicare & Medicaid Services. Under the newly proposed rule, the formula for calculating Medicare disproportionate share payments would incorporate hospitals’ Medicare Advantage inpatient days and not just their fee-for-service inpatient days. Medicare DSH payments are made to hospitals that serve especially high proportions of low-income and uninsured patients and are intended to help them with the cost of providing those services. Go here to see the proposed regulation.

iqtsupport2020-08-07T06:00:49-04:00August 7, 2020|Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy|

Administration Reveals Regulatory Priorities for 2020

The Trump administration’s health care regulatory priorities for 2020 have been outlined by the Office of Management and Budget in a newly released “Statement of Regulatory Priorities for Fiscal Year 2020.” The statement, an annual OMB document, organizes the priorities as follows: Facilitating patient-centered markets Fixing health care financing through protecting private insurance and Medicare Fixing health care financing through reforming the individual market Fixing health care financing through making the ACA and Medicaid fiscally sustainable Bringing value to health care through price and quality transparency Bringing value to health care through patient-centered health IT Bringing value to health care [...]

iqtsupport2019-11-22T06:00:34-05:00November 22, 2019|Affordable Care Act, Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations, Medicare, Medicare regulations|

MedPAC Weighs in on Proposed Medicare Payment Changes

The Medicare Payment Advisory Commission has submitted formal comments to the Centers for Medicare & Medicaid Services in response to the latter’s publication of a proposed regulation that would govern how Medicare will pay for acute-care hospital inpatient services and long-term hospital care in the coming 2020 fiscal year. The 14-page MedPAC report addresses four aspects of the proposed Medicare payment regulation: inpatient- and outpatient drug- and device related payment proposals proposed changes in the hospital area wage index the reporting of hospitals’ uncompensated care on the Medicare cost report’s S-10 worksheet the long-term hospital prospective payment system MedPAC is [...]

iqtsupport2019-06-26T06:00:55-04:00June 26, 2019|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare regulations, MedPAC, post-acute care|