No Surprises Act

FEDERAL HEALTH POLICY UPDATE FOR THE WEEK OF SEPTEMBER 12-16

The following is the latest health policy news from the federal government for the week of September 12-16. Some of the language used below is taken directly from government documents. No Surprises Act The Department of Health and Human Services, the federal Office of Personnel Management, the Internal Revenue Service, the Department of the Treasury, the Department of Labor, and the Employee Benefits Security Administration have issued a request for information (RFI) seeking stakeholder comment on how to implement the No Surprises Act’s requirement that health care providers and payers give explanations of benefits and good-faith estimates of costs for [...]

iqtsupport2022-09-19T16:10:33-04:00September 19, 2022|340b, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC, Telehealth|

Federal Health Policy Update for Tuesday, August 23

The following is the latest health policy news from the federal government as of 2:45 p.m. on Tuesday, August 23. Some of the language used below is taken directly from government documents. CMS “Roadmap for the End of the COVID-19 Public Health Emergency” While the COVID-19 public health emergency (PHE) has not ended and HHS Secretary Becerra has committed to giving states and the health care community 60 days’ notice before formally ending it – notice he has not given – the federal government is already planning for life after the PHE and its latest step in this process is [...]

iqtsupport2022-08-23T17:33:16-04:00August 23, 2022|Centers for Medicare & Medicaid Services, COVID-19, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care, Telehealth|

Federal Health Policy Update for Monday, June 27

The following is the latest health policy news from the federal government as of 2:15 p.m. on Monday, June 27. Some of the language used below is taken directly from government documents. White House The White House COVID-19 response team has briefed the press about the administration’s latest efforts in the response to COVID-19. Find a transcript of that briefing here and find the slides presented during that briefing here. Supreme Court In a case that challenged a 2005 change in how CMS calculates Medicare disproportionate share (Medicare DSH) payments, the Supreme Court has, in a 5-4 decision, reversed a [...]

iqtsupport2022-06-27T16:37:45-04:00June 27, 2022|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare reimbursement policy, Telehealth|

Providers Say They Need More Time to Comply With Surprise Bill Requirement

Health care providers say they need more time to comply with the federal surprise billing law’s requirement that they supply certain patients with good-faith estimates of the potential charges they are likely to incur for medical procedures. Preparing such estimates for self-insured, uninsured, and other requesting patients is far more difficult and time-consuming than policy-makers thought it would be, provider groups insist, and they also note that there currently is no automated means of producing such estimates within the time limits imposed by the No Surprises Act, which was signed into law in late 2020. The requirement is scheduled to [...]

iqtsupport2022-06-17T06:00:48-04:00June 17, 2022|Centers for Medicare & Medicaid Services|

Federal Health Policy Update for Thursday, April 21

The following is the latest health policy news from the federal government as of 2:45 p.m. on Thursday, April 21. Some of the language used below is taken directly from government documents. Proposed FY 2023 Medicare Inpatient Prospective Payment System Regulation CMS has published its proposed FY 2023 Medicare inpatient prospective payment system regulation outlining how it envisions paying hospitals for the inpatient care they provide to Medicare patients in the coming fiscal year. Highlights of the proposed regulation include: A proposed 3.2 percent increase in inpatient rates and a 0.7 percent increase in LTCH rates. A $654 million cut [...]

iqtsupport2022-04-21T17:30:19-04:00April 21, 2022|Centers for Medicare & Medicaid Services, COVID-19, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

Surprise Bill Law’s “Good-Faith Estimate” to Challenge Providers

The requirement to give patients “good-faith estimates” of the costs associated with planned medical procedures will pose one of the biggest challenges to providers seeking to meet the implementation requirements of the 2020 No Surprises Act, which was intended to protect consumers from surprise medical bills, especially from providers not in their health insurers’ provider networks. Under the law’s implementing regulations, providers are often responsible for delivering good-faith estimates to their patients within 24 hours of scheduling a procedure. Eventually, the “convening provider” also will need to anticipate patients’ potential costs beyond the procedure itself and collect estimates for those [...]

iqtsupport2022-04-11T06:00:59-04:00April 11, 2022|hospitals|

Federal Health Policy Update for Thursday, April 7

The following is the latest health policy news from the federal government as of 2:30 p.m. on Thursday, April 7. Some of the language used below is taken directly from government documents. White House The administration is proposing to address a flaw in the Affordable Care Act often referred to as the “family glitch.” Under the ACA, people who do not have access to “affordable” health insurance through their jobs may qualify for a premium tax credit to purchase coverage on the ACA’s health insurance marketplaces. Current regulations define employer-based health insurance as “affordable” if the coverage for the employee [...]

iqtsupport2022-04-07T17:12:01-04:00April 7, 2022|Affordable Care Act, Alternative payment models, Centers for Medicare & Medicaid Services, CMMI, Coronavirus, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, Telehealth|

Federal Health Policy Update for Wednesday, March 2

The following is the latest health policy news from the federal government as of 3:00 p.m. on Wednesday, March 2. Some of the language used below is taken directly from government documents. Provider Relief Fund The Provider Relief Fund FAQ has been updated with three modified questions that address 1099 forms and procedures involved in returning Provider Relief Fund money to the federal government. Find the three updates, all marked “Modified 2/25/2022,” on pages 6 and 8 of the Provider Relief Fund FAQ. Federal Response to Surprise Billing Regulation Court Decision Last week a federal court decision invalidated a major [...]

iqtsupport2022-03-02T17:41:03-05:00March 2, 2022|Accountable Care Organization, 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, Medicare regulations, Medicare reimbursement policy, MedPAC|

FEDERAL HEALTH POLICY UPDATE FOR FRIDAY, FEBRUARY 25

The following is the latest health policy news from the federal government as of 2:30 p.m. on Friday, February 25. Some of the language used below is taken directly from government documents. Provider Relief Fund HHS made more than $560 million in Provider Relief Fund (PRF) Phase 4 General Distribution payments to more than 4100 providers across the country this week. According to HHS, approximately 86 percent of all Phase 4 applications have now been processed and the remaining applications will continue to be processed throughout early 2022. To date, HHS has distributed $11.5 billion of the $17 billion allocated [...]

iqtsupport2022-02-25T16:45:53-05:00February 25, 2022|ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, health equity, Medicare DSH, Medicare regulations, MedPAC|

Provider Groups Seek Delay in Surprise Billing Arbitration Rule

Health care provider groups are continuing their push to urge a federal court to suspend the portion of the recently implemented No Surprises Act regulation that governs the arbitration process when providers and payers cannot agree on payments. According to the providers, regulators make a policy argument in defense of their implementation of the 2020 surprise billing law, but they argue that policy is established by Congress, not regulators, and that the approach regulators have introduced is contrary to congressional intent as articulated in the law. Specifically, they maintain that the arbitration process establishes a benchmark rate rather than using [...]

iqtsupport2022-02-14T13:00:12-05:00February 14, 2022|Congress|