Posted
on September 21, 2023
The following is the latest health policy news from the federal government for September 15 – 21. Some of the language used below is taken directly from government documents.
Congress
- With only nine days left in the current federal fiscal year, Congress still has not agreed on any kind of spending bill to keep the federal government operating past September 30. If the federal government shuts down, the Department of Health and Human Services (HHS) will “use the full extent of the authority under the Antideficiency Act (ADA) to maintain existing HHS activities…” In previous shutdowns, Medicare has continued to pay providers and that policy is not expected to change. You can review the HHS contingency staffing plan here.
- The House of Representatives planned to vote this week on H.R. 5378, the Lower Costs, More Transparency Act that called for the elimination of Medicaid DSH cuts for two years; increased requirements for hospital price transparency; and a number of site-neutral payment policies. House leaders ultimately pulled the bill from consideration this week but have signaled that they intend to return to the legislation later this year. View a section-by-section summary of H.R. 5378 here.
Centers for Medicare & Medicaid
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Posted
on August 24, 2023
The following is the latest health policy news from the federal government for August 11-24. Some of the language used below is taken directly from government documents.
Centers for Medicare & Medicaid Services
- After suspending the No Surprises Act-created Independent Dispute Resolution process in the wake of a court ruling striking down a recent increase in fees for that process, CMS has established a new rate structure for initiating the adjudication of payment disagreements between providers and payers. It explains the new rate structure in this new FAQ, which nevertheless notes that despite the creation of new rates, the Independent Dispute Resolution process remains suspended until further notice.
- CMS has updated the ICD-10 MS-DRG grouper version 41 with changes that will take effect on October 1. Go here for further information, additional resources, and links to downloads.
- CMS has posted a brief animated explainer video, “Social Determinants of Health Items: Determining When a Proxy Response is Allowed,” to help home health, hospice, and long-term-care hospitals determine when the use of a proxy response is permitted for the following social determinants of health items: A1005 – ethnicity; A1010 – race; A1110 – language; A1250 – transportation; B1300 – health literacy;
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Filed under:
Accountable Care Organization,
ACO,
Alternative payment models,
Center for Medicare and Medicaid Innovation,
Centers for Medicare & Medicaid Services,
CMMI,
COVID-19,
health equity,
MACPAC,
Medicaid,
Medicaid and CHIP Payment and Access Commission,
Medicaid managed care,
Medicaid regulations,
Medicare,
Medicare post-acute care,
Medicare reimbursement policy,
MedPAC,
social determinants of health
Posted
on August 10, 2023
The following is the latest health policy news from the federal government for August 4-10. Some of the language used below is taken directly from government documents.
Centers for Medicare & Medicaid Services
- CMS has temporarily suspended the federal Independent Dispute Resolution process, which adjudicates problems involving surprise medical bills, in the wake of a federal court ruling that found some of the process’s underlying regulations invalid. CMS has directed the certified Independent Dispute Resolution entities to pause all dispute resolution activities. As a result, providers and insurers temporarily cannot initiate new disputes. Learn more from this CMS notice.
- CMS has written to all 50 states with its review of their progress toward redetermining Medicaid eligibility as part of the Medicaid unwinding process. Its letters include data on states’ call center performance, renewal application processing times, and procedural termination rates. The letters point out areas where states are not meeting performance expectations and offer suggestions for improving that performance. Find the letters here.
- CMS has issued a toolkit for Medicaid and CHIP agencies to foster improvements in access, quality, and equity in postpartum care in their Medicaid and CHIP programs. This technical assistance has two components: quality improvement
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Filed under:
Alternative payment models,
Centers for Medicare & Medicaid Services,
COVID-19,
hospitals,
MACPAC,
Medicaid,
Medicaid and CHIP Payment and Access Commission,
Medicare,
Medicare reimbursement policy,
MedPAC,
Telehealth
Posted
on August 3, 2023
The following is the latest health policy news from the federal government for July 29-August 3. Some of the language used below is taken directly from government documents.
Medicare Payment Regulations
- CMS has issued a final rule updating Medicare payment policies and rates for inpatient and long-term-care hospital services under its inpatient prospective payment system and long-term care prospective payment system for FY 2024. The final rule increases hospital inpatient rates 3.1 percent and LTCH rates 3.3 percent in FY 2024. Other highlights include a nearly $1 billion cut in Medicare disproportionate share (Medicare DSH) and Medicare DSH uncompensated care payments; changes in diagnosis codes and health equity hospital categorizations to address health equity and a program that will pay bonuses to hospitals that provide excellent care to especially large numbers of dually eligible (Medicare and Medicaid) patients; continuation of Medicare’s low-wage hospital policy and changes in its rural wage index calculation methodology; and more. Learn about these and other aspects of the final FY 2024 inpatient prospective payment system and long-term care prospective payment system from this CMS news release; a CMS fact sheet; and a pre-publication version of the final rule.
- CMS has issued a
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Filed under:
Alternative payment models,
Center for Medicare and Medicaid Innovation,
Centers for Medicare & Medicaid Services,
CMMI,
COVID-19,
health equity,
Medicaid,
Medicare,
Medicare disproportionate share,
Medicare DSH,
Medicare post-acute care,
Medicare regulations,
Medicare reimbursement policy,
Telehealth
Posted
on July 20, 2023
The following is the latest health policy news from the federal government for March 13-16. Some of the language used below is taken directly from government documents.
Congress
- Senator Bernie Sanders (I-VT), chair of the Senate Health, Education, Labor and Pensions (HELP) Committee, has introduced a bill, the “Primary Care and Health Workforce Expansion Act.” The bill would:
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- Increase funding for community health centers by $65 billion over five years, fund the National Health Service Corps at $8.3 billion over five years, and provide $250 million for HRSA coordination for the Women, Infants, and Children (WIC) program.
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- Add 10,000 graduate medical education (GME) slots over five years; reauthorize the Children’s Hospital Graduate Medical Education Program and the Teaching Health Center Graduate Medical Education Program; and reauthorize, expand, and fund other teaching and training programs for primary care, rural health care, and programs at historically Black colleges and universities (HBCUs).
- Reauthorize, expand, and create training programs and grant and loan programs to increase the number of nurses.
- Reauthorize and increase funding to increase the number of dentists,
- Create new programs and fund existing programs to expand the behavioral health workforce, the direct care workforce, and the number of family caregivers.
To …
Filed under:
Alternative payment models,
Center for Medicare and Medicaid Innovation,
Centers for Medicare & Medicaid Services,
Congress,
COVID-19,
health equity,
MACPAC,
Medicaid,
Medicaid and CHIP Payment and Access Commission,
Medicare,
Medicare regulations,
Medicare reimbursement policy
