Archive for Alternative payment models

 

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 lower court ruling and upheld CMS’s policy to count days of care for which Medicare does not pay in the Medicare fraction of the Medicare DSH percentage – a policy change widely viewed as disadvantageous to hospitals that care for larger numbers of low-income patients.  This means that Medicare exhausted days and days of care provided to Medicare enrollees with another source of third-party coverage count in the numerator and denominator of the Medicare fraction.  In most cases this results in a lower percentage of a hospital’s Medicare patients also being eligible for SSI and the lowering of that …

Federal Health Policy Update for Monday, June 13

The following is the latest health policy news from the federal government as of 2:30 p.m. on Monday, June 13.  Some of the language used below is taken directly from government documents.

White House

  • The White House has issued a fact sheet outlining its plan for administering COVID-19 vaccines to children under the age of five.  Find the fact sheet here.  The White House also held a background call with the press to discuss this plan; go here to see a transcript of that call.
  • The White House COVID-19 response team has held a briefing for the press to discuss the latest in the federal response to the virus.  Find a transcript of that briefing here.

Centers for Medicare & Medicaid Services

  • CMS has created new HCPCS codes so providers may bill for stand-alone vaccine counseling they provide to Medicaid and CHIP beneficiaries; these codes can be used for stand-alone vaccine counseling provided in-person and/or via telehealth.  Go here for a list of the codes and an explanation of what each code covers.
  • CMS has developed and published webinar content from its Performance Period 2022 Eligible Clinician Electronic Clinical Quality Measure (eCQM) Education and Outreach Webinar Series.  PDF

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

During the April 2022 Medicaid and CHIP Payment and Access Commission meeting, the Commission voted to approve a package of recommendations to:

  • create a new approach for monitoring access to care for Medicaid beneficiaries;
  • improve vaccine access for adult Medicaid beneficiaries;
  • improve the oversight and transparency of directed payments in Medicaid managed care; and
  • encourage the adoption of health information technology (IT) in behavioral health.

The recommendations will appear in MACPAC’s June report to Congress.

The meeting began with a review of recommendations and a draft chapter for the June report to Congress on a new approach for monitoring access to care for Medicaid beneficiaries. Staff presented a draft chapter with a package of five recommendations for a new access monitoring system. The chapter discusses the challenges and limitations of the current monitoring approach, the goals and key elements for a new system, and the rationale and implications for Commission recommendations that call on the Centers for Medicare & Medicaid Services (CMS) to develop a robust and ongoing access monitoring system.

Next, the Commission

MedPAC Meets

The government agency that advises Congress on Medicare payment matters met publicly in Washington, D.C. last week.

During the virtual meeting, members of the Medicare Payment Advisory Commission discussed:

  • addressing high prices of drugs covered under Medicare Part B
  • initial findings from MedPAC’s analysis of Part D data on drug rebates and discounts
  • segmentation in the stand-alone Part D prescription drug plan market
  • leveraging Medicare policies to address social determinants of health
  • an approach to streamline and harmonize Medicare’s portfolio of alternative payment models
  • aligning fee-for-service payment rates across ambulatory settings

MedPAC is an independent congressional agency that advises Congress on issues involving Medicare.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

For a look at the agenda for the two-day meeting and to find the presentations for each of these subjects, go here.…

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 alone is considered affordable; if the coverage for the employee is considered affordable but if it is not considered affordable for the employee’s family, those family members are not eligible for a premium tax credit.  This “family glitch” affects about five million people.

The Treasury Department and the Internal Revenue Service are proposing to eliminate the family glitch so that family members of workers who are offered affordable coverage only for themselves but not for their family may qualify for premium tax credits to buy ACA coverage.  Should this change be made, an estimated 200,000 uninsured people would gain coverage …