Archive for Alternative payment models

 

Federal Health Policy Update for April 7

The following is the latest health policy news from the federal government for March 31 – April 7.  Some of the language used below is taken directly from government documents.

The White House

President Biden has signed an executive order calling for the modernization of the regulatory review process.  Among other objectives, the order seeks to improve the effectiveness of the regulatory review process and promote inclusive regulatory policy and public participation.  The order gives the Office of Management and Budget, through its Office of Information and Regulatory Affairs and in consultation with the Council of Economic Advisers and representatives of relevant agencies, one year to revise and update the regulatory review process.  Find the executive order here.

Medicare Payment Regulations

  • CMS has released its proposed Medicare inpatient rehabilitation facility (IRF) prospective payment system rule for FY 2024.  The proposed rule calls for increasing IRF rates three percent and adjusting the outlier threshold to maintain outlier payments at three percent of total IRF payments.  CMS also proposes permitting hospitals to open new IRF units at any time during the cost reporting period that would be paid under the IRF prospective payment system if the hospital notifies the CMS regional office

Federal Health Policy Update for March 30

The following is the latest health policy news from the federal government for March 24-30.  Some of the language used below is taken directly from government documents.

Centers for Medicare & Medicaid Services

  • CMS’s Center for Medicare and Medicaid Innovation (CMMI) has extended its Medicare Advantage Value-Based Insurance Design (VBID) Model for calendar years 2025 through 2030 and will introduce changes intended to address more fully the health-related social needs of patients, advance health equity, and improve care for patients with serious illness.  Learn more from this CMS announcement, which includes a link to additional information about the program.
  • CMS has published an update to its 2023 CMS quality reporting document architecture category I implementation guide and its schematron for hospital quality reporting.  This is an update to the implementation guide version 1.1 published in January and it outlines requirements for eligible hospitals and critical access hospitals to report electronic clinical quality measures (eCQMs) for the calendar year 2023 reporting period for its Hospital Inpatient Quality Reporting Program, Medicare Promoting Interoperability Program, and Outpatient Quality Reporting Program.  Find the updated guide here and go here for the schematron (the schematron link opens to a zip file download).
  • CMS has

Federal Health Policy Update for Friday, March 10

The following is the latest health policy news from the federal government for March 6-10.  Some of the language used below is taken directly from government documents.

White House FY 2024 Budget Proposal

The Biden administration this week released its proposed FY 2024 federal budget.  Among its many proposals are measures to extend the life of the Medicare hospital trust fund and reduce Medicare beneficiaries’ health care costs; to reduce prescription drug costs for consumers, Medicare, and Medicaid; to return high Medicaid managed care organization profits to the federal government; to make behavioral health care more affordable for seniors; to expand the health care workforce; to improve access to care in rural areas and among underserved communities; to improve HIV/AIDS and hepatitis C prevention and treatment for Medicaid participants; and more.  Learn more about the health care aspects of the administration’s budget proposal from this White House fact sheet on its Medicare proposal; additional White House fact sheets; this HHS news release outlining the budget’s health care highlights; and the budget document itself, where the Department of Health and Human Services section begins on page 75.

Centers for Medicare & Medicaid Services

  • CMS has posted anticipated 2023 state

Federal Health Policy Update for February 23

The following is the latest health policy news from the federal government for February 17-23.  Some of the language used below is taken directly from government documents.

Centers for Medicare & Medicaid Services

  • CMS has issued an informational bulletin to states reiterating certain federal requirements that pertain to health care-related taxes.  Recently, CMS became aware that some health care-related tax programs appear to involve agreements among providers to redistribute their Medicaid payments to hold taxpayers harmless for the cost of the tax.  The bulletin reminds states that such arrangements are prohibited.  Find the CMS bulletin here.
  • CMS has posted a presentation on accessibility requirements in Medicaid and CHIP.  Find it here.
  • As required by law, HHS has published a semi-annual list of rule-making actions under development throughout the department.  Find that list here, along with a link to a formal Federal Register notice.
  • Writing in the journal Health Affairs, CMS officials report that in a limited review of hospital compliance with the agency’s hospital price transparency rule, the proportion of hospitals in compliance with both parts of the rule rose from 27 percent in 2021 to 70 percent in 2022 and more than 80 percent currently

Federal Health Policy Update for December 22

The following is the latest health policy news from the federal government for the week of December 19-22.  Some of the language used below is taken directly from government documents.

Congress

As of this writing, Congress continues to work on an FY 2023 omnibus spending bill:  the Senate has passed it but the House has not yet addressed it.  Highlights of what negotiators have agreed to – but that have not yet been adopted – include:

  • Preventing the additional four percent Medicare sequester for two years.
  • Reducing by more than half the 4.5 percent cut in Medicare payments to physicians that was scheduled to take effect on January 1.  The agreement calls for reducing that 4.5 percent cut to just two percent in 2023 and then imposing a 3.5 percent cut in 2024.
  • Extending COVID-19 public health emergency Medicare telehealth policies for two years, through 2024.
  • Ending the maintenance-of-effort requirement from the Families First Coronavirus Response Act that prohibited states from removing ineligible individuals from their Medicaid rolls.  Under that law, states were prohibited from reviewing the eligibility of Medicaid beneficiaries for the duration of the COVID-19 public health emergency in exchange for a 6.2 percentage point increase in FMAP.