Archive for Center for Medicare and Medicaid Innovation

 

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 Tuesday, June 21

The following is the latest health policy news from the federal government as of 2:45 p.m. on Tuesday, June 21.  Some of the language used below is taken directly from government documents.

Centers for Medicare & Medicaid Services

  • The Supreme Court has ruled that CMS acted inappropriately when it reduced 340B payments to hospitals.  In a unanimous decision, the court found that the law creating the program gives the federal government two ways to set 340B payments for outpatient drugs for qualified providers and that the manner in which CMS cut those payments in 2018 followed neither.  Learn more from the Supreme Court opinion.
  • CMS has approved requests from Maine, Minnesota, New Mexico, and Washington, D.C. to expand from 60 days to 12 months postpartum Medicaid and CHIP coverage, as authorized temporarily by the American Rescue Plan.  This brings to 14 the number of states that have taken advantage of this option.  Learn more from this HHS news release.
  • The latest edition of MLN Connects, CMS’s online newsletter about Medicare reimbursement issues, includes items about FY 2023 ICD-10 diagnosis codes, the July update of the ambulatory surgical center payment system, revised requirements for mental health visits via

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

Federal Health Policy Update for Friday, April 1

The following is the latest health policy news from the federal government as of 2:30 p.m. on Friday, April 1.  Some of the language used below is taken directly from government documents.

Provider Relief Fund

  • After April 5, this program also will stop accepting claims for administering vaccines to uninsured individuals.  See this notice for further information about both deadlines for submitting claims.

Proposed Medicare Payment Regulations for FY 2023

  • CMS has published its proposed inpatient rehabilitation facility (IRF) prospective payment system and IRF quality reporting program for FY 2023.  The agency proposes a 2.8 percent net increase in Medicare rates; a permanent cap of five percent on year-over-year wage index losses for any reason; an increase from $9491 to $13,038 in the outlier threshold; and changes in the IRF quality reporting program in future years – but not 2023 – that address patient vaccinations and health equity.  CMS also is soliciting comments on incorporating discharge to home health in an IRF transfer policy.  Learn more from this CMS news release and from the proposed rule itself.  Interested parties have until May 31 to submit formal comments.
  • CMS has published its proposed FY 2023 Medicare hospice payment rule, which

Federal Health Policy Update for Tuesday, March 22

The following is the latest health policy news from the federal government as of 2:30 p.m. on Tuesday, March 22.  Some of the language used below is taken directly from government documents.

Provider Relief Fund

  • As of March 22 at 11:59 p.m. (eastern) the HRSA (Health Resources and Services Administration) COVID-19 Uninsured Program will stop accepting claims for testing and treatment due to lack of funds and on April 5 at 11:59 p.m. (eastern) the HRSA COVID-19 Uninsured Program and COVID-19 Coverage Assistance Fund will stop accepting vaccination claims due to a lack of funds.  HRSA has released additional information about this significant change in federal COVID policy with the publication of two new documents:

o   HRSA COVID-19 Uninsured Program Shutdown FAQs

o   HRSA COVID-19 Coverage Assistance Fund Shutdown FAQs

Separately, HRSA advises that “Submitted claims will be paid subject to the availability of funds.”  This means that when the money is gone HRSA will no longer be able to pay claims.  The administration continues to encourage Congress to provide additional funding to support COVID-related activities and replenish this fund but it is not clear at this point if it will succeed in doing so.

  • Providers that received Provider Relief