Posted
on March 23, 2023
The following is the latest health policy news from the federal government for March 17-23. Some of the language used below is taken directly from government documents.
No Surprises Act
After a February ruling in federal court that aspects of CMS’s implementation of the 2020 No Surprises Act contradicted the language of the act itself and unfairly favored payers over providers, CMS ordered a moratorium on new arbitration decisions for disputes filed on or after October 25, 2022 while it reviewed and revised its guidance on how payment disputes should be decided. Now, CMS has completed that task and issued new guidance to the Independent Dispute Resolution entities that adjudicate the disputes and to the parties in those disputes and ordered the resumption of the arbitration of disputed cases. Go here to see the new CMS guidance to the parties in disputes and here for the new guidance to the Independent Dispute Resolution entities.
Department of Health and Human Services
- HHS has published a notice explaining that even though the COVID-19 public health emergency is expected to end formally on May 11, the continued prevalence of COVID-19 and its variants merits the continuation of FDA emergency use authorizations that would
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Posted
on March 21, 2023
Fifteen years ago, a federal court ruled that the Centers for Medicare & Medicaid Services was calculating Medicare disproportionate share payments (Medicare DSH) incorrectly and ordered the agency to fix the problem and reimburse eligible hospitals for the underpayments they had experienced.
Now, after 15 years of waiting, 40 of those hospitals are suing for their money.
In a suit filed in federal court, the hospitals outline the actions CMS has and has not taken to correct the problem and write that
The agency’s contractors have not performed the revised determinations required under the ruling and the rule and have not paid the plaintiff hospitals any of the additional amounts due them for the periods at issue.
In seeking back payment and damages, the plaintiffs also write that
The agency’s unreasonable delay has cost the plaintiff hospitals tens of millions of dollars in funds that should have been paid to them many years ago for the higher costs that they incurred to treat low-income patients more than a decade ago.
The purpose of Medicare DSH payments is to help hospitals that care for unusually large numbers of low-income and uninsured patients with the cost of caring for those patients.
Learn …
Posted
on March 16, 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.
Medicare Payment Advisory Commission (MedPAC)
MedPAC has published its “March 2023 Report to the Congress: Medicare Payment Policy.” In this year’s report MedPAC considers the context of the Medicare program, including the near-term consequences of COVID-19 and the longer-term effects of program spending on the federal budget and the program’s financial sustainability. It evaluates payment adequacy and make recommendations concerning Medicare payment policy in 2024 for selected fee-for-service payment systems but explains that it has discontinued its practice of offering rate recommendations for long-term-care hospitals (LTCHs) and ambulatory surgical centers, citing inadequate data on which to base recommendations. It offers recommendations to redistribute current Medicare disproportionate share hospital (Medicare DSH) and uncompensated care payments and to provide additional resources to Medicare safety-net hospitals and clinicians who furnish care to Medicare beneficiaries with low incomes. Finally, MedPAC reviews the current state of the Medicare Advantage program (Part C) and its prescription drug program (Part D).
MedPAC’s rate recommendations to Congress and the administration, which it approved at its January 2023 meeting and which are …
Filed under:
Centers for Medicare & Medicaid Services,
COVID-19,
MACPAC,
Medicaid,
Medicaid and CHIP Payment and Access Commission,
Medicaid disproportionate share,
Medicaid DSH,
Medicaid DSH allotments,
Medicare,
Medicare disproportionate share,
Medicare DSH,
Medicare post-acute care,
Medicare regulations,
Medicare reimbursement policy,
MedPAC
Posted
on March 10, 2023
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
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Filed under:
340b,
Accountable Care Organization,
ACO,
Alternative payment models,
Centers for Medicare & Medicaid Services,
COVID-19,
Medicaid,
Medicaid and CHIP Payment and Access Commission,
Medicaid disproportionate share,
Medicaid DSH,
Medicaid DSH allotments,
Medicaid managed care,
Medicaid regulations,
Medicare post-acute care,
Medicare regulations,
Medicare reimbursement policy,
MedPAC
Posted
on March 8, 2023
With more than 140 rural hospitals closing since 2010 and more currently in financial trouble, a modest number of such facilities are hoping to avoid a similar fate by applying to the Centers for Medicare & Medicaid Services to become “rural emergency hospitals,” a new Medicare provider type created to preserve access to care in rural areas.
Hospitals that become rural emergency hospitals will receive an annual fee of more than $3 million from Medicare and a five percent increase in their Medicare payments but must retain 24-hour emergency services while limiting their inpatient services to leave just enough time to arrange for emergency patients who need such care to be moved elsewhere.
According to federal regulators, more than 50 rural hospitals have inquired about the new provider type and seven have applied for the new rural emergency hospital designation.
Learn more about rural emergency hospitals and how they may help preserve access to care in rural areas from the Kaiser Health News report “Struggling to Survive, the First Rural Hospitals Line Up for New Federal Lifeline.”
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