Archive for CMMI

 

Federal Health Policy Update for Thursday, July 7

The following is the latest health policy news from the federal government as of 2:30 p.m. on Thursday, July 7.  Some of the language used below is taken directly from government documents.

The Courts

Hospitals may sue state Medicaid programs for failing to ensure that private insurers – such as Medicaid managed care plans – pay hospitals in a timely manner for the care they provide to their Medicaid patients, a federal appeals court has ruled.  See the court’s decision in this case.

Centers for Medicare & Medicaid Services

  • CMS has proposed a series of changes in the Medicare cost report, including but not limited to changes in the S-10 form.  Go here for a link to a zip file of seven documents explaining what CMS proposes.  Stakeholder comments are due July 22.
  • CMS has unveiled a suite of new resources to improve CMS and state oversight of Medicaid and CHIP managed care programs.  Released in a Center for Medicaid and CHIP Services Informational Bulletin, this new information includes tools, templates, and updates on tactics to improve states’ reporting on their Medicaid and CHIP managed care programs.  The bulletin outlines the latest updates of a new web-based portal for state reporting on

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

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 …

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