Posted
on August 24, 2023
The following is the latest health policy news from the federal government for August 11-24. Some of the language used below is taken directly from government documents.
Centers for Medicare & Medicaid Services
- After suspending the No Surprises Act-created Independent Dispute Resolution process in the wake of a court ruling striking down a recent increase in fees for that process, CMS has established a new rate structure for initiating the adjudication of payment disagreements between providers and payers. It explains the new rate structure in this new FAQ, which nevertheless notes that despite the creation of new rates, the Independent Dispute Resolution process remains suspended until further notice.
- CMS has updated the ICD-10 MS-DRG grouper version 41 with changes that will take effect on October 1. Go here for further information, additional resources, and links to downloads.
- CMS has posted a brief animated explainer video, “Social Determinants of Health Items: Determining When a Proxy Response is Allowed,” to help home health, hospice, and long-term-care hospitals determine when the use of a proxy response is permitted for the following social determinants of health items: A1005 – ethnicity; A1010 – race; A1110 – language; A1250 – transportation; B1300 – health literacy;
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Filed under:
Accountable Care Organization,
ACO,
Alternative payment models,
Center for Medicare and Medicaid Innovation,
Centers for Medicare & Medicaid Services,
CMMI,
COVID-19,
health equity,
MACPAC,
Medicaid,
Medicaid and CHIP Payment and Access Commission,
Medicaid managed care,
Medicaid regulations,
Medicare,
Medicare post-acute care,
Medicare reimbursement policy,
MedPAC,
social determinants of health
Posted
on May 25, 2023
The following is the latest health policy news from the federal government for May 19-25. Some of the language used below is taken directly from government documents.
Congress
The House Energy and Commerce Committee has advanced to the full House two bills with significant implications for health care providers.
- H.R. 3561 calls for delaying $8 billion a year in Medicaid DSH cuts for two years – cuts scheduled to take effect in October; imposing site-neutral payments for drug infusion services provided in off-campus hospital outpatient departments; imposing stronger price transparency requirements on hospitals; and requiring hospitals to report selected ownership information to the federal government.
- H.R. 3290 would impose new reporting requirements on participants in the 340B prescription drug discount program.
Centers for Medicare & Medicaid Services
- CMS has updated its FAQ on waivers and flexibilities after the end of the COVID-19 public health emergency. Among the issues the revised FAQ addresses are hospital billing for services delivered via telehealth, including such matters as billing for originating site facility fees (including when patients are served by hospital-based outpatient departments), clinic visits, mental health services provided remotely; and billing for “hospitals without walls” services. The FAQ also addresses changes in COVID-19-related
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Posted
on May 4, 2023
The following is the latest health policy news from the federal government for April 28 – May 4. Some of the language used below is taken directly from government documents.
End of the COVID-19 Public Health Emergency
- DeBrunner & Associates has prepared a summary of the status of selected government health care waivers and flexibilities upon the expiration of the COVID-19 public health emergency on May 11. The DeBrunner summary covers telehealth, COVID-19 treatment and coverage, flexible hospital operations, long-term-care hospitals, inpatient rehabilitation facilities and units, patient cost-sharing, and state Medicaid waivers. Find the summary here.
- The COVID-19 public health emergency led to the temporary creation of a number of flexibilities in the delivery of health care, including one issued by the Drug Enforcement Agency (DEA) that made possible prescribing controlled medications via telehealth. With the coming end of the public health emergency on May 11, and with it the expiration of some but not all COVID-related flexibilities, the DEA has announced that it is temporarily extending this flexibility while continuing to evaluate the situation. It has submitted a draft regulation to the Office of Management and Budget to this effect but will provide no further information about it
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Filed under:
Centers for Medicare & Medicaid Services,
COVID-19,
health equity,
hospitals,
MACPAC,
Medicaid,
Medicaid and CHIP Payment and Access Commission,
Medicaid managed care,
Medicaid regulations,
Medicare,
Medicare reimbursement policy,
Telehealth
Posted
on April 27, 2023
The following is the latest health policy news from the federal government for April 21-27. Some of the language used below is taken directly from government documents.
End of the COVID-19 Public Health Emergency
- DeBrunner & Associates has prepared a summary of the status of selected government health care waivers and flexibilities upon the expiration of the COVID-19 public health emergency on May 11. The DeBrunner summary covers telehealth, COVID-19 treatment and coverage, flexible hospital operations, long-term-care hospitals, inpatient rehabilitation facilities and units, patient cost-sharing, and state Medicaid waivers. Find the summary here.
- CMS has posted a new FAQ that addresses its waivers and flexibilities upon the end of the COVID-19 public health emergency. Find it here.
- CMS has updated its “COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing” document to indicate that this FAQ will expire at the end of the COVID-19 public health emergency and will not be updated and directing stakeholders to other agency resources for answers to frequently asked questions. Go here to learn more.
Centers for Medicare & Medicaid Services
- CMS has issued a proposed rule that would reduce barriers to care for Deferred Action for Childhood Arrivals (DACA) individuals by removing
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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,
Medicaid long-term services and supports,
Medicaid regulations,
Medicare,
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
