Medicare rates would rise for some providers and fall for others based on recommendations made to Congress last week by the Medicare Payment Advisory Commission, the independent congressional agency that advises Congress on Medicare reimbursement matters.

MedPAC’s rate recommendations to Congress and the administration, which it approved at its January 2023 meeting, are:

• Outpatient and inpatient prospective payment systems – under current law, the estimated increase would be about 2.9 percent; MedPAC proposes 2.9 percent plus one percent.
• Physician services – increase fees 50 percent of the projected increase in the medical economic index (MEI).
• Skilled nursing facilities – reduce the current base rate three percent.
• Home health services – reduce the current base rate seven percent.
• Hospice services – a complex proposal to increase some payments 2.9 percent but to reduce payments “for providers with very long lengths of stay and lost costs relative to payments.”
• Outpatient dialysis – MedPAC endorses the current law’s call for a 1.8 percent increase.

Breaking with recent years, MedPAC 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.

In addition, MedPAC offers recommendations for redistributing current Medicare disproportionate …

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 …

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

The government agency that advises Congress on Medicare payment matters met publicly in Washington, D.C. last week.

During the virtual meeting, members of the Medicare Payment Advisory Commission discussed:

• reforming Medicare’s wage index system
• addressing the high prices of drugs covered under Medicare Part B
• a prototype design for a post-acute care prospective payment system
• favorable selection and future directions for Medicare Advantage payment policy
• aligning fee-for-service payment rates across ambulatory care settings

MedPAC is an independent congressional agency that advises Congress on issues involving Medicare.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

For a look at the agenda for the two-day meeting and to find the presentations for each of these subjects, go here.…

The following is the latest health policy news from the federal government for February 6-16.  Some of the language used below is taken directly from government documents.

No Surprises Act

• A federal judge in Texas has vacated parts of a regulation governing the arbitration process that is a major aspect of implementation of the No Surprises Act.  In his ruling, the judge found that the arbitration process unfairly favored payers over providers, most notably by placing undue emphasis on the qualified payment amount (QPA) that is a major part of the arbitration process.  The decision explains that “The Court first held that the interim rule improperly ‘places its thumb on the scale for the QPA, requiring arbitrators to presume the correctness of the QPA and then imposing a heightened burden on the remaining statutory factors to overcome the presumption.’”  It adds that “The interim rule, moreover, characterized the non-QPA factors as ‘permissible additional factors’ that an arbitrator may consider only ‘when appropriate’ and concludes that “The interim rule thus conflicted with the Act, which unambiguously requires arbitrators to consider ‘all the specified information in determining which offer to select’ and nowhere instructs them ‘to weigh any one factor or circumstance