Archive for Medicare regulations


HHS Posts Regulatory Agenda

The U.S. Department of Health and Human Services has posted a list of the regulations it is already working on or intends to work on in the coming months.

Included in the list are links to the individual subjects that lead to descriptions of the subject and HHS’s intentions as well as the latest information on the status of the anticipated regulation and its priority within the agency’s overall regulatory work.  Among the listed regulations are a number that address Medicare and Medicaid.

Go here to see the list.…

Physicians Push Back Against Medicare Telemedicine Proposal

A proposal to enable Medicare to make greater use of telemedicine as a means of serving patients is receiving surprising pushback from physicians.

The Centers for Medicare & Medicaid Services has proposed paying doctors $14 for what would amount to a five-minute telephone “check-in” call with patients.

Some physicians note that they already have such telephone conversations patients – and do not charge for those calls.  Others fear the new service will increase their patients’ health care costs because they would incur a co-pay for such conversations.  The chairman of the Medicare Payment Advisory Commission (MedPAC), himself a physician, has written that “Direct-to-consumer telehealth services…appear to expand access, but at a potentially significant cost and without evidence of improved quality.”

Learn more about CMS’s telemedicine proposal, what Medicare hopes to accomplish by expanding access to telehealth services, and why some providers do not share CMS’s enthusiasm for telemedicine in this Kaiser Health News article.


MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues.

The issues on MedPAC’s October agenda were:

  • managing prescription opioid use in Medicare Part D
  • opioids and alternatives in hospital settings: payments, incentives, and Medicare data
  • Medicare payment policies for advanced practice registered nurses and physicians
  • Medicare’s role in the supply of primary care physicians
  • Medicare payments for services provided in inpatient psychiatric facilities
  • episode-based payments and outcome measures under a unified payment system for post-acute care
  • Medicare policy issues related to non-urgent and emergency care

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  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.

Go here for links to the policy briefs and presentations that supported MedPAC’s discussion of these issues.


CMS: More Medicare Site-Neutral Payments Coming

The federal government is unlikely to stop with outpatient visits in its drive to make more Medicare payments on a site-neutral basis.

That was the message Centers for Medicare & Medicaid Services administrator Seema Verma delivered at a public event last week.

We are taking a look at [site-neutral payments] across the board and looking at our authority and where we can weigh in on it.  But I think the post-acute space is something where there are a lot of differentials in payments and something we’re very interested in exploring.

CMS recently proposed extending its use of site-neutral payments for Medicare-covered outpatient services and the Medicare Payment Advisory Commission (MedPAC) has recommended that CMS pursue site-neutral payments among the different types of post-acute-care providers.

Learn more about Verma’s remarks and CMS’s intentions in this Fierce Healthcare article.


Medicare Site-Neutral Outpatient Payment Proposal Would Have Disproportionate Impact

The Centers for Medicare & Medicaid Services’ proposal to make more Medicare outpatient payments on a site-neutral basis would significantly cut Medicare’s overall outpatient spending but most of that cut would be borne by just a few hospitals.

A report prepared for the Integrated Health Care Coalition concluded that

…CMS’ Off-Campus Site-Neutral Proposal in the FY 2019 CMS OPPS [note:  outpatient prospective payment system] NPRM [note:  notice of proposed rulemaking] will disproportionate affect about six percent of 3,333 hospitals that participate in the program.  200 hospitals will shoulder 73 percent of the proposed payment reductions….For the top 200, the average reduction will be 5.5 percent.  For the remaining hospitals, the reduction will be 0.5 percent.

Learn more about the CMS proposal and its potential implications in this story in Becker’s Hospital Review or go here to see the complete analysis.…