Archive for Medicare regulations

 

“Hospital at Home” Growing

The concept of treating “hospitalized” patients at home could play a more prominent role in the delivery of hospital services in the coming years.

Hospital at home programs have been around for decades but took on greater importance when COVID-19 began filling hospital beds.  With many communities experiencing a shortage of beds, the Centers for Medicare & Medicaid Services issued an “acute hospital care at home waiver” in November of 2020 to help compensate for the bed shortage and encourage home programs.  Now that the COVID crisis has passed, health care interests are not necessarily moving away from the idea of providing hospital-like care to some patients in their own homes.

The case for hospital care at home can be compelling.  Some communities – especially those in rural areas – lack hospital beds or even hospitals at all; recovery at home eliminates the risk of hospital-acquired infections; and one study found that patients who received their hospital care at home were “discharged” from care faster and experienced fewer post-discharge emergency department visits and hospital readmissions.  The concept of hospital care at home is already in use in other countries and one analysis suggests that hospital care at home could account …

Federal Health Policy Update for January 20

The following is the latest health policy news from the federal government for the week of January 13-20.  Some of the language used below is taken directly from government documents.

Centers for Medicare & Medicaid Services

  • CMS has published updates to the Healthcare Common Procedure Coding System (HCPCS) codes on the Required Face-to-Face Encounter and Written Order Prior to Delivery List.  The update adds ten codes to the list of items that require a face-to-face encounter between provider and patient and a written order prior to delivery as a condition of payment.  Go here for a summary of the update and a link to a formal Federal Register notice.  The update takes effect on April 17.
  • CMS has published a technical update of codes used for billing by ambulatory surgical centers.  Find it here.
  • The latest edition of MLN Connects, CMS’s online newsletter with information about Medicare reimbursement matters, includes features on the latest FY 2023 ICD-10 codes and grouper software effective April 1; January 2023 integrated outpatient code editor files, including updates; tip sheets for post-acute-care quality reporting programs during the COVID-19 public health emergency; and more.  Find it here.
  • CMS has updated and expanded its

Federal Health Policy Update for January 12

The following is the latest health policy news from the federal government for January 6-12.  Some of the language used below is taken directly from government documents.

Renewal of COVID-19 Public Health Emergency Declaration

HHS Secretary Xavier Becerra has signed an order extending the previous declaration of a COVID-19 public health emergency.  This declaration extends the emergency to April 11.  The administration continues to assure stakeholders it will provide 60 days’ notice prior to the end of the public health emergency.

MedPAC Medicare Rate Recommendations

  • Every year MedPAC recommends to Congress rate increases for the different kinds of health care providers for the coming year.  While MedPAC’s recommendations are not binding, they are highly respected and often find their way into future public policy.  MedPAC commissioners are holding public meetings today and tomorrow (January 12 and 13) and so far have offered the following recommendations:
    • Hospital payments – an increase of what current law calls for plus one percent, a transition to beginning to distribute Medicare DSH and uncompensated care payments through a new Medicare safety-net index (MSNI), and an increase of $2 billion in the MSNI pool.
    • Physician payments – an update of 50 percent of the projected

Federal Health Policy Update for December 22

The following is the latest health policy news from the federal government for the week of December 19-22.  Some of the language used below is taken directly from government documents.

Congress

As of this writing, Congress continues to work on an FY 2023 omnibus spending bill:  the Senate has passed it but the House has not yet addressed it.  Highlights of what negotiators have agreed to – but that have not yet been adopted – include:

  • Preventing the additional four percent Medicare sequester for two years.
  • Reducing by more than half the 4.5 percent cut in Medicare payments to physicians that was scheduled to take effect on January 1.  The agreement calls for reducing that 4.5 percent cut to just two percent in 2023 and then imposing a 3.5 percent cut in 2024.
  • Extending COVID-19 public health emergency Medicare telehealth policies for two years, through 2024.
  • Ending the maintenance-of-effort requirement from the Families First Coronavirus Response Act that prohibited states from removing ineligible individuals from their Medicaid rolls.  Under that law, states were prohibited from reviewing the eligibility of Medicaid beneficiaries for the duration of the COVID-19 public health emergency in exchange for a 6.2 percentage point increase in FMAP. 

Federal Health Policy Update for December 8

The following is the latest health policy news from the federal government for the week of December 4-8.  Some of the language used below is taken directly from government documents.

No Surprises Act

  • CMS has published an FAQ about implementation of good faith estimates for uninsured and self-pay patients under the No Surprises Act.  In the FAQ the agency explains that it will extend enforcement discretion for situations in which good faith estimates do not include expected charges from co-providers or co-facilities.  This enforcement discretion was expected to end on January 1 but CMS now writes that it will remain suspended pending future rulemaking.  Find the FAQ here.

Centers for Medicare & Medicaid Services