Archive for Medicare regulations

 

Federal Health Policy Update for April 20

Posted on April 20, 2023

The following is the latest health policy news from the federal government for April 8 – 20.  Some of the language used below is taken directly from government documents.

The White House

The Biden administration has announced a plan to expand health coverage for Deferred Action for Childhood Arrivals (DACA) individuals.  To this end, it announced that HHS will soon propose a rule amending the definition of “lawful presence,” for purposes of Medicaid and Affordable Care Act coverage, to include DACA recipients.  If finalized, the rule would make DACA individuals eligible for these programs for the first time.  Under the proposed rule, DACA individuals would be able to apply for coverage through the health insurance marketplace, where they may qualify for financial assistance based on income, and through their state Medicaid agency.  Learn more from this White House fact sheet.  HHS Secretary Xavier Becerra has released a letter on the same subject.

Congress

Congresswoman Yvette Clarke (D-NY) has introduced H.R. 2665, the Supporting Safety Net Hospitals Act, bipartisan legislation that would delay pending cuts to Medicaid disproportionate share hospital (Medicaid DSH) payments.  Currently, Medicaid DSH payments would be cut, beginning in 2024, by $8 billion a year through 2027.  …

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Filed under: Affordable Care Act, Centers for Medicare & Medicaid Services, Congress, COVID-19, health equity, hospitals, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicaid disproportionate share, Medicaid DSH, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, post-acute care

Federal Health Policy Update for April 7

Posted on April 7, 2023

The following is the latest health policy news from the federal government for March 31 – April 7.  Some of the language used below is taken directly from government documents.

The White House

President Biden has signed an executive order calling for the modernization of the regulatory review process.  Among other objectives, the order seeks to improve the effectiveness of the regulatory review process and promote inclusive regulatory policy and public participation.  The order gives the Office of Management and Budget, through its Office of Information and Regulatory Affairs and in consultation with the Council of Economic Advisers and representatives of relevant agencies, one year to revise and update the regulatory review process.  Find the executive order here.

Medicare Payment Regulations

  • CMS has released its proposed Medicare inpatient rehabilitation facility (IRF) prospective payment system rule for FY 2024.  The proposed rule calls for increasing IRF rates three percent and adjusting the outlier threshold to maintain outlier payments at three percent of total IRF payments.  CMS also proposes permitting hospitals to open new IRF units at any time during the cost reporting period that would be paid under the IRF prospective payment system if the hospital notifies the CMS regional office
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Filed under: Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, health equity, Medicaid, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC, social determinants of health

Federal Health Policy Update for March 16

Posted on March 16, 2023

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 …

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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, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC

Federal Health Policy Update for Friday, March 10

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

CMS Proposes Regulation Governing Medicare DSH

Posted on March 1, 2023

The Centers for Medicare & Medicaid Services has proposed altering its regulations governing the calculation of eligible hospitals’ Medicare disproportionate share payments (Medicare DSH).

According to CMS,

This proposed rule would revise our regulations on the counting of days associated with individuals eligible for certain benefits provided by section 1115 demonstrations in the Medicaid fraction of a hospital’s disproportionate patient percentage.

This is essentially the same change CMS included in its proposed FY 2022 and FY 2023 inpatient prospective payment system rules and then did not adopt in the final rule.  In proposing this change again CMS suggests that this has always been its policy and it therefore needs to update its regulations to reflect that since courts are finding that the existing regulations are contrary to this policy.

Learn more from CMS’s announcement of the proposed rule and from the formal Federal Register notice.  Stakeholder comments are due by May 1.

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Filed under: Centers for Medicare & Medicaid Services, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations