Archive for Medicare reimbursement policy

 

MedPAC Reports to Congress

MedPAC has submitted its annual report to Congress.

The congressionally mandated report, titled Report to Congress: Medicare and the Health Care Delivery System, consists of seven chapters:

  • Realizing the promise of value-based payment in Medicare: an agenda for change.
    Challenges in maintaining and increasing savings from accountable care organizations (ACOs).
    Replacing the Medicare Advantage quality bonus program.
    Mandated report: Impact of changes in the 21st Century Cures Act to risk adjustment for Medicare Advantage enrollees.
    Realigning incentives in Medicare Part D.
    Separately payable drugs in the hospital outpatient prospective payment system (OPPS).
    Improving Medicare’s end-state renal disease (ESRD) prospective payment system (PPS).

While MedPAC’s recommendations are not binding on Congress or the administration, they are highly respected and often find themselves worked into new law or regulations.

Go here to see MedPAC’s news release accompanying the report and here to find the report itself.…

MedPAC Offers 2021 Medicare Rate Recommendations

MedPAC has recommended to Congress changes in Medicare payment rates in the coming year.

In its annual report to Congress, the Medicare Payment Advisory Commission recommended the following rate changes:

acute-care hospitals – a two percent rate increase and a suggestion that the difference between this two percent increase and the payment increase specified by law be used to increase the rewards hospitals may earn under Medicare’s hospital value incentive program.  As a result, the value incentive program would offer a possible 0.8 percent in bonus payments, and with the recommended elimination of the 0.5 percent penalty for which hospitals are at risk, hospitals could average net increases of 3.3 percent.

  • ambulatory surgical centers – no rate increase and a requirement that such facilities report cost data
  • physicians – rates updated as already provided for by law
  • long-term acute-care hospitals – a two percent increase
  • inpatient rehabilitation facilities – a five percent rate reduction
  • skilled nursing facilities – no rate increase
  • dialysis facilities – rates updated as already provided for by law
  • hospice services – no rate increase and the aggregate hospice cap should be wage-adjusted and reduced 20 percent
  • home health agencies – a seven percent rate reduction

While …

CMS Authorizes Waiving of Some Medicare Coronavirus Fees

Medicare Advantage organizations, Medicare Part D plans, and Medicare-Medicaid managed care plans have been directed by the Centers for Medicare & Medicaid Services to waive cost-sharing for testing and treatment of the novel coronavirus.

This news was transmitted to those payers in a March 10 letter from CMS.

The directive also authorizes Medicare Advantage plans to waive coronavirus-related telehealth fees and authorizes Part D plans to relax refill-too-soon limits, provide maximum expended day supplies of prescription drugs, reimburse enrollees for prescription drugs obtained from out-of-network pharmacies, ease prior authorization limits on drugs prescribed to treat patients with the disease, and encourage greater use of home or mail delivery of such drugs when appropriate.

Learn more from CMS’s letter to Medicare Advantage organizations, Medicare Part D plans, and Medicare-Medicaid managed care plans.…

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 March agenda were:

  • Addressing Medicare Shared Savings Program vulnerabilities
  • The role of specialists in alternative payment models and accountable care organizations
  • Realigning incentives in Medicare Part D
  • Redesigning the Medicare Advantage quality bonus program
  • Mandated report: Impact of changes in the 21st Century Cures Act to risk adjustment for Medicare Advantage enrollees
  • Improving Medicare’s end-stage renal disease prospective payment system
  • Separately payable drugs in the hospital outpatient prospective payment system

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.…

Number of Medicare-Dependent Hospitals Declines

The number of Medicare-dependent hospitals in the U.S. fell 28 percent between 2011 and 2017, the U.S. Government Accountability Office reports.

Medicare-dependent hospitals receive additional payments from Medicare if at least 60 percent of their discharges or inpatient days are associated with Medicare patients, if they have 100 or fewer beds, and if their historic costs in one of three base years are greater than what they would have been paid through Medicare’s inpatient prospective payment system.  The Medicare-dependent program was created in 1989 to protect vulnerable small, mostly rural hospitals, and in any given year not all eligible hospitals qualify for additional Medicare payments.

The Medicare-dependent hospital program is neither large nor expensive.  In 2017, only 138 hospitals qualified for Medicare-dependent status, down from 193 in 2011.  The median additional revenue hospitals derived from the program was $812,000, which accounted for a median of 1.4 percent of their total reported revenue.  In 2018, Medicare spent only $119 million for additional payments for eligible hospitals and the number of Medicare-dependent hospitals that actually qualified for the supplemental payments that year declined 15 percent.

Why the decline in the number of Medicare-dependent hospitals?  A new GAO report explains that

Our analysis