Archive for Medicare reimbursement policy

 

Federal Health Policy Update for Monday, August 8`

The following is the latest health policy news from the federal government as of 2:30 p.m. on Monday, August 8.  Some of the language used below is taken directly from government documents.

Congress

On Sunday, the Senate passed the Democrats’ health care, climate, and tax bill, H.R. 5376, The Inflation Reduction Act, by a vote of 51-50, with Vice President Harris casting the tie-breaking vote.  Health care provisions in the reconciliation bill include:

  • allowing Medicare to negotiate prescription drug prices
  • limiting out-of-pocket prescription drug costs for Medicare enrollees to $2,000 a year
  • extending for three years enhanced Affordable Care Act subsidies for individuals to buy health insurance on the marketplace.

The bill now heads to the House, which expects to pass it Friday.  Find the Democrats’ summary of the bill’s health care provisions here.

White House

President Biden has issued an “Executive Order on Securing Access to Reproductive and Other Healthcare Services” to build on action the administration has taken to protect access to reproductive health care services.  The executive order coincides with the first meeting of the Task Force on Reproductive Healthcare Access and includes actions to support patients traveling out of state for medical care, even raising …

On Second Thought, CMS Decides to Share Hospital Performance Data

After originally proposing not to publish certain recent hospital performance data because it feared it might be skewed by COVID-19-related challenges, the Centers for Medicare & Medicaid Services has decided to go ahead and publish that data – but not to use it in Medicare payment calculations.

Under Medicare’s hospital-acquired condition program, hospitals are rated on their performance on ten safety indicators.  Regulators, however, feared that doing so based on hospital performance during the pandemic might penalize hospitals whose communities were especially hard hit by the pandemic.  Patient safety groups opposed CMS’s April proposal to withhold the data and the agency ultimately compromised, announcing this week that it would post the data in its star ratings on its Care Compare web site but not use that data to reduce payments to hospitals.

Some hospital groups continue to oppose publication of the data based on their concern that it does not reflect the COVID-related challenges some providers have faced over the past two-and-a-half years.

Learn more about CMS’s decision in the Fierce Healthcare article “Patient safety advocate cheers CMS’ reversal on quality reporting, but hospitals say the data are no good.”

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Federal Health Policy Update for Tuesday, August 2

The following is the latest health policy news from the federal government as of 2:45 p.m. on Tuesday, August 2.  Some of the language used below is taken directly from government documents.

White House

The White House has announced two new actions to address the youth mental health crisis:  it will award nearly $300 million from the FY 2022 bipartisan omnibus agreement to expand access to mental health services in schools and it will encourage governors to invest more in school-based mental health services.  Learn more about this effort, including the individual funding components of the $300 million in new spending, from this White House fact sheet.

Medicare Payment Regulations

  • CMS has issued its final Medicare inpatient prospective payment system and long-term care prospective payment system regulation for FY 2023.  Highlights of the final rule include a 4.3 percent increase in Medicare hospital inpatient rates and a 2.3 percent increase in LTCH rates; a reduction of $318 million in the Medicare DSH uncompensated care payment pool; introduction of a new “birthing-friendly hospital” designation for hospitals that meet certain criteria; the introduction of three new health equity measures; a permanent five percent cap on year-to-year wage index reductions; and more. 

Congress Seeks Bigger Bump for Medicare Hospital Payments

More than 140 members of Congress have written to Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure asking her to implement a bigger increase in Medicare payments for hospital inpatient services than the agency has proposed for FY 2023.

According to separate bipartisan letters from House and Senate members, the proposed FY 2023 increase – 2.8 percent – fails to reflect inflation and rising health care staffing costs.  The letter signed by 112 House members states that

We worry the proposed payment updates do not accurately reflect today’s cost of patient care and, when tethered with other policy changes included in the proposed rule, would result in a payment decrease for IPPS [Medicare inpatient prospective payment system] hospitals in FY 2023.  We respectfully urge CMS to further evaluate this proposal and consider using its special exceptions and adjustments authority to revise the final IPPS rule to ensure hospitals have the resources they need to provide optimal care. 

Learn more from the Fierce Healthcare article “142 bipartisan lawmakers push CMS to reconsider inpatient payment rule updates” and from the House letter.

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Federal Health Policy Update for Wednesday, July 27

The following is the latest health policy news from the federal government as of 2:30 p.m. on Wednesday, July 27.  Some of the language used below is taken directly from government documents.

Final Medicare Payment Regulations for FY 2023

  • CMS has issued its final FY 2023 Medicare inpatient rehabilitation facility (IRF) payment system regulation, finalizing a rate increase of 3.9 percent, which is greater than the 2.8 percent the agency proposed in April.  To learn more about CMS’s final IRF payment rule for FY 2023, see this CMS fact sheet and the final rule itself.
  • CMS also has finalized its Medicare inpatient psychiatric facility prospective payment system final rule for FY 2023, including a 2.5 percent rate increase.  Learn more from this CMS fact sheet and the final rule itself.
  • In addition, CMS has published its FY 2023 hospice payment rate update final rule, finalizing a 3.8 percent rate increase.  Learn more from this CMS fact sheet and from the final rule itself.

White House

The White House COVID-19 response team has briefed the press about the administration’s latest efforts in the response to COVID-19.  Find a transcript of its latest briefing here.

The White House …