This week The Centers for Medicare & Medicaid Services announced that it is lifting a suspension on hospital survey activities that was implemented during this winter's surge in COVID-19 cases and hospitalizations. An immediate resumption of...
Last week, the Centers for Medicare and Medicaid Services (CMS) finalized a rule that would define private equity and real estate investment trusts as they relate to nursing home ownership, a step forward in the Biden administration's plans to improve quality of care in nursing homes and scrutinize nursing home ownership...
Last Thursday, the Centers for Medicare and Medicaid Services (CMS) finalized the 2024 Medicare Physician Fee Schedule rule, which includes a 3.34% decrease to the schedule's conversion factor, setting it at $32.74, a $1.15 decrease from 2023.
The agency finalized other increases for visits including primary and longitudinal care, and...
The Centers for Medicare and Medicaid Services (CMS) released the CY2024 Outpatient and Ambulatory Surgical Center Prospective Payment System (OPPS), which included an increase for outpatient hospitals and ASCs of 3.1%.
The final rule's raise was larger than the 2.8% initially proposed, which the agency attributed to industry response...
Arizona Health Care Cost Containment System (AHCCCS) is investing $47.5 million from ARP Awards to help strengthen HCBS in Arizona.
Starting on December 4, 2023, eligible HCBS providers can apply for up to $1 million for programmatic or infrastructure projects to improve HCBS for round 2 of the ARP Program Awards. All applications...
On Monday, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule that would impose tighter regulations on Medicare Advantage insurers. The rule covers some hotly debated issues including prior authorization, supplemental benefits and marketing.
President Joe Biden announced last year that his administration would...
Last week, the Centers for Medicare and Medicaid Services (CMS) finalized the CY2024 Home Health Prospective Payment System (HH PPS) Rule, which included cuts that cancelled out market basket raises to the industry.
The pay cut is a result of the Patient-Driven Groupings Model (PDGM), which ties reimbursements to patient...
The Centers for Medicare and Medicaid Services (CMS) has offered its suggestion for a solution to the Supreme Court decision that would return $9 billion to hospitals that were paid less than rates the court said were set unconstitutionally.
Last year, the U.S. Supreme Court (SCOTUS) ruled unanimously that the differential payment...
Last week, the Biden administration announced a proposed rule through the U.S. Department of Health and Human Services (HHS), Labor and the Treasury Department that would implement the independent dispute resolution process (IDR process) outlined by the No Surprises Act, which seeks to protect patients and medical services consumers from...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) released the End Stage Renal Disease (ESRD) Prospective Payment System (PPS) Final Rule for CY2024 and it includes high expected costs for the Medicare program, but renal disease advocacy groups are accusing the agency of underpaying standalone clinics and introducing a pay...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) announced this week that it would expand coverage for PET scans used in the diagnosis of Alzheimer's disease.
CMS has been hesitant to open reimbursements for the procedure, and the agency has long said that it would only cover one brain scan per beneficiary for a patient's...
As the nursing home industry pushes back on the Biden administration's proposal for mandatory federal staffing minimums, a new study suggests the U.S. may want to pivot away from recruitment and towards staffing retention in order to stabilize staffing rates.
Last month, Medicare proposed a new rule that would require long-term care...
Low-income Medicare beneficiaries are expected to see some much needed relief as a result of a new rule issued by the Centers for Medicare and Medicaid Services (CMS) this week. The rule seeks to simplify the enrollment and renewal processes for Medicare Savings Programs (MSPs), as many beneficiaries are currently encumbered from...CMS Rules
Physicians and related stakeholder groups have rallied against the 2024 physician fee schedule proposed rule, which was issued in July. The rule is expected to be finalized shortly, but providers are saying that any cuts could jeopardize access to primary care.
The proposed rule contains a 3.36% cut to the conversion factor for...
Last week, the Southern District Court of Ohio heard the first oral arguments from the U.S. Chamber of Commerce (CoC, the Chamber) and the U.S. Department of Justice (DOJ). The Chamber requested an injunction of the Medicare negotiation program before October 1, which is the deadline for companies to sign an agreement to participate in...
Last Friday, the White House and the Centers for Medicare and Medicaid Services (CMS) released their long-awaited proposal for a federal minimum staffing mandate in nursing homes.
The proposal would require Medicare and Medicaid nursing homes to provide a baseline minimum 0.55 hours of care from a registered nurse per resident per day...
The Biden administration released its list of 10 drugs for direct price negotiations with manufacturers. The highly anticipated list is the most recent step in enacting a part of the Inflation Reduction Act (IRA) of 2022. The drugs listed are largely treatments related to Type 2 diabetes, blood thinning, arthritis and cancer...
States will now be required to report health quality measures for Medicaid beneficiaries including children's health, adult behavioral health and health home data to the Centers for Medicare and Medicaid Services (CMS).
The Core Set of Children's Health Care Quality Measures for Medicaid and the Children's Health Insurance Program...CMS Rules
The FY 2024 Hospital Inpatient Prospective Payment System (IPPS) and Long-term Care Hospital Prospective Payment System (LTCH PPS) rule was finalized by the Centers for Medicare and Medicaid Services (CMS) on August 1 and contains a shocking projected cut to disproportionate share hospitals (DSH).
For all hospitals, the rule provides...
The Centers for Medicare and Medicaid Services (CMS) published a final rule on Friday that will give skilled nursing facilities (SNFs) a much needed 4% pay increase in 2024.
The proposed rule contained a 3.7% increase but the final policy reflects a 3% market basket update in addition to 3.6% increase to correct previous forecasting...
The Centers for Medicare and Medicaid Services (CMS) announced the creation of a new payment model for people diagnosed with dementia.
The Guiding an Improved Dementia Experience (GUIDE) Model is an alternative payment model focused on preserving quality of life for diagnosed dementia patients while keeping them at home and providing...
