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...CMS Rules
The Biden administration finalized rules that would increase transparency and increase protections for Medicaid members in managed care plans. It also finalized the Ensuring Access to Medicaid Services Rule on Monday that requires home care providers to use a minimum of 80% of Medicaid payments to pay aides and nurses.
The new...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) issued proposed rules for the FY 2025 inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) payment system. The agency proposes raising payments and the industry decried the boost as insufficient.
Hospitals will receive a 2.6% increase or $2.9 billion across...
The Biden administration brought down the hammer on Medicare Advantage insurers and their brokers when the Centers for Medicare and Medicaid Services (CMS) released the 2025 Medicare Advantage Part D final rule last Thursday.
The rule increases regulatory scrutiny on prior authorization, network adequacy standards and marketing for...
The Centers for Medicare and Medicaid Services released the proposed rule for 2025 hospice reimbursement including a 2.6% raise in per diems and two new quality measures.
The 2.6% net increase would amount to a $705 million increase from FY 2024, including a 3% market basket update and a 0.4% cut for productivity. According to the...
On Monday, the Centers for Medicare and Medicaid Services (CMS) finalized the Rate Announcement for Medicare Advantage (MA) and Medicare Part D programs for Calendar Year (CY) 2025 which includes a rate increase of 3.7% in addition to finalized Part D rules.
The final rule didn't deviate much from the CMS proposed payment rate issued...
After another record-breaking enrollment period, CMS is warning states using HealthCare.gov to be wary of unscrupulous agents switching consumers' ACA plans without consent to pocket commissions. Also this week the federal agency released a final rule setting network adequacy standards for Marketplace plans and giving states the option...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) will end the Hospice Benefit Component of the Value-based Insurance Design (VBID) Model at the end of the year.
The hospice carve-in was designed to test coverage of hospice, palliative and transitional care coverage through the Medicare Advantage program. According to Hospice News,...CMS Rules
Earlier this month, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule that would improve oversight of accrediting organizations (AOs).
Recently, AOs have come under fire for failing to update accreditation of providers and suppliers that fail to meet requirements for the Medicare and Medicaid programs. AOs are...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) have taken the next step on the Medicare Prescription Payment Plan draft guidance, which is required by the Inflation Reduction Act of 2022 to advance President Joe Biden's plan to lower drug costs for seniors.
The draft guidance provides communication and education requirements for...
Regarding inpatient admissions, algorithms or artificial intelligence alone cannot be used by Medicare Advantage (MA) insurers as the basis to deny admission or downgrade to an observation stay; a patient’s circumstances must be considered against the permissible applicable Medicare coverage criteria under which MA operates.
The...
Medicare Advantage insurers are struggling to maintain strong projections of growth following the news of very meager reimbursement rate reductions.
The Centers for Medicare and Medicaid Services (CMS) anticipates that the 0.16% reduction in the MA benchmark rate in 2025 will come as an effect of modifications to the diagnostic coding...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) revealed their proposals for Medicare Advantage plans in 2025, but the Biden administration appears to be pulling punches that it otherwise let fly in non-election years.
CMS said on Wednesday that it expects the average benchmark payment for MA plans to decrease by 0.2% in 2025...CMS Rules
On Wednesday, the Centers for Medicare and Medicaid Services (CMS) proposed an overall increase to MA plans of 3.7%, a $16 billion bump over 2024. At the start of each new year, MA stakeholders wait for CMS to propose next year's MA capitation rates and Part C & D payment policies. After what is expected to be a vigorous comment...CMS Rules
Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) finalized a rule that will truncate the timeline for prior authorization processes to 72 hours for people who receive health coverage from insurers participating in Medicare Advantage, Medicaid managed care, or the Affordable Care Act exchange.
The CMS...CMS Rules
In November, the Centers for Medicare and Medicaid Services (CMS) announced a Notice of Funding Opportunity (NOFO) for the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model.
The AHEAD Model is intended to cut costs for states and improve overall patient health while advancing health equity, according to...
Last week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would allow Medicare beneficiaries more opportunities to appeal their hospital status, appeal after hospital discharge and a retrospective appeal for a class action lawsuit.
According to the American Hospital Association, the proposed rule is...
This week, federal regulators issued an interim final rule that would take action against states that have not complied with the federal Medicaid eligibility rules or reporting requirements during the redetermination period.
The rule says that the Centers for Medicare and Medicaid Services (CMS) will require noncompliant states to...
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...