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
On Sunday, the Centers for Medicare & Medicaid Services (CMS) issued two proposed rules for inpatient and long-term care hospitals. The first aims to fund medical residency positions in hospitals in rural and underserved communities in order to address workforce shortages in those areas and would require hospitals to report COVID-19...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) issued a final rule making changes to the Comprehensive Care for Joint Replacement (CJR) payment model last week. The final rule extends the payment model for three performance years for participating hospitals and allows for CMS to test modifications to the model.
The final rule...CMS Rules
After a 1.7 billion in nursing home payment increase, the federal government is mulling several options to recalibrate the Medicare payment structure for skilled nursing facilities as it seeks to achieve its intended goal of budget neutrality, with the aim of shutting off excess payments as soon as possible.
According to the...CMS Rules
The Medicare Payment Advisory Commission (MedPAC) agreed that the Department of Health and Human Services (HHS) must put together a consolidated group of alternative payment models in order to improve demonstrations.
From the commission's recommendation:
The Secretary should implement a more harmonized portfolio of fewer spending...CMS Rules
This week, the Supreme Court suspended hearings on Medicaid work requirements as other Trump era Medicaid policies come under fire. Plus, states aren't quite meeting reporting requirements and more reporting adjustments could be on the way.
The U.S. Supreme Court suspended its review of the Medicaid work requirements and removed the...CMS Rules
Provider groups aren't too worried about the 2% Medicare payment cut that is scheduled to go back into effect on April 1st after being paused for the COVID-19 pandemic. The cuts originally went into effect in 2013 and were paused to protect providers like hospitals and doctor groups that are now confident that the cuts will continue to...CMS Rules
The American Journal of Managed Care published a study last Friday looking at the increase of outpatient knee replacement surgeries paid through private insurance after the Centers for Medicare and Medicaid Services' (CMS) decision to remove knee replacements from the Inpatient Only list.
According to the AJMC study, there was an...CMS Rules
The newly installed Biden Administration and the ongoing turbulence of the pandemic have resulted in a flurry of recent changes in the world of the Affordable Care Act—all as an impending Supreme Court decision on its very existence looms in the background.
Many Americans lost jobs due to the pandemic, and with them their...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) price transparency rule went into effect on January 1st. The rule, which requires that hospitals disclose prices of basic procedures in searchable files or consumer-friendly interfaces, was met with uncertainty and criticism from hospitals and other stakeholders for being too strict a...CMS Rules
On January 14, the Centers for Medicare and Medicaid Services (CMS) released the Notice of Benefit and Payment Parameters for 2022. This included a finalized user fee of 2.25% of premiums for insurers on the federally facilitated exchange. The rule also allows states to enroll eligible patients in the individual marketplace.
Last Friday, the Centers for Medicare and Medicaid Services (CMS) approved a final rule requiring payers to build application program interfaces to support data exchange and streamline prior authorization. Medicaid and the Children’s Health Insurance Program (CHIP); healthcare exchange plans are also required to comply with the...CMS Rules
Last Thursday, the Centers for Medicare & Medicaid Services proposed that states could use Section 1332 waivers to customize their Exchanges and allow web-based insurers to sell insurance by 2023; some stakeholders contend the changes undermine key tenets of the Affordable Care Act.
The agency's final rule, Notice of Benefit and...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) released 20 new proposed measures for quality and efficiency measures under consideration. CMS reviews and updates all quality measures annually for its programs, reviewing and removing less relevant ones and proposing more innovative metrics.
From CMS Administrator Seema...CMS Rules
On Tuesday, the United States Court of Appeals for the District of Columbia ruled that the Department of Health and Human Services may continue with the hospital price transparency rule on January 1. The American Hospital Association requested an injunction against the 2019 final rule that will require hospitals to make their standard...CMS Rules
Last Wednesday, a United States District Court judge issued an injunction against the Centers for Medicare and Medicaid Services’ (CMS) Most Favored Nation drug pricing model for 14 days. The demonstration was set to begin on January 1, but the court ruled that the COVID-19 pandemic emergency was not sufficient to immediately finalize...CMS Rules
Through the last few weeks in office and in anticipation of the new calendar year, the Centers for Medicare and Medicaid Services (CMS) passed a slew of rules, deadline extensions and requests for participation in order to bolster cost-lowering initiatives and incentivize participation in value-based care programs.
The federal...CMS Rules
Last week, the Center for Medicare and Medicaid Innovation (CMMI) announced the Geographic track for the Direct Contracting model. This week, the Centers for Medicare and Medicaid Services (CMS) expounded on the program, announcing that the model could be extended to Medicare Managed Care Organizations (MCOs) serving dually eligible...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) proposed a new rule to streamline prior authorizations and improve electronic healthcare data transfers between doctors, patients and insurance companies. The rule will require payers involved in certain government programs to build apps for the purpose of this exchange and prior...CMS Rules
Across the board, providers are unhappy and vocal about the calendar year 2021 pay rule released by the Centers for Medicare and Medicaid Services (CMS) last week. Due to strict budget neutrality, the agency offset a pay increase for primary care providers by cutting payment to specialists by up to 10%.
Primary care doctors and nurses...CMS Rules
Last week, the Centers for Medicare and Medicaid Services (CMS) released a propose rule for 2022 Notice of Benefit and Payment Parameters. The proposed rule would lower the user fee or Affordable Care Act (ACA) insurers to 2.25% of the premium for the coverage year 2022 and also would enable states to partner directly with the private...