On June 29, the Centers for Medicare and Medicaid Services (CMS) updated its guidance on requirements for long-term care facilities on staffing levels, arbitration, infection prevention and the administration of certain medications. The agency...
A new final rule is in effect as of July 1, 2022. CMS says that the Transparency in Coverage Final Rule is the first of several rules that will be met with stronger compliance enforcement in accordance with the No Surprises Act of 2021 and instead of targeting hospitals for the clear publication of potential prices for a range of...
The Centers for Medicare and Medicaid Services (CMS) has approved Colorado's plan to create a public insurance option through a Section 1332 innovation waiver. The "Colorado Option" will be offered in the Colorado Affordable Care Act Health Insurance Exchange beginning in 2023.
According to Healthcare Dive, the Colorado Option is the...CMS Rules
Earlier this year, President Joe Biden relaunched his Cancer Moonshot Initiative, which was initially established under the Obama administration to accelerate research into cancer prevention and cures. As part of the initiative, the Biden administration announced a new alternative payment model (APM) from the Center for Medicare and...CMS Rules
The rule includes proposals and routine updates to the Medicare Home Health Prospective Payment System (HHPPS) and the home infusion therapy services’ payment rates for CY 2023.
This rule proposes a permanent, budget-neutral approach to smooth year-to-year changes in the pre-floor/pre-reclassified hospital wage index as critics...
As nursing homes across the country are grappling with staff shortages exacerbated by the COVID-19 pandemic, the Biden administration is considering a rule that nursing homes spend most of their Medicaid payments on direct care for residents rather than operations or capital improvements.
According to Modern Healthcare, the rule would...
The hospital price transparency rule, which was issued by the Centers for Medicare and Medicaid Services and went into effect on January 1, 2021, is largely being ignored by hospitals who would prefer to absorb any financial penalty than comply. CMS has only started to impose fines as of last Wednesday, according to an agency email, but...
Last Friday, the Centers for Medicare and Medicaid Services (CMS) published a report that reviewed the Medicare Supplementary Medical Insurance (SMI) Trust Fund for 2023 and determined that cost-savings from unexpectedly low Medicare Part B spending in 2022 could be recommended to drive premium cuts for Part B coverage next year.
The...CMS Rules
The Leapfrog Group, a healthcare consumer safety watchdog group, has asked the Centers for Medicare and Medicaid Services (CMS) to revoke plans to end reporting on serious medical and surgical complications that occur in hospitals.
The 2023 Hospital Inpatient Prospective Payment System (IPPS) proposed rule contains within it a measure...
Last Friday, the Centers for Medicare and Medicaid Services (CMS) published a long-awaited final rule for Medicare Advantage (MA) that increases the agency's efforts to provide oversight to participating plans.
The rule includes new reasons for denying contracts or expanding contracts based on past performance. Modern Healthcare...
The No Surprises Act, a law that aims to protect Americans covered by private health plans from receiving surprise medical bills relating to emergency services or non-emergency services from out-of-network providers at in-network facilities, has been met with trouble since its implementation at the beginning of the year.
In February,...
Last Friday, April 22, 2022, the Centers for Medicare and Medicaid Services (CMS) issued a proposal to rectify a few of the issues many Americans face with Medicare enrollment.
The CMS press release says the proposed rule will implement provisions from the Consolidated Appropriations Act of 2021 and President Joe Biden's executive...
On Monday, the Centers for Medicare and Medicaid Services (CMS) published the Hospital Inpatient Prospective Payment (IPPS) and Long Term Care Hospitals (LTCH PPS) Proposed Rule, which will update Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs for fiscal year 2023. The rule includes a 3.2% increase...
This week in Medicare Advantage (MA), the program is on track to account for 54% of Medicare spending by 2030 and the Centers for Medicare and Medicaid Services (CMS) finalized the plan rates for 2023. Also, Humana takes a look at social needs in Medicare Advantage before COVID and eHealth looks at the rise in premiums and deductibles...CMS Rules
On Monday, the Centers for Medicare and Medicaid Services (CMS) filed the Fiscal Year 2023 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Proposed Rule. The reimbursements include a 3.9% increase to industry reimbursements, but in aggregate the impact of payment policies would result in a decrease of $320 million in...CMS Rules
On February 24, the Centers for Medicare and Medicare Services (CMS) gave a long-awaited announcement regarding the future of the Global and Professional Direct Contracting Model (GPDC). The existing model will phase out by December 31, 2022 and will be redesigned to create the Accountable Care Organization Realizing Equity, Access and...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) will give physician groups participating in the Merit-based Incentive Payment System (MIPS) additional time to apply for a waiver that will allow their data to be re-weighted to account for the impacts of COVID-19 and the surge in cases related to the Omicron variant. CMS has assured...
Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) announced proposed payment policy changes for the Medicare Advantage and Part D programs for Calendar Year (CY) 2023. The proposal includes a 7.98% payment increase and health equity provisions for MA participation, for example in star ratings.
The advance notice was...
The Centers for Medicare and Medicaid Services (CMS) announced a new proposed rule that takes aim at prescription drug costs in Medicare Advantage (MA) and Medicare Part D plans. The agency said the rule would reduce out-of-pocket costs for beneficiaries and improve price transparency as well as "market competition in the Part D...CMS Rules
Last week, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that included changes to the physician fee schedule (PFS) and changes to payments for Medicare Part B. The agency also announced an increase in Part B beneficiary premiums due in part to the authorization of the controversial Alzheimer's drug Aduhelm,...
