CMS Rules

Hospices Get 3.1% Pay Bump in 2024 Final Rule CMS Rules

Hospices Get 3.1% Pay Bump in 2024 Final Rule

Last Friday, the Centers for Medicare and Medicaid Services (CMS) published the final rule for the FY 2024 Hospice Payment Rate Update. Hospices will receive 3.1% pay bump, which will work out to roughly $780 million. According to the CMS Fact Sheet, the rule also raises the payment cap to $33,494.01. The agency also notes that it...
CMS Rules

CMS Releases Proposed Rules for 2024 PFS, OPPS and ASC

The Centers for Medicare and Medicaid Services (CMS) CY 2024 Physician Fee Schedule (PFS) and Outpatient Prospective Payment System (OPPS) proposed rules released this week have caught major criticism from the industry for cuts to physician pay and inadequate raises for hospitals. But the OPPS proposal also contains a number of...
CMS Rules

ESRD Facilities Get PPS Pay Bump, Home Dialysis Gaining Steam

Hospital-based end stage renal disease (ESRD) facilities are poised to receive a 2.6% increase in the ESRD prospective payment proposed rule for 2024, but home-based dialysis care is gaining traction. Experts are also recommending earlier screening for chronic kidney disease. Under the 2024 End Stage Renal Disease Prospective Payment...
CMS Rules

CMS Proposes 2.7% Cuts to Home Health Agencies in 2024 PPS

Last Friday, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule for the 2024 Home Health Prospective Payment System. The proposal shocked the home health industry by enforcing an aggregate decrease of 2.2% for Medicare payments to home health agencies (HHAs). The cut arises from a proposed pay bump of 2.7%...
CMS Rules

States Employ Tech to Overcome Medicaid Redetermination Challenges

States are employing tech vendors to help facilitate communications for the Medicaid redeterminations process, but they can't curb the high volume of enrollees losing coverage. More than 90 million Americans must undergo eligibility review over the next several months and the U.S. Department of Health and Human Services has estimated...
CMS Rules

CMS Announces It Will Cover Alzheimer's Drugs, With a Caveat

Last Thursday, the Centers for Medicare and Medicaid Services (CMS) announced that it would reverse course on anti-amyloid treatments for Alzheimer's patients and cover Leqembi should it receive full approval from the U.S. Food and Drug Administration (FDA). June is Alzheimer's Awareness month. Leqembi, produced by Biogen and Eisai,...
CMS Rules

New Proposed Rule Takes Aim at PBMs and Managed Care

The Biden administration issued a proposed rule through the Centers for Medicare and Medicaid Services that aims to increase transparency of prescription drug costs and managed care plan operations for Medicaid enrollees. It would do this by implementing a new drug price verification survey tool and requiring the inclusion of drug...
CMS Rules

CMS Announces SNF Claims Will Be Scrutinized More Closely

The Centers for Medicare and Medicaid Services (CMS) published a memo concerning a crackdown on improper claims for skilled nursing facilities. CMS also announced that it would begin a demonstration for inpatient rehabilitation facilities in Alabama that will allow all Medicare claims to be subject to review. As of June 5, all SNFs...
CMS Rules

CMS Streamlines Prior Authorization for MA in New Rule

Last week, the Centers for Medicare and Medicaid Services released a final rule taking aim at prior authorization and its use in Medicare Advantage. The rule also makes changes to the star ratings program and marketing reforms. The rule stipulates that once a health plan grants prior authorization for a service, the approval will...
CMS Backtracks on 2024 MA Rate Notice and Part D Rule Changes CMS Rules

CMS Backtracks on 2024 MA Rate Notice and Part D Rule Changes

Published Friday, the rate notice includes a 3.32% overall pay raise which was up from the 1.03% in the proposed rule. The Centers for Medicare and Medicaid Services (CMS) appears to have ceded to the demands of the insurance industry; the new pay rates translate to a $13.8 billion increase for insurers, according to Axios, CMS will...
CMS Proposes SNF FY 2024 Rates CMS Rules

CMS Proposes SNF FY 2024 Rates

On Monday, the Centers for Medicare and Medicaid Services (CMS) proposed the FY 2024 Skilled Nursing Facility (SNF) Payment Prospective Systems (PPS) rates. It includes an increase of 3.7%, or $1.2 billion in Medicare Part A payments to SNFs. The rate increase reflects a 6.1% market basket update to the payment rates comprised of a...
CMS Proposed Hospice Rule Includes Crackdown on Hospice Fraud CMS Rules

CMS Proposed Hospice Rule Includes Crackdown on Hospice Fraud

On Friday, the Centers for Medicare and Medicaid Services issued a proposed rule that would give hospice providers a 2.8% reimbursement increase and would institute a number of penalties for hospices that fail to meet reporting requirements. The rule signals a long-expected federal crackdown on hospice fraud, waste and...
CMS Rules

CMS Extends MA VBID Model, Hospice Benefit Component through 2030

Last week, the Centers for Medicare and Medicaid Services (CMS) announced plans to extend the Medicare Advantage (MA) Value-Based Insurance Design Model for five more years, through 2030. According to the American Hospital Association, 52 Medicare Advantage organizations with a collective 9.3 million enrollees are participating int he...
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