The Department of Health and Human Services (HHS) Assistant Secretary for Planning and Evaluation (ASPE) continued its research series on the Inflation Reduction Act this week with a look at the impact of the $2,000 Part D out-of-pocket cap on...CMS Rules
The costs were also unprecedented for the CMS Innovation Center's models, driven primarily due to risk score growth and prescription drug costs that could not be contained by policy modifications.
The costs are "substantial and unmitigable," exceeding $2.3 billion in 2021 and $2.2 billion in 2022, according to the CMS Blog post on...CMS Rules
Last Friday, the Centers for Medicare and Medicaid Services announced that it would substantially raise standard monthly premiums for Medicare Part B.
Medicare Part B covers physicians' services, outpatient hospital services, home health services and other medical and health services not covered by Part A. The premium for Part B will...CMS Rules
Last week, the Centers for Medicare and Medicaid Services (CMS) finalized the Medicare Physician Fee Schedule for 2025. It includes a 2.9% cut to physician pay.
The fee schedule includes policies aimed at improving access to primary care and boosting reimbursement for behavioral health, but the pay cut instantly drew harsh criticism...CMS Rules
Last week, the Centers for Medicare and Medicaid Services (CMS) published the CY 2025 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule. Hospital outpatient departments and ASCs will receive a 2.9% raise next year.
The boost includes a 3.4% market basket boost...CMS Rules
On Monday, the Biden administration announced a new proposed rule by the U.S. Department of Health and Human Services (HHS) together with the Labor Department (DOL) and the U.S. Department of Treasury, that would expand access to contraceptive products by making them free to all women of reproductive age with private health...CMS Rules
A coalition of 20 Republican-led states filed a lawsuit against the Biden administration's nursing home minimum staffing mandate, but the rule could end up saving thousands of lives each year once implemented.
The lawsuit was led by the attorneys general of Iowa, South Carolina and Kansas, and filed in the District Court for the...CMS Rules
Last week, the Centers for Medicare and Medicaid Services (CMS) announced new proposed rules for the ACA Marketplace in 2026. The agency intends for the rules to control the quality of brokers and agents who enroll people in plans and updates the risk adjustment program.
Since June, CMS has suspended at least 200 brokers on suspicion...
In response to 2023 bogus charges for intermittent urinary catheter billing within the Medicare Shared Savings Program (Shared Savings Program) program, the federal government released a final rule that holds ACOs harmless for the suspicious billing activity. The program showed a 20-fold increase in catheter billing from 10 durable...
The Centers for Medicare and Medicaid Services did not come to play this week when they filed 75,000 pages of records in response to a lawsuit brought against the nursing home staffing mandate.
This was the opening move by CMS since the American Health Care Association (AHCA) filed suit against the mandate earlier this year. According...
The Centers for Medicare and Medicaid Services (CMS) has finalized a landmark rule that will require insurers to provide parity between their coverage for mental health and medical or surgical benefits. The rule also aims to expand access to mental and behavioral health services.
The rule fulfills a proposal from last summer and will...
After backlash from stakeholders, in the final rule on August 1 the Centers for Medicare and Medicaid Services (CMS) increased the inpatient hospital stay from 2.6% as was proposed in the April draft rule, to 2.9% in fiscal 2025. Despite the increase, stakeholders continue to share concerns that the increase is not enough.
Senior Vice...
The Centers for Medicare and Medicaid Services (CMS) estimated the 2025 pay bump will increase inpatient rehabilitation facilities (IRFs) payments by $280 million for FY 2025.
IRFs can be freestanding facilities or specialized units within acute care hospitals. They provide an intensive rehabilitation program and patients who are...
The Centers for Medicare & Medicaid Services (CMS) issued a final rule on July 31, 2024, for the fiscal year 2025 skilled nursing facility prospective payment system. This rule will bump nursing homes Medicare Part A pay rate by 4.2%, amounting to an additional $1.4 billion compared to FY 2024.
This final rule also changes CMS’...
On Tuesday, the Biden administration released guidance on rules for the Medicare Prescription Payment Plan, a key aspect of the healthcare initiatives laid out in the Inflation Reduction Act of 2022 that aims to lower out-of-pocket costs for seniors with Medicare Part D prescription drug coverage.
The program is slated to launch in...CMS Rules
Last week, a federal court in Texas issued a stay on a Centers for Medicare and Medicaid Services (CMS) final rule that would have increased oversight of agents and brokers contracting by Medicare Advantage plans. The stay will remain in effect for the duration of the lawsuit unless lifted by an appellate court.
The stay follows the...
At the end of June, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) that includes updates for renal dialysis payments and requirements for the ESRD Quality Incentive Program.
Renal dialysis services will get a 2.2% raise in both...
This week the U.S. Department of Health and Human Services (HHS) released a final rule that establishes disincentives for healthcare providers who have committed information blocking. The new rule sets penalties for hospitals, clinicians participating in MIPS and accountable care organizations (ACOs) in the Medicare Shared Savings...CMS Rules
In order to rein in runaway healthcare spending under the Medicare program, political interest has turned to site-neutral payments as a method of keeping costs low. This week, KFF looks into site neutral payments in a new fact sheet and podcast.
Hypothetically, site-neutral payment reforms would reduce the amount Medicare pays for...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) have decided to recalculate the 2024 Medicare Advantage (MA) star ratings and allow plans to resubmit bids for 2025 if their scores increase. Insurers are thrilled.
Two federal courts recently determined that CMS improperly calculated MA star ratings for 2024 after applying a...
