CMS Rules

CMS Rules

MA Insurers Sounding Alarms They May Not Maintain Growth Due to Rate Cuts

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

Industry Applauds CMS Prior Authorization Rule, Requests Further Action

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

CMS Accepting Applications for AHEAD Model

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...
CMS Finalizes 2024 Physician Fee Schedule CMS Rules

CMS Finalizes 2024 Physician Fee Schedule

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...
CMS Rules

CMS Finalizes CY2024 Outpatient and ASC Payment System (OPPS)-Small Increase

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...
AHCCCS Opens Applications for $47.5 Million in Directed Payments to Home and Community Based Services (HCBS) in Second Round of American Rescue Plan (ARP) Program CMS Rules

AHCCCS Opens Applications for $47.5 Million in Directed Payments to Home and Community Based Services (HCBS) in Second Round of American Rescue Plan (ARP) Program

Arizona Health Care Cost Containment System (AHCCCS) is investing $47.5 million from ARP Awards to help strengthen HCBS in Arizona. Starting on December 4, 2023, eligible HCBS providers can apply for up to $1 million for programmatic or infrastructure projects to improve HCBS for round 2 of the ARP Program Awards. All applications...
CMS Finalizes CY2024 Home Health PPS, Offering a 0.8% Raise CMS Rules

CMS Finalizes CY2024 Home Health PPS, Offering a 0.8% Raise

Last week, the Centers for Medicare and Medicaid Services (CMS) finalized the CY2024 Home Health Prospective Payment System (HH PPS) Rule, which included cuts that cancelled out market basket raises to the industry. The pay cut is a result of the Patient-Driven Groupings Model (PDGM), which ties reimbursements to patient...
CMS Proposes Rectifying 340B Payments in Lump Sum CMS Rules

CMS Proposes Rectifying 340B Payments in Lump Sum

The Centers for Medicare and Medicaid Services (CMS) has offered its suggestion for a solution to the Supreme Court decision that would return $9 billion to hospitals that were paid less than rates the court said were set unconstitutionally. Last year, the U.S. Supreme Court (SCOTUS) ruled unanimously that the differential payment...
CMS Rules

HHS Announces No Surprises Act Federal Independent Dispute Resolution Process

Last week, the Biden administration announced a proposed rule through the U.S. Department of Health and Human Services (HHS), Labor and the Treasury Department that would implement the independent dispute resolution process (IDR process) outlined by the No Surprises Act, which seeks to protect patients and medical services consumers from...
CMS Rules

CMS Finalizes 2024 ESRD PPS, Kidney Care Partners Rebukes the Agency

The Centers for Medicare and Medicaid Services (CMS) released the End Stage Renal Disease (ESRD) Prospective Payment System (PPS) Final Rule for CY2024 and it includes high expected costs for the Medicare program, but renal disease advocacy groups are accusing the agency of underpaying standalone clinics and introducing a pay...
CMS Rules

CMS to Relax Rules on PET Scans

The Centers for Medicare and Medicaid Services (CMS) announced this week that it would expand coverage for PET scans used in the diagnosis of Alzheimer's disease. CMS has been hesitant to open reimbursements for the procedure, and the agency has long said that it would only cover one brain scan per beneficiary for a patient's...
Study Suggests Nursing Homes Should Focus on Staff Retention CMS Rules

Study Suggests Nursing Homes Should Focus on Staff Retention

As the nursing home industry pushes back on the Biden administration's proposal for mandatory federal staffing minimums, a new study suggests the U.S. may want to pivot away from recruitment and towards staffing retention in order to stabilize staffing rates. Last month, Medicare proposed a new rule that would require long-term care...
CMS Rules

CMS Announces Medicare Savings Program Accessibility Final Rule

Low-income Medicare beneficiaries are expected to see some much needed relief as a result of a new rule issued by the Centers for Medicare and Medicaid Services (CMS) this week. The rule seeks to simplify the enrollment and renewal processes for Medicare Savings Programs (MSPs), as many beneficiaries are currently encumbered from...
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