The Biden administration released its list of 10 drugs for direct price negotiations with manufacturers. The highly anticipated list is the most recent step in enacting a part of the Inflation Reduction Act (IRA) of 2022. The drugs listed are largely treatments related to Type 2 diabetes, blood thinning, arthritis and cancer...
It looks like the Biden administration will fall short on its promise to institute federal staffing minimums for nursing homes after a new study by the Centers for Medicare and Medicaid Services (CMS) commissioned to determine the appropriate level of staffing made no recommendations.
Instead, the study said, there were no staffing...
States will now be required to report health quality measures for Medicaid beneficiaries including children's health, adult behavioral health and health home data to the Centers for Medicare and Medicaid Services (CMS).
The Core Set of Children's Health Care Quality Measures for Medicaid and the Children's Health Insurance Program...National News
Consumer advocacy group Families USA is coordinating the formation of a new coalition in support of hospital price transparency reforms and advocating for legislation that would strengthen federal oversight on transparency regulations.
The Centers for Medicare and Medicaid Services (CMS) moved to improve oversight for the Hospital...
The Centers for Medicare and Medicaid Services (CMS) is cracking down on hospices by adding new enforcement mechanisms and survey capabilities.
Earlier this month, the agency announced that four states, including Arizona, would be under strict scrutiny for the creation of new hospices after a wave of hospice businesses in the states...
It's difficult to say how Medicaid redeterminations are going.
At least 4,777,000 Medicaid enrollees have been disenrolled across the country as of August 15. The KFF Disenrollment Tracker has found that there's large discrepancies in enrollment data state-by-state, with Texas disenrolling the vast majority of its Medicaid population...CMS Rules
The FY 2024 Hospital Inpatient Prospective Payment System (IPPS) and Long-term Care Hospital Prospective Payment System (LTCH PPS) rule was finalized by the Centers for Medicare and Medicaid Services (CMS) on August 1 and contains a shocking projected cut to disproportionate share hospitals (DSH).
For all hospitals, the rule provides...
The Centers for Medicare and Medicaid Services (CMS) announced the creation of a new payment model for people diagnosed with dementia.
The Guiding an Improved Dementia Experience (GUIDE) Model is an alternative payment model focused on preserving quality of life for diagnosed dementia patients while keeping them at home and providing...
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...
A new report shows that most hospitals are failing to meet the requirements of the Hospital Price Transparency Rule.
Only 36% of the 2,000 hospitals reviewed by PatientRightsAdvocate.org (PRA) were in full compliance with the rule. The report is the fifth Semi-Annual Hospital Price Transparency Compliance Report issued by the PRA....CMS Rules
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...
A white paper by the Harvard Medical School in partnership with software company Inovalon found that Medicare Advantage enrollees are more likely to be poor than enrollees in Traditional Medicare.
The average income of a Medicare fee-for-service (FFS) beneficiary is $85,085 but the median Medicare Advantage enrollee earns $76,720....
The Centers for Medicare and Medicaid Services (CMS) announced they would pay the 1,600 hospitals that participate in the 340B drug discount program a total of $9 billion in lump sum payments in response to the Supreme Court decision that found the program underpaid for prescription drugs. But the Medicare program also announced that it...
The Biden administration released revised guidance for the Medicare drug price negotiation program late last week in response to the mounting lawsuits against the policy required by the Inflation Reduction Act (IRA) of 2022.
Drugmakers Merck and Bristol Myers Squibb, as well as industry representatives like the U.S. Chamber of...
More than 300 members of Congress sent a letter to the Biden administration asking it to use its regulatory authority to reduce the ability for insurers to use administrative hurdles like prior authorization to inhibit patient access to care.
The letter was signed by a bipartisan group of 61 senators and 233 members of the House of...Arizona News
On Monday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would make changes to the end-stage renal disease (ESRD) Prospective Payment System (PPS) for dialysis services. The rule includes a slight pay increase for dialysis providers and increases payments for some dialysis drugs and biologics.
CMS is...
The Alliance of Community Health Plans (ACHP) demanded a major overhaul of Medicare Advantage and is asking the Centers for Medicare and Medicaid Services (CMS) and Congress to change the program's regulatory aspects.
ACHP calls the new plan MA for Tomorrow, and will break down policies into five areas: improving quality, streamlining...
The federal government is worried that procedural disenrollments are too high as the Medicaid redetermination process proceeds.
On Monday, U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra published a letter requesting that states take advantage of allowances and flexibilities authorized by HHS in their...CMS Rules
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...National News
Nursing homes are decrying the severity of the nursing workforce shortage as the minimum staffing proposal looms large.
More than 500 nursing home providers joined a protest on Capitol Hill this week to sound the alarm on legislation that could implement a minimum staffing measure for nursing homes. According to Skilled Nursing News,...