The Centers for Medicare and Medicaid Services (CMS) issued proposed rules for the FY 2025 inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) payment system. The agency proposes raising payments and the industry decried the boost as insufficient.
Hospitals will receive a 2.6% increase or $2.9 billion across...National News
President Joe Biden released his budget proposal this week which centers Medicare-boosting policies, lowering prescription drug prices and continuing subsidies to Affordable Care Act exchange insurers.
The president is pitching his $7.3 trillion budget for 2025 on the argument that it will curb national debt and reduce the deficit by...
A new survey from the Commonwealth Fund, a thinktank that promotes improvements in the healthcare system, found that most older Americans say they like their coverage regardless of whether they are enrolled in Medicare Advantage or Medicare fee-for-service (FFS). However, more people in Medicare Advantage plans reported delays in care...
The National Association of Accountable Care Organizations (NAACOS), a nonprofit which represents accountable care organizations (ACOs), uncovered a Medicare fraud scheme that may have cost the government $2 billion.
Federal officials are now investigating the fraudulent billing of nearly 406,000 patients for catheters. The Washington...CMS Rules
Earlier this month, the Centers for Medicare and Medicaid Services (CMS) proposed a new rule that would improve oversight of accrediting organizations (AOs).
Recently, AOs have come under fire for failing to update accreditation of providers and suppliers that fail to meet requirements for the Medicare and Medicaid programs. AOs are...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) revealed their proposals for Medicare Advantage plans in 2025, but the Biden administration appears to be pulling punches that it otherwise let fly in non-election years.
CMS said on Wednesday that it expects the average benchmark payment for MA plans to decrease by 0.2% in 2025...National News
A new report from the Employee Benefit Research Institute (EBRI) found that Medicare beneficiaries have massive out-of-pocket expenses that will require future retirees to save hundreds of thousands of dollars before leaving work.
EBRI built a simulation model that projected rates of return on assets in retirement that incorporated...Arizona News
Cigna is one step closer to dropping its Medicare business this week after finalizing the sale of its MA plans to the Health Care Service Corp. (HCSC) for $3.3 billion, so long as federal regulators approve the deal. It is set to finalize by the first quarter of 2025.
Late last year, the insurance giant was scrambling to find...National News
Last week, the Supreme Court heard arguments in two cases that challenge the precedent set by Chevron v. National Resources Defense Council in 1984 that determined courts should generally defer to the wisdom of a state or federal agency when interpreting federal statute.
This precedent, now referred to as Chevron deference, appears to...
Last week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would allow Medicare beneficiaries more opportunities to appeal their hospital status, appeal after hospital discharge and a retrospective appeal for a class action lawsuit.
According to the American Hospital Association, the proposed rule is...
Last week, Humana published its 10th annual Value-Based Care (VBC) Report for 2023. The report found that Medicare Advantage patients in value-based arrangements were more likely to receive preventive care and were hospitalized less frequently.
The report found that because clinicians are incentivized to provide patients with...
New studies are showing the benefits of value-based care organizations, including the rapid rise of accountable care organizations (ACOs).
Physician participation in accountable care organizations (ACOs) has increased to represent most doctors, according to a survey of 3,500 physicians by the American Medical Association (AMA)....Arizona News
AHCCCS released a new Olmstead Plan that outlines priorities within the healthcare delivery system for people at risk of institutionalization, including those with behavioral needs and members enrolled in the Arizona Long Term Care System (ALTCS).
The 1999 United States Supreme Court Olmstead decision provided a legal framework for...
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...
From January 2022 to January 2023, 4,264 prescription drugs had price increases, of which 46% or 1,982 were increased above the inflation rate, according to ASPE researchers in a recent study.
Drug manufacturers make most of their prescription drug retail price changes in January and July annually and may change the list price at any...
A new study reviews the volume of advertisements that seniors receive during or around the Medicare enrollment period, and how these reports relate to recent changes in how Medicare Advantage programs will be expected to conduct future advertising campaigns.
The Commonwealth Fund found that "certain marketing experiences reported in ...
Under the Inflation Reduction Act (IRA) people with Medicare may pay a lower coinsurance for some Part B drugs if the drug’s price increases faster than the rate of inflation.
The IRA, signed by President Biden in 2022, applied to Part D the same year, whereas Part B took effect in 2023. The Centers for Medicare & Medicaid...
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...
A new class of highly popular diabetes drugs have changed the landscape for conventional wisdom on obesity and weight loss, but cost of the drug and weight stigma are preventing the drug from widespread authorization by insurers, including Medicare.
Ozempic and its sister drug Wegovy, produced by NovoNordisk, were the first of two...CMS Rules
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...