Last week, the Health Care Payment Learning and Action Network (LAN) published its 2022 Methodology and Results report, which is the result of a data collection survey of health plans and states for an account of how money moves through alternative payment models and how these programs function in terms of barriers and access.
In...
The U.S. Department of Health and Human Services (HHS) has signaled that it will delay the end of the public health emergency (PHE) related to the COVID-19 pandemic until April, quelling fears from stakeholders that not enough time was given to review Medicaid eligibility for everyone enrolled since the pandemic began.
In Arizona,...
This week, accountable care has a new definition following the Health Care Payment Learning and Action Network (LAN) Summit, and the Centers for Medicare and Medicaid Services (CMS) look to get more Affordable Care Act (ACA) plans into value-based insurance design.
Out with the old, in with the new. LAN received feedback from...
The 2022 Midterm Elections have concluded, and while election officials in Arizona continue to tally votes, health industry stakeholders and lobbying officials are already set to work boosting their issues and setting sights on the end-of-the-year budget reconciliation in Congress.
In Arizona, Senate Republicans have selected a new...National News
The Medicare open enrollment season is in full swing and is expected to further entrench Medicare Advantage's market penetration. Traditional Medicare and Medicare Advantage are both working to incentivize enrollment and stabilize their representation in the market.
Over a third of Medicare beneficiaries intend to stick with whatever...National News
Due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) lessened penalties for the Hospital Readmissions Reductions Program (HRRP), a Medicare program that evaluates how often patients return to a hospital within 30 days and reduces payments for hospitals with higher readmission rates. But while many hospitals...CMS Rules
On November 1, the Centers for Medicare and Medicaid Services (CMS) finalized the Calendar Year (CY) 2023 Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System rules. In the rule, OPPS and ASC payment rates will increase by 3.8% and announced a new provider designation: the rural...News
The U.S. government has started holding talks with pharmaceutical manufacturers in compliance with the provisions of the Inflation Reduction Act (IRA) that allows Medicare to negotiate prices for some drugs.
The Centers for Medicare and Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure announced at a health conference in...Reports & Surveys
On Monday, the Commonwealth Fund, a private foundation that researches health care system solutions to promote high quality care and efficiency across health systems, published a report on how seniors choose between Medicare and Medicare Advantage.
The report found that the decision is not simple, and beneficiaries carefully weigh...National News
President Biden has set a goal of ending hunger and increasing healthy eating and physical activity by 2030 so fewer Americans experience diet-related diseases, which disproportionately impact communities of color, rural communities, people with disabilities, veterans, older adults, LGBTQI+ populations, and military families.
The...National News
The federal government is curious about states' use of value-based payment (VBP) in nursing facility reimbursement through Medicaid programs. In August, the Assistant Secretary for Planning and Evaluation (ASPE) published an issue brief on its investigation into which states use VBP and how well the systems work.
On the federal level,...
Well ahead of the expected publication, the Centers for Medicare and Medicaid Services (CMS) posted a draft of updated Minimum Data Set specifications (MDS 3.0) last Friday. The comprehensive item set version 1.18.11 is expected to radically transform the future of nursing home reimbursements by states.
CMS said that the final version...
Over the weekend, Senate Democrats came together to pass the massive Inflation Reduction Act, which includes a proposal to give Medicare the power to negotiate certain drug prices, as well as a three-year extension of Affordable Care Act (ACA) subsidies to insurers in the form of tax credits that were initially passed as part of the...National News
This week, the Medicare Payment Advisory Commission (MedPAC), the independent legislative branch agency tasked with analyzing the Medicare program for the purpose of offering insight and advice into the program for policymakers, published its annual Data Book.
The MedPAC Data Book, "Health Care Spending in the Medicare Program," is a...National News
Last Wednesday, Senate Majority Leader Chuck Schumer (D-N.Y.) announced a reconciliation package that includes drug pricing reforms, a three-year extension of the Affordable Care Act (ACA) tax credits enacted under the American Rescue Plan (ARP), in addition to deficit reduction and investments in climate and energy security. Senator Joe...Featured
Last week, the Centers for Medicare and Medicaid Services (CMS) released a Framework for Health Equity at CMS, a frequently-used term by the agency that has been mentioned in nearly every initiative of President Joe Biden's Department of Health and Human Services (HHS).
According to the CMS blog post "Establishing the Framework for...National News
Talks between Sen. Joe Manchin (D-W.Va.) and Senate Majority Leader Charles E. Schumer (D-N.Y.) laid the groundwork for a new drug pricing proposal that may be advanced during a budget reconciliation process; the proposal also includes a cap on annual out-of-pocket prescription drug costs for beneficiaries, limits the amount drug...CMS Rules
Earlier this year, President Joe Biden relaunched his Cancer Moonshot Initiative, which was initially established under the Obama administration to accelerate research into cancer prevention and cures. As part of the initiative, the Biden administration announced a new alternative payment model (APM) from the Center for Medicare and...National News
In addition to overturning Roe v. Wade and with it abortion access for millions of American women, the Supreme Court ended their term this year with a slew of other decisions that will carry new precedent for health industry legal cases going forward.
Last Friday, the high court announced an end to a years-long fight between the U.S....National News
This week in value-based care, a fresh look at untangling VBC for providers looking to enter into an ACO or payment model, results from the Comprehensive ESRD Care Model, and some market moves in long-term and home healthcare.
A new study published in Health Affairs on Monday demonstrates that the first Medicare accountable care...
