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Posts tagged with "Medicare"

National News

Inflation Reduction Act Passes Senate, Sans Insulin Price Cap

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

MedPAC Publishes 2022 Data Book on Medicare Spending: Info on Duals, APMs, MA and More!

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

Senators Announce Deal Struck on Reconciliation Bill

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

CMS Releases Framework for Health Equity

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

Top Senate Democrats Again Pushing for Medicare to Negotiate Lower Drug Prices

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

CMMI Announces Enhancing Oncology APM

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

SCOTUS Health Care Decision Round-Up

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's Value-Based Care 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...
Social Security and Medicare Trust Funds Get Short-Term Relief from Pandemic Economic Changes, Maintain Grave Outlook Long Term White Papers, E books, Reports and more

Social Security and Medicare Trust Funds Get Short-Term Relief from Pandemic Economic Changes, Maintain Grave Outlook Long Term

Last Thursday, the Social Security and Medicare boards of trustees released their annual reports on each program and reported that the economic recovery was much stronger than anticipated following the COVID-19 pandemic. However, both programs will still face long-term concerns that could reduce retirement benefits and reduce...
National News

Medicare and Medicare Advantage Update: Rates, Prior Auth, Website Update

Employer plans pay more than double the amount that Medicare pays for the same services, and a large number of Medicare beneficiaries continue to experience adverse events in hospital settings. On the policy side, the Congressional Budget Office has dashed the hopes of lowering the Medicare eligibility age to 60 and efforts to reform...
National News

Mandatory Participation and the Limits of Value-based Care Models

Value-based care is now a ubiquitous term across the medical industry, primarily led by Medicare payment models that prioritize quality of care above overall cost. But some are questioning the concept's utility and expanse over the Medicare market. Legislation proposed in both the U.S. House of Representatives and Senate would...
National News

Hospitals, Chronic Disease Management, Home Health, Pharmacies Foray into Value-based Care

This week, value-based care (VBC) is frequently seen as a method for primary care providers to best serve patients, but increasingly more facets of the healthcare industry are investigating how technology, data analytics and value-based insurance design can help swap volume for value and deliver results for their patients. Hospitals...
CMS Proposes SEP for New Beneficiaries, Closing Coverage Gaps CMS Rules

CMS Proposes SEP for New Beneficiaries, Closing Coverage Gaps

Last Friday, April 22, 2022, the Centers for Medicare and Medicaid Services (CMS) issued a proposal to rectify a few of the issues many Americans face with Medicare enrollment. The CMS press release says the proposed rule will implement provisions from the Consolidated Appropriations Act of 2021 and President Joe Biden's executive...
CMS IPPS and LTCH PPS Proposed Rules: Health Equity and 3.2% Increase CMS Rules

CMS IPPS and LTCH PPS Proposed Rules: Health Equity and 3.2% Increase

On Monday, the Centers for Medicare and Medicaid Services (CMS) published the Hospital Inpatient Prospective Payment (IPPS) and Long Term Care Hospitals (LTCH PPS) Proposed Rule, which will update Medicare fee-for-service payment rates and policies for inpatient hospitals and LTCHs for fiscal year 2023. The rule includes a 3.2% increase...
Lawsuits Filed Against Nursing Homes, COVID-19 Waivers and Telehealth Fraud, Medicare and Medicaid Fraud National News

Lawsuits Filed Against Nursing Homes, COVID-19 Waivers and Telehealth Fraud, Medicare and Medicaid Fraud

As COVID-19 restrictions relax and business practices return to normal guidelines, a large number of negligence and wrongful death suits have been filed due to a repeal of liability protections and statutory deadlines. Johnson & Johnson was unable to overturn a ruling in a deceptive marketing case regarding transvaginal mesh...
CMS Rules

CMS Calls For 4.6% Cuts to SNFs in FY 2023 PPS Proposed Rule

On Monday, the Centers for Medicare and Medicaid Services (CMS) filed the Fiscal Year 2023 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Proposed Rule. The reimbursements include a 3.9% increase to industry reimbursements, but in aggregate the impact of payment policies would result in a decrease of $320 million in...
National News

VBC News: MSSP Turns 10, Palliative Care Struggles, Rural Payment Models & Reining in Rx Costs

This week, the Center for Medicare hinted at new value-based approaches to palliative care; health equity takes precedence in the national conversation on rural payment models; and value-based contracts are analyzed for their ability to mitigate drug costs. The Medicare Shared Savings Program (MSSP) is now ten years old, and with it...
Arizona News

Additional COVID-19 Relief Funding Stalled in Congress Amid Dire White House Concerns

The White House is calling on Congress to act swiftly and pass another round of COVID-19 related funding, noting the consequences for testing, vaccination, boosters, monoclonal antibody treatments, surveillance and research in the fight against the coronavirus pandemic will be dire. This week, more than $5 million in Phase 4 Provider...
National News

National Health Policy Round Up: Medicare, Health Equity & Transgender Youth Services

The Biden administration has pledged to provide Americans with better in-roads to health coverage and to even the playing field for people at a systemic disadvantage from receiving adequate healthcare. This week, a number of policy decisions highlight the administration's commitment to these goals in Medicare coverage, health equity and...
National News

HRSA Releases Additional $560 Million in Phase 4 Provider Relief Funding

On February 24, the U.S. Department of Health and Human Services (HHS) announced that it would release an additional $560 million in Provider Relief Fund (PRF) payments for healthcare providers who have reported losses due to the COVID-19 pandemic. The funds will be released by the Health Resources and Services Administration (HRSA) and...
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