The end of the COVID-19 Public Health Emergency will result in a historic realignment of Medicaid funds and enrollees as state Medicaid programs shed beneficiaries they have previously been obligated to keep. While a great deal of attention has been paid to how this will impact states and individual enrollees, there has been less discussion [...] Read More
With holiday gatherings commencing and COVID-19, flu, and respiratory syncytial virus (RSV) cases rising, it’s reasonable to expect that, in addition to sharing infections, many families will soon be trading observations on how men and women manage illness differently. While this may offer fodder for dinner table debates and good-natured ribbing between spouses or siblings, [...] Read More
Key Takeaways The COVID-19 public health emergency (PHE) will likely be extended beyond January 11, 2023. Centers for Medicare & Medicaid Services (CMS) and Urban Institute research showed that many people are not aware of the upcoming return of regular Medicaid renewals. This research highlights the importance of outreach and information campaigns, clear terminology in [...] Read More
On November 29, the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA) released a 340B Drug Pricing Program; Administrative Dispute Resolution Period proposed rule, which proposes changes to the administrative dispute resolution (ADR) process for the 340B Drug Pricing Program (340B Program). This process is intended to resolve disputes [...] Read More
Fraud, waste, and abuse continue to challenge federal and federally funded healthcare programs. While it is difficult to quantify the extent of the cost of healthcare fraud, the U.S. Government Accountability Office estimates that the Centers for Medicare & Medicaid Services (CMS) annually makes $50 billion in improper payments through Medicare alone. As the federal government employs [...] Read More
Section 216 of the Protecting Access to Medicare Act of 2014 (PAMA) was intended to reduce Medicare spending on lab testing by implementing a market-based fee schedule and was prompted by the recognition that Medicare was paying higher rates for many tests than were private payers.[1] - Next phase in of up to 15 percent [...] Read More
On November 1, the Centers for Medicare & Medicaid Services (CMS) issued the Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Final Rule with Comment Period, which finalizes updates to the outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for calendar year (CY) 2023. See the press [...] Read More
On the evening of October 31, 2022, the Centers for Medicare & Medicaid Services (CMS) released the CY 2023 final payment rule for home health agencies (HHAs). This rule includes the annual payment update for Home Health Agencies (HHAs) as well as policies for the Home Health Quality Reporting Program (HH QRP) and Home Health [...] Read More
The Applied Policy team convened for a company-wide retreat in October. The three-day event offered an opportunity to recommit to a shared vision and to reunite in person as the company transitions back from a fully remote work model. Coming from as far away as Switzerland, team members gathered at the company’s Alexandria, Virginia, headquarters [...] Read More
Since the passage of the Inflation Reduction Act (IRA) in August, much attention has been paid to its provisions specific to drug pricing. A scaled back version of the nearly $2 trillion Build Back Better (BBB) Act which stalled in the Senate last year, the IRA carried forward many of the BBB’s healthcare provisions, including [...] Read More