On July 9, 2021, the Biden Administration issued an executive order (EO), “Promoting Competition in the American Economy,” to address corporate consolidation, lack of competition and high prices for consumers, and low wages.[i] The health care portion of the EO focuses on improving competition to address health care prices and access to care in four [...] Read More
On the evening of June 28, 2021, the Centers for Medicare & Medicaid Services and the Department of the Treasury put a proposed rule on display[1] that includes rules and policies designed to promote greater access to comprehensive health insurance coverage through the Exchanges, consistent with applicable law and recent Presidential executive orders.[2],[3],[4] The proposed [...] Read More
On June 15, 2021, the Medicare Payment Advisory Commission (MedPAC) released one of their two annual Reports to Congress.[1],[2] The report includes recommendations to revise Medicare Advantage (MA) benchmark policy, streamline the portfolio of alternative payment models (APMs), replace the existing skilled nursing facility value-based purchasing program, revise indirect medical education (IME) payments, and improve [...] Read More
On June 15, 2021, the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) released one of their two annual Reports to Congress.[1],[2] The June report addresses high-cost specialty drugs in the Medicaid program; access to mental health services for Medicaid and Children’s Health Insurance Program (CHIP) enrollees; the use of EHR [...] Read More
On April 29, 2021, the Centers for Medicare & Medicaid Services (CMS) posted the final rule Comprehensive Care for Joint Replacement Model Three-Year Extension and Changes to Episode Definition and Pricing to the inspection desk of the Federal Register (link). This final rule extends the Comprehensive Care for Joint Replacement (CJR) model through December 31, [...] Read More
On the evening of April 27, 2021, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule, Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Final Policy Changes and Fiscal Year 2022 Rates (link), which updates the FY 2022 payment systems and [...] Read More
Budget Proposal Hearing Summaries from Appropriation Subcommittees April 15, 2021: House Subcommittee on Labor, Health & Human Services (HHS), Education, & Related Agencies · Chairwoman Rosa DeLauro (D-CT) lauded the proposal and noted the success of vaccination efforts (link) · Ranking Member Tom Cole (R-OK) believed this request spends too much on domestic programs at [...] Read More
On April 8th, 2021, the Centers for Medicare & Medicaid Services (CMS) released a fact sheet and unpublished proposed rule, Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2022, which updates payment rates and policies for these facilities: Increase [...] Read More
Congress is working on Phase 5 of coronavirus relief using the budget reconciliation process. As described by the House Committee on the Budget, “Budget reconciliation provides a fast-track process for consideration of bills to implement the policy choices embodied in the annual congressional budget resolution.”[1] Just like with the budget resolution, reconciliation bills are not [...] Read More
On January 15, 2021, the Centers for Medicare & Medicaid Services (CMS), working with the Office of the National Coordinator for Health Information Technology (ONC), issued a press release, fact sheet, and an unpublished final rule that aims to increase the electronic exchange of health care data and improve prior authorization processes. This final rule [...] Read More