In proposing a mandatory, episode-based payment model for certain hospitals, the Centers for Medicare & Medicaid Services (CMS) has provided a window into how value-based care might be addressed under a possible second Biden Administration. At issue is the Transforming Episode Accountability Model (TEAM), which was included within the fiscal year (FY) 2025 Hospital Inpatient [...] Read More
On April 22, the Centers for Medicare & Medicaid Services (CMS) released two final rules: Ensuring Access to Medicaid Services and Medicaid and Children's Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality. These rules aim to improve care access, promote transparency and accountability, streamline data collection and monitoring, and increase opportunities to promote [...] Read More
Applied Policy’s CEO Jim Scott was among the approximately 1,000 attendees at the American Hospital Association’s (AHA’s) Annual Membership Meeting, held April 14-16 in Washington, D.C. The event, which brought together hospital presidents, CEOs, administrators, and senior executives, afforded an opportunity for Applied Policy to speak with healthcare leaders from across the country and to [...] Read More
Applied Policy was honored to participate in the American Medical Group Association's (AMGA's) 2024 Conference, held from April 9-12 at the Rosen Shingle Creek Hotel in Orlando, Florida. AMGA represents more than 440 multispecialty medical groups and integrated delivery systems, with the mission of advancing these groups and systems as the preeminent model for delivering [...] Read More
On April 10, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2025 Hospital Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals and the Long-Term Care Hospital (LTCH) Prospective Payment System proposed rule. See the press release here. The rule included a proposal for a mandatory payment model called [...] Read More
Under the inpatient prospective payment system (IPPS), firms that own new and expensive technologies can apply for these technologies to receive new technology add-on payments (NTAPs.) The NTAP program was created in 2001 after Congress, concerned that the existing IPPS reimbursement structure did not incentivize the use of new technologies, passed a law[1] requiring the [...] Read More
On April 10, 2024 the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2025 Hospital Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals and the Long-Term Care Hospital (LTCH) Prospective Payment System proposed rule. See the press release here. CMS released a fact sheet accompanying the rule. The rule proposes [...] Read More
The Medicaid Disproportionate Share Hospital (DSH) program is an important component of the United States' broader effort to provide healthcare to its most disadvantaged citizens. Initiated to offset the financial burdens faced by hospitals delivering care to uninsured and low-income patients, DSH payments have become a cornerstone of funding for many safety-net hospitals. However, while [...] Read More
The counterpart to Medicaid’s Disproportionate Share Hospital (DSH) program, Medicare’s DSH program was established with the shared objective of providing financial support to hospitals that serve a large number of low-income patients. Yet, despite this common purpose, the two programs differ significantly in terms of operational frameworks, eligibility criteria, and policy issues. Background The impetus [...] Read More
On February 20, 2024, the Centers for Medicare & Medicaid Services (CMS) released the final “Medicaid Program: Disproportionate Share Hospital Third-Party Payer Rule” to address legislative provisions in the Consolidated Appropriations Act, 2021 (CAA 2021), which makes changes to the hospital-specific limit on Medicaid disproportionate share hospital (DSH) payments.[1] The rule aims to provide more [...] Read More