Healthcare spending in the United States is expected to surpass $4.7 trillion in 2023. As Applied Policy has previously reported, some of that money may be spent on unproven, ineffective, unnecessarily expensive, or even harmful practices. Some of it will be spent on effective treatments for which there are less expensive alternatives. Some of it [...] Read More
On April 10th, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2024 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 sheetaccompanying the rule. The rule proposes to: increase [...] Read More
On April 5, 2023, the Centers for Medicare & Medicaid Services (CMS) released its Medicare Program; Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (CMS-4201-F) with a fact sheet and press release. The final [...] Read More
On April 3, the Centers for Medicare & Medicaid Services (CMS) released the fiscal year (FY) 2024 Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) proposed rule. CMS released a fact sheet accompanying the rule. This rule proposes to: increase IRF payment rates by 3.0 percent, revise and rebase the IRF market basket to a [...] Read More
The Centers for Medicare & Medicaid Services (CMS) has released its Announcement of Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies that would update program policies for Medicare Advantage and Medicare Part D beginning in 2024. Notably, CMS changes center on implementing provisions of the Inflation [...] Read More
The Medicaid and CHIP Payment and Access Commission (MACPAC) held a virtual public meeting on March 2, 2023. The meeting included sessions on additional analyses of potential recommendation for countercyclical disproportionate share hospital allotments and updates on unwinding the continuous coverage requirements and other flexibilities. The full agenda for the meeting and presentations for additional sessions [...] Read More
The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have announced a policy change expanding coverage for continuous glucose monitors (CGMs). The decision, which the Centers for Medicare & Medicaid Services (CMS) hopes will decrease health disparities in the diabetes community, is expected to improve health outcomes for many Medicare beneficiaries with diabetes, while reducing [...] Read More
In what it described as part of “ongoing efforts to increase access to care and to reduce unnecessary administrative burdens for stakeholders,” The Centers for Medicare & Medicaid Services (CMS) has discontinued the use of Certificates of Medical Necessity (CMN) and Durable Medical Equipment (DME) Information forms (DIFs) for claims with dates of service on [...] Read More
The Centers for Medicare & Medicaid Services (CMS) has released its Advance Notice of Methodological Changes for Calendar Year (CY) 2024 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies that would update program policies for Medicare Advantage and Medicare Part D beginning in 2024, if finalized. Notably, CMS proposals [...] Read More
In a welcome development for the laboratory industry, on December 29, 2022, President Biden signed the Continuing Appropriations Act of 2023 which instructs the Centers for Medicare & Medicaid Services to suspend for one year the implementation of the next round of price cuts to the Medicare Part B Clinical Laboratory Fee Schedule (CLFS) called [...] Read More