On December 8 and 9, 2022, the Medicaid and Children’s Health Insurance Program (CHIP) Payment Advisory Commission (MACPAC) held a virtual public meeting. The meeting included sessions on possible recommendations for improving Medicaid race and ethnicity data collection and reporting, required annual analysis of Disproportionate Share Hospital allotments, recent developments in Section 1115 demonstration waivers [...] 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
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
On October 31, the Centers for Medicare & Medicaid Services (CMS) issued the 2023 End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) final rule. The official CMS fact sheet is available here. In this final rule, CMS makes the following updates: Increases ESRD payment rates by 3.1 percent; Denies all three applications for transitional add-on [...] Read More
In June, Applied Policy’s diagnostic experts introduced a new series, “IVD Test Reimbursement: Coverage, Coding, and Payment.” For our August edition, we take a deeper dive into coding. What is coding and why is it important? Coding is the language used to report medical procedures, supplies, products, and services on health insurance claims to Medicare [...] Read More
On April 29, 2022, the Centers for Medicare & Medicaid Services (CMS) released its final rule and a fact sheet, containing policies for Medicare Advantage (MA) and Medicare Part D plans in CY (contract year) 2023. The rule includes the following changes: Redefining ‘negotiated price’ for Part D drugs so prices at point of sale [...] Read More
On April 28, 2022, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) issued the final 2023 Notice of Benefit and Payment Parameters. See the Press Release here and the Fact Sheet here. In a statement, HHS Secretary Becerra said that “[b]y including new standardized plan [...] Read More
On April 18th, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (2023) proposed Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System rule. See the press release here. CMS has provided a rule overview fact sheet and maternal health fact sheet relating to [...] Read More
On March 31, 2022, the Centers for Medicare & Medicaid Services (CMS) released the fiscal year (FY) 2023 proposed rule for inpatient psychiatric facilities (IPFs), which includes proposed policies for payment and quality reporting in these facilities. CMS also released a fact sheet on the proposed rule. This year’s proposals are primarily payment related including [...] Read More
On March 31, 2022, the Centers for Medicare & Medicaid Services (CMS) released the fiscal year (FY) 2023 proposed Inpatient Rehabilitation Facilities (IRFs) payment rule. The proposed rule includes the annual payment update and proposals related health equity in the IRF Quality Reporting Program. CMS released a fact sheet accompanying the rule. This proposed rule [...] Read More