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
On April 4, 2024, the Centers for Medicare & Medicaid Services (CMS) released its Medicare Program; Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Program for Contract Year 2024--Remaining Provisions and Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, [...] Read More
On April 2, 2024, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) issued the final Notice of Benefit and Payment Parameters for 2025 (CMS-9895-F) with a press release and fact sheet. This rule makes the following changes: Changes certain EHB prescription drug benefit requirements, Strengthens [...] Read More
On April 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released its Announcement of Calendar Year (CY) 2025 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 2025. CMS also issued its Final Calendar Year [...] 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 March 28, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2025 Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) and Quality Reporting (IPFQR) Updates proposed rule. CMS released a fact sheet accompanying the rule. In this rule, CMS proposes to: Increase IPF PPS payment rates by 2.7 percent; [...] Read More
Each March, the Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) is required to report to Congress on the Medicaid program. In this report, MACPAC discusses engaging beneficiaries through Medical Care Advisory Committees to inform Medicaid policymaking, denials and appeals in Medicaid managed care, and its annual analysis of Medicaid disproportionate [...] Read More
Each March, the Medicare Payment Advisory Commission (MedPAC) is required to report to Congress on the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage (MA) program, and the Medicare prescription drug program (Medicare Part D). In this report, MedPAC provides payment update recommendations for Medicare FFS payment systems, status updates on ambulatory surgical centers (ASCs), [...] Read More
On March 7 and 8, 2024, the Medicaid and CHIP Payment and Access Commission (MACPAC) held a virtual public meeting, which included the following sessions: Proposed recommendation for improving the transparency of Medicaid financing; Themes from an expert roundtable on physician-administered drugs; and Panel discussion on authorities and state Medicaid approaches for covering health-related social [...] Read More
On March 7 and 8, 2024, the Medicare Payment Advisory Commission (MedPAC) held a virtual public meeting, which included the following sessions: Assessing data sources for measuring health care utilization by Medicare Advantage enrollees: Encounter data and other sources; Preliminary analysis of Medicare Advantage quality; Rural hospital and clinical payment policy: A workplan for 2024-2025; [...] Read More