On January 25 and 26, 2024, the Medicaid and CHIP Payment and Access Commission (MACPAC) held a virtual public meeting, which included the following sessions: Denials and Appeals in Medicaid Managed Care; Policy Options for Improving the Transparency of Medicaid Financing; Findings from Expert Roundtable on Evaluating the Effects of Medicaid Payment Changes on Access [...] Read More
The Centers for Medicare & Medicaid Services (CMS) has released its Advance Notice of Methodological Changes for Calendar Year (CY) 2025 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 2025, if finalized. CMS also issued [...] Read More
On January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) released the Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies final rule, which finalizes policies to streamline prior authorization processes for medical items and services and improve healthcare data electronic exchange standards and [...] Read More
On January 11 and 12, 2024, the Medicare Payment Advisory Commission (MedPAC) held a virtual public meeting, which included the following sessions: Assessing payment adequacy and updating payments: Physician and other health professional services; Assessing payment adequacy and updating payments: Hospital inpatient and outpatient services; Assessing payment adequacy and updating payments: Outpatient dialysis services; hospice [...] Read More
On November 6, 2023, the Centers for Medicare & Medicaid Services (CMS) released its Medicare Program: Contract Year 2025 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; Health Information Technology Standards and Implementation Specifications (CMS-4205-P) with a [...] Read More
On November 2, the Centers for Medicare & Medicaid Services (CMS) issued the final calendar year (CY) 2024 Physician Fee Schedule, which finalizes policies for physician payment and other outpatient services covered under Medicare Part B. CMS released a fact sheet and a press release in tandem with the final rule. CMS also published a [...] Read More
On November 1, 2023, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2024 final payment rule for home health agencies (HHAs). The final rule includes the annual payment update and changes to the home health quality reporting program and value-based purchasing model. The final rule also includes provisions on durable [...] Read More
On October 27, the Centers for Medicare & Medicaid Services (CMS) issued the End-Stage Renal Disease (ESRD) Prospective Payment System final rule for calendar year (CY) 2024. See the fact sheet here. This rule finalizes the following changes: Increases ESRD payment rates by 2.1 percent, Finalizes a new transitional add-on pediatric ESRD dialysis payment adjustment, [...] Read More
On October 5, 2023, the Medicare Payment Advisory Commission (MedPAC) held a virtual public meeting. The meeting included the following sessions: Considering current law updates to Medicare’s payment rates for clinician services; Examining staffing ratios and turnover rates in nursing facilities; An alternative method to establish Medicare payments for select conditions treated in inpatient rehabilitation [...] Read More
Federal Administrative Law Judges (ALJs) exercise considerable authority in our national healthcare system. ALJs in the Food and Drug Administration routinely make adjudicatory decisions regarding drugs and medical devices. Those working within the Department of Labor may render decisions impacting a healthcare provider’s workforce or workplace. And the determinations of ALJs within the Drug Enforcement [...] Read More