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
On July 13th, the Centers for Medicare & Medicaid Services (CMS) issued the Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems proposed rule, which proposes updates to the OPPS and the Medicare ASC payment system for calendar year (CY) 2024. See the press release here. CMS has provided a rule overview [...] Read More
On June 22, 2023, Centers for Medicare & Medicaid Services (CMS) released the highly anticipated proposed Medicare device coverage pathway for breakthrough medical devices, known as Transitional Coverage for Emerging Technologies (CMS-3421). Rather than a newly proposed rule, CMS released a proposed notice, which describes the process CMS will use to provide transitional coverage for [...] Read More
The American Academy of Professional Coders (AAPC) held its highly anticipated national conference, HEALTHCON 2023, in Nashville, Tennessee, May 22-24. The event attracted a wide range of professionals from the healthcare industry. Applied Policy’s April Gutmann and Meghan Basler, attended the conference to gain valuable insights into billing and coding practices across different payment systems [...] Read More
Step therapy is the process under which a health insurance plan requires a patient to try one or more alternative—typically lower cost— drugs or treatment options before they can access the prescription which their physician has identified as the optimal treatment option for their diagnosis. For AHIP, the association representing America’s health plans, the stepwise [...] Read More
As noted last month, prior authorizations can be an important means of identifying clinically inappropriate or duplicative care. They are also increasingly employed as gatekeeping mechanisms to control healthcare spending by limiting utilization. This month, in the second installment of our conversation about prior authorizations, we examine how the U.S. healthcare system has given rise [...] Read More
On April 25, the Centers for Medicare & Medicaid Services (CMS) hosted an office hours session to help providers, facilities, and Medicare beneficiaries prepare for the end of the COVID-19 public health emergency (PHE) on May 11, 2023. The Agency will post a recording of the session on the CMS National Stakeholder Calls webpage. Will [...] Read More
On April 17, 2023, 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 2024. See the Press Release here and the Fact Sheet here. In a statement, HHS Secretary Becerra said that “[t]he Biden-Harris Administration has [...] Read More
As an appreciation for the impact of social determinants of health moves from academia to practical applications, many healthcare providers, payers, and policymakers are exploring the potential of “food as medicine.” From healthcare systems delivering medically tailored meals (MTMs) for patients with complex medical conditions to Medicaid programs subsidizing the purchase of fruits and vegetables [...] Read More
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