Prior Authorizations: An Introduction
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…
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CMS Proposes FY 2024 Inpatient Payment Policies for Hospitals, Increasing Payment Rates, Advancing Equity, and Proposing Quality Reporting Changes (CMS-1785-P)
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…
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CMS Finalizes CY 2024 Policy Changes for Medicare Advantage and Part D Plans Impacting Plan Utilization Management, Patient Protections, and Health Equity
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,…
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CMS Increases Payments for Inpatient Rehabilitation Facilities in FY 2024, Proposes Changes to the Quality Reporting Program
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…
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For 2024, CMS Finalizes Changes Resulting in a 3% Increase in Plan Payments and Implements Inflation Reduction Act Provisions on Part D Benefit
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…
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An Overview of CMS Continuous Enrollment Condition Unwinding Webinar and Key Resources for Medicaid Stakeholders and Providers
In March 2020, the Families First Coronavirus Response Act established the “continuous enrollment condition,” which provided states with extra federal Medicaid funding in exchange for maintaining enrollments for…
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When medicine gets it wrong
We trust modern medicine to be evidence-based: grounded in the most current and reliable research available. But sometimes medicine gets it wrong, and clinicians engage in unproven, ineffective,…
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MedPAC Holds March 2023 Meeting
On March 2 and 3, 2023, the Medicare Payment Advisory Commission (MedPAC) held a virtual public meeting. The meeting included sessions on the following: Reforming Medicare’s wage index…
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MACPAC Holds March 2023 Meeting
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…
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CMS expands Medicare coverage for Continuous Glucose Monitors
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…
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Certificates of need
Thirty-five states and the District of Columbia currently have some form of certificate of need (CON) requirement under which specified healthcare organizations—including hospitals, outpatient facilities, and long-term care facilities—must secure…
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CMS eliminates requirement for CMNs and DIFs
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…
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