Healthcare Dive

SEPTEMBER 9, 2024

The insurer’s Wellpoint subsidiary is expanding its ACA footprint for the 2025 coverage year, likely in a bid to capture enrollees who recently lost Medicaid coverage.

ACA 141

ACA Medicaid Medicaid 141

Hall Render

AUGUST 27, 2024

The Centers for Medicare & Medicaid Services (“CMS”) will publish the 2025 Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”) in the Federal Register on August 28 with an effective date of October 1, 2024. In FY 2025, acute care hospitals are estimated to experience a $3.2 for a total increase of 2.9%.

Hospitals 40

Hospitals Payment Systems Medicare Medicare 40

HIT Consultant

JULY 15, 2024

– The Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining changes to Medicare payments under the Physician Fee Schedule (PFS) for services furnished and other Medicare Part B issues on or after January 1, 2025.

Medicare 52

Medicare Medicare Payment Systems Medicaid 52

Innovaare Compliance

APRIL 7, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% or $16 billion in 2025 over 2024 in expected MA payments. generics) beginning in 2025 [1].

Medicare 59

Medicare Medicare COVID-19 Medicaid 59

Innovaare Compliance

APRIL 7, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% or $16 billion in 2025 over 2024 in expected MA payments. generics) beginning in 2025 [1].

Medicare 52

Medicare Medicare COVID-19 Medicaid 52

Jane Sarashon

JULY 18, 2024

Following the BLS report on the CPI for June 2024, PwC published their new annual report from PwC titled Behind the Numbers 2025 tells us that commercial health care spending is expected to grow some 8.0% (Motor vehicle insurance costs grew a whopping 19.5% in the report, FYI). for Group plans and 7.5% and 7.0%, respectively.

Doctors 59

Doctors Prescription Drug Pricing Hospitals Health Insurance 59

Healthcare IT News - Telehealth

APRIL 22, 2024

Currently, it also is covered in some form by about 32 state Medicaid programs. If AMA makes these changes to RPM codes, coverage changes would most likely go into effect in 2025 or later. These have been the four most common general RPM codes for a few years now. Medicare was the first to cover RPM.

Medicare 170

Medicare Medicare Medicaid Medicaid 170

Innovaare Compliance

FEBRUARY 25, 2024

The Centers for Medicare & Medicaid Services (CMS) uses the Hierarchical Condition Category (CMS-HCC) medicare risk adjustment model to determine monthly capitation fees for Medicare Advantage (MA) plans. The coverage gap will be eliminated in 2025, and manufacturers’ discounts will begin in ICL. PDT on June 3, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

SEPTEMBER 10, 2024

On July 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) issued its calendar year 2025 Medicare Physician Fee Schedule (“MPFS”) proposed rule (“Proposed Rule”), to implement certain payment updates effective January 1, 2025.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Innovaare Compliance

JUNE 30, 2024

The Centers for Medicare & Medicaid Services (CMS) provides standardized model materials to facilitate the process. Notable changes related to Part D Re-design and regulations in the final rule are highlighted below: Part D Coverage Gap is removed in CY 2025, as all references should be (e.g., Section 2.1 and Section 3.2,

Medicare 52

Medicare Medicare Compliance Medicaid 52

Innovaare Compliance

FEBRUARY 19, 2024

On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice describing the Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ahead of the final notice to be published on April 1, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

FEBRUARY 19, 2024

On January 31, 2024, the Centers for Medicare & Medicaid Services (CMS) released a draft of the 2025 Advance Notice describing the Methodological Changes for Calendar Year (CY) 2025 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ahead of the final notice to be published on April 1, 2024.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Health Care Law Brief

FEBRUARY 2, 2024

On Tuesday, January 16, 2024, Governor Kathy Hochul released the SFY 2025 New York State Executive Budget (“Executive Budget”). While still subject to legislative approval, the Executive Budget incorporates the recently approved amendment (“Waiver Amendment”) to New York’s Medicaid Section 1115 Demonstration that includes $7.5

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Fierce Healthcare

JULY 10, 2024

A proposed rule outlining the Centers for Medicare & Medicaid Services’ (CMS’) intended Medicare payment rates and policy updates for outpatient and ambulatory surgical centers (ASCs) in the co | The administration's CY 2025 OPPS and ASC Payment Systems proposed rule looks to improve obstetrical services, quality reporting and care access. (..)

Payment Systems 124

Payment Systems Medicare Medicare Medicaid 124

Fierce Healthcare

JULY 11, 2024

The Centers for Medicare & Medicaid Services' (CMS') proposed calendar year 2025 physician fee schedule rule, out Wednesday, proposed an assortment of new payments and coverage for digital heal | CMS' proposed changes to digital health payment for physicians includes new codes for mental health-related digital therapeutics, an assortment (..)

Medicaid 129

Medicaid Medicaid Medicare Medicare 129

Fierce Healthcare

APRIL 1, 2024

Insurers will feel resentful Monday as the feds opted to not reverse its decision to decrease Medicare Advantage benchmark payments by 0.16%, the Centers for Medicare and Medicaid announced. | Benchmark payments will still decrease 0.16% but the feds expect it will still pay up to $600 billion in payments to plans in 2025.

Medicare 143

Medicare Medicare Medicaid Medicaid 143

Hall Render

AUGUST 29, 2024

On August 28, 2024, the Centers for Medicare & Medicaid Services (“CMS”) published the Fiscal Year 2025 Inpatient Prospective Payment System (“IPPS”) Final Rule (“Final Rule”), which can be found here. Applications for this process are due March 31, 2025, and any FTE gained will be effective July 1, 2026.

Hospitals 40

Hospitals Medicare Medicare Payment Systems 40

Health Care Law Brief

FEBRUARY 8, 2024

This year’s Health and Mental Hygiene Bill (“HMH Bill”) (part of the Governor’s FY 2025 Executive Budget) proposes a $233 billion balanced budget, which includes $35.5 billion to fund Medicaid, $4.8 The Department of Health (“DOH”) would establish Medicaid reimbursement rates for such off-site services.

Medicaid 52

Medicaid Medicaid Nurses Licensing 52

Fierce Healthcare

APRIL 2, 2024

States now can add routine adult dental services as an essential health benefit, the Centers for Medicare & Medicaid Services announced in its 2025 Notice of Benefit and Payment Parameters fina | In its annual Notice of Benefit and Payment Parameters final rule, CMS prioritized dental and prescription drug benefits, network adequacy standardization (..)

ACA 110

ACA Medicaid Medicaid Medicare 110

Center for Health Insurance Reform

MAY 15, 2024

The Centers for Medicare & Medicaid Services have recently finalized rules and standards governing health plans and Marketplaces under the Affordable Care Act.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

HIT Consultant

JULY 18, 2024

– In accordance with the AMA semi-annual early release schedule, the new codes will be effective January 1st, 2025 and published in the 2025 CPT Code book. CPT Codes: CPT codes are essential for healthcare reimbursement, used by government payers such as Medicare and Medicaid, as well as commercial insurance companies.

FDA 114

FDA Medicaid Medicaid Medicare 114

Hall Render

MARCH 21, 2024

The Centers for Medicare & Medicaid Services (“CMS”) recently announced the ACO Primary Care Flex Model (“Flex Model”), a new voluntary model within MSSP for low-revenue ACOs, that begins January 1, 2025. ACOs currently participating in the MSSP may also participate in the Flex Model by applying to the MSSP as a renewal applicant.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Fierce Healthcare

AUGUST 21, 2023

The Centers for Medicare & Medicaid Services (CMS) released new draft guidance Monday on how it plans to roll out a program that allows Medicare members to spread out monthly payments for presc | New draft guidance gives a blueprint for pharmacies to begin offering monthly payments on prescription drugs starting in 2025.

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Hall Render

NOVEMBER 6, 2024

On November 5, 2024, the Centers for Medicare & Medicaid Services (“CMS”) extended the due date to complete and submit the new Form CMS-855A SNF Disclosures Attachment for every Skilled Nursing Facility (“SNF”). The Form CMS-855A SNF Disclosures Attachment will not be due until May 1, 2025.

Nurses 40

Nurses Medicare Medicare Medicaid 40

Hall Render

OCTOBER 15, 2024

On October 3, 2024, the Centers for Medicare & Medicaid Services (“CMS”) published an interim final rule that eliminated the low wage index hospital policy and related budget neutrality adjustments. for FY 2025. for FY 2025. This action was prompted by the D.C.

Hospitals 40

Hospitals Medicaid Medicaid Medicare 40

Hanys

FEBRUARY 23, 2024

Our new fact sheets explain why the final SFY 2024-2025 budget must: Close the Medicaid gap. Reject Medicaid cuts. We're telling legislators to stabilize New York's hospitals and nursing homes and protect New Yorkers' access to care. Provide low- and no-cost relief.

Nursing Homes 52

Nursing Homes Medicaid Medicaid Nurses 52

Healthcare IT News - Telehealth

AUGUST 29, 2024

The American Telemedicine Association and ATA Action in a letter to the Centers for Medicare and Medicaid Services seeks to preserve pandemic-era Medicare telehealth flexibilities that it says are responsible for improving access to healthcare across the U.S. Email: afox@himss.org Healthcare IT News is a HIMSS Media publication.

Medicare 114

Medicare Medicare Medicaid Medicaid 114

Hall Render

NOVEMBER 15, 2024

VMG Health’s 2025 ASC survey predicts challenges in areas such as physician recruitment, labor shortages and supply chain issues, with 72% of ASC providers prioritizing new surgeons. The company removed Steward Health Care from its portfolio, with new tenants set to start paying rent in Q1 2025.

Medicaid 40

Medicaid Medicaid Nurses Hospitals 40

Natalia Mazina

OCTOBER 30, 2022

The Act – at its core – gives CMS ability to negotiate drug prices for Medicare and Medicaid plans. I will only focus on what the Act has in store for pharmacies and will highlight the most important provisions for the pharmacy industry. By 2026, CMS will directly negotiate prices for selected drugs (initially the 10 most expensive drugs ).

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Innovaare Compliance

NOVEMBER 29, 2023

On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. The Readiness List is comprehensive and touches on all aspects of administering a Medicare Advantage plan (MA), a Prescription Drug Plan (PDP), an 1876 Cost Plan, and a Medicare-Medicaid Plan (MMP).

Medicare 52

Medicare Medicare Compliance Medicaid 52

Hall Render

NOVEMBER 14, 2024

Effective Date The effective date of the Final Rule is January 1, 2025. Practical Takeaways HHAs should review the Final Rule’s new requirement and develop the required acceptance-to-service policy before January 1, 2025. 100–07), as needed.

Payment Systems 40

Payment Systems Medicare Medicare Medicaid 40

HIT Consultant

SEPTEMBER 17, 2024

A national rollout is planned, with Crisis Care services for teens expected by 2025. Brightside Health is also expanding coverage to Medicaid beneficiaries, which is particularly significant given that 27 million children under 18 are enrolled in Medicaid and suicide ranks as the third leading cause of death among teens aged 14 to 18.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Bill of Health

OCTOBER 17, 2024

This aligns with recent guidance from the Centers for Medicare and Medicaid Services that Medicare Advantage plans may not make a determination of medical necessity solely based on algorithms using broad data sets. 2025) research interests are focused on the intersection of health and the law. Rebekah Ninan’s (J.D.

Medicare 150

Medicare Medicare Health Insurance Licensing 150

HIT Consultant

OCTOBER 2, 2024

Claimable plans to rapidly expand its support to over 100 treatments by early 2025, including those for Multiple Sclerosis, Cardiac Diseases, Diabetes, Obesity, Asthma, and certain cancers. and accepts denials from all insurance providers, including Medicare, Medicaid, and major private insurers. per appeal plus shipping. ”

Medicaid 59

Medicaid Medicaid Medicare Medicare 59

Hall Render

NOVEMBER 6, 2024

Effective Date The Final Rule is scheduled to be published on November 7, 2024, with an effective date of January 1, 2025. Revised 42 CFR Section 483.80(g)

Nursing Homes 40

Nursing Homes Nurses Medicaid Medicaid 40

Healthcare IT Today

APRIL 24, 2023

In a few years, MedArrive has built an impressive list of customers – especially with managed Medicaid health plans – demonstrating a significant ability to improve the health of very at-risk populations while also lowering costs.

Medicaid 96

Medicaid Medicaid Health Insurance Telemedicine 96

Hall Render

OCTOBER 22, 2024

Effective October 1, 2024, the Centers for Medicare & Medicaid Services (“CMS”) introduced significant updates to the CMS-855A form , specifically requiring a new Skilled Nursing Facility (“SNF”) Attachment for every SNF. Accompanying guidance to the revised form may be found here.

Medicare 40

Medicare Medicare Nurses Medicaid 40