Hall Render

FEBRUARY 22, 2024

In the FY 2024 IPPS Final Rule (the “Final Rule”), the Centers for Medicare & Medicaid Services (“CMS”) incorporated certain social risk factors into the Hospital Value-Based Purchasing (“VBP”) Program (“the Program”).

Hospitals 66

Hospitals Medicare Medicare Medicaid 66

Hall Render

FEBRUARY 10, 2023

CVS plans to grow the Oak Street business to 300 locations by 2026. North Carolina legislators are considering a Medicaid expansion bill that includes a repeal of its CON law. CVS Health announced plans to buy Oak Street Health for $9.5 billion in cash. Oak Street Health is a large primary care provider with 160 locations.

Medicaid 40

Medicaid Medicaid Hospitals Governance 40

Healthcare Law Blog

JANUARY 26, 2024

On December 13, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, titled Advancing Interoperability and Improving Prior Authorization Processes (“Proposed Rule”), to improve patient and provider access to health information and streamline processes related to prior authorizations for medical items and services.

US Department of Health and Human Services 52

US Department of Health and Human Services Medicare Medicare Medicaid 52

HIT Consultant

FEBRUARY 9, 2023

Czekai, MPH, VP of Strategic Partnerships at Cohere Health The Centers for Medicare & Medicaid Services (CMS) recently proposed a new rule to advance interoperability and improve the prior authorization (PA) process for Medicare and Medicaid patients. LinkedIn – [link].

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Medicaid Medicaid Medicare Medicare 98

Hall Render

JULY 25, 2023

A new mandatory bundled payment model is likely on its way in 2026, and the Center for Medicare & Medicaid Innovation (“CMMI”) is seeking input on how to structure the model to work for existing population-based models, including accountable care organizations (“ACOs”). Comments must be submitted by August 17, 2023.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

CMS.gov

OCTOBER 2, 2018

Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Administrator, Centers for Medicare & Medicaid Services. Medicaid & CHIP. Better Data Will Serve as the Foundation in Modernizing the Medicaid Program. Between 2013 and 2016, Federal spending on Medicaid grew by over $100 billion.

Medicaid 40

Medicaid Medicaid Fraud Health Outcomes 40

Matt Kinley

OCTOBER 22, 2024

Large health facilities and clinics will see an increase to $23 per hour in 2024, reaching $25 per hour by 2026.Other Facilities with a large percentage of Medicare and Medicaid patients, rural independent hospitals, and small county facilities will start at $18 per hour in 2024, with a 3.5%

Compliance 40

Compliance Hospitals Medicaid Medicaid 40

Innovaare Compliance

APRIL 27, 2023

A perspective on recent industry shifts influencing ACA plan operations in states, which are yet to adopt ACA Medicaid expansion Health Exchange plans covered under ACA (Accountable Care Act) witnessed 36% enrollment growth between 2021 and 2023. This is the sharpest rise in ACA enrollment since inception.

ACA 52

ACA Medicaid Medicaid Health Outcomes 52

Healthcare IT News - Telehealth

MARCH 25, 2024

The Centers for Medicare and Medicaid Services just released data on its Acute Hospital Care at Home initiative , which thus far has admitted 11,159 patients suffering from respiratory infections, heart failure and severe sepsis. This is largely driven by an aging population and increasing preferences for care in familiar surroundings.

Hospitals 177

Hospitals Health Outcomes Medicaid Medicaid 177

C&M Health Law

DECEMBER 23, 2022

Most of the Proposed Rule’s provisions will be effective on January 1, 2026. The below summary does not focus on the Medicaid and Children’s Health Insurance Program (CHIP) Fee for Service (FFS) proposals. The deadline to submit comments is March 13, 2023. Our initial takeaways are summarized below.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Hall Render

MAY 30, 2023

On April 4, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“Proposed Rule”) that would update Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for fiscal year 2024.

Nurses 40

Nurses COVID-19 Vaccine COVID-19 Medicare 40

HIT Consultant

JUNE 7, 2023

In 2016, the Golden State began its Whole-Person Care (WPC) pilots at the county level integrating physical health, behavioral health, and social services for complex needs Medicaid enrollees. billion (about $42 per person in the US) per year after paying for the cost of food with most savings occurring within Medicare and Medicaid.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Hall Render

AUGUST 11, 2023

On August 7, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule (“Final Rule”) that updated Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for fiscal year (“FY”) 2024.

Nurses 40

Nurses COVID-19 Vaccine COVID-19 Payment Systems 40

Health Care Law Brief

FEBRUARY 8, 2024

billion to fund Medicaid, $4.8 In addition to the 1115 Waiver, which funds the Medicaid Hospital Global Budget for financially distressed safety net hospitals transitioning from volume-based reimbursement models to value-based models, the HMH Bill would also establish the Healthcare Safety Net Transformation Program (“HSNT Program”).

Medicaid 52

Medicaid Medicaid Nurses Licensing 52

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

Medisys Compliance

APRIL 18, 2022

In October 2021, the Center for Medicare and Medicaid Innovation (CMMI) announced a goal of having every Medicare beneficiary and the majority of Medicaid beneficiaries covered by some type of alternative payment model (APM) by 2030. Incentives for Medicaid clinicians who also treat Medicare patients. APMs Overview.

Medical Billing 52

Medical Billing Medical Billing Outsourcing Medicaid Medicaid 52

Health Populi

FEBRUARY 14, 2018

Three factors will drive healthcare costs to 2026: prices for medical goods and services, changes in income growth, and shifting enrollment from private health insurance to Medicare — driven by the aging of Boomers. trillion in 2026 when healthcare spending will be $1 in every $5 in the American economy (approaching 20%).

Health Insurance 79

Health Insurance Medicare Medicare Medicaid 79

Hall Render

SEPTEMBER 5, 2024

On August 1, 2024, the Centers for Medicare & Medicaid Services (“CMS”) released the Fiscal Year 2025 Hospital Inpatient Prospective Payment System Final Rule (“Final Rule”), finalizing the proposed Transforming Episode Accountability Model (“TEAM”). TEAM will begin on January 1, 2026.

Payment Systems 40

Payment Systems Hospitals Medicare Medicare 40

Healthcare Law Blog

DECEMBER 15, 2022

The Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule , “Advancing Interoperability and Improving Prior Authorization Processes” (the “Proposed Rule”), that is intended to improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Healthcare IT Today

OCTOBER 12, 2023

The Centers for Medicare & Medicaid Services (CMS) have taken a bold step by mandating a standard for prior authorization. I talked to Nikki Henck, Senior Director of Utilization Management at Sagility , about the implementation and potential impact of this proposed requirement, which, if finalized, will be enacted in January 2026.

Electronic Medical Records 112

Electronic Medical Records Doctors Governance Medicaid 112

MedTrainer

NOVEMBER 30, 2023

The Missouri Department of Social Services (DSS) is the state agency responsible for providing essential support and services to vulnerable individuals and families, including child welfare, assistance programs, and oversees the MO HealthNet Division , which is the state’s Medicaid program.

Compliance 52

Compliance Compliance Officers Hospitals Public Health 52

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.

Hospitals 40

Hospitals Payment Systems Medicare Medicare 40

Hall Render

MARCH 20, 2024

The improved information requirements apply to the following payers, including: Medicare Advantage plans; Medicaid and Children’s Health Insurance Program (“CHIP”) managed care plans; State Medicaid and CHIP fee-for-service payers; and Qualified Health Plans only in the Federally Facilitated Exchanges.

Medicare 40

Medicare Medicare Health Insurance Medicaid 40

Medisys Compliance

JULY 27, 2022

In the CY 2017 PFS Final Rule, the Centers for Medicare & Medicaid Services (CMS) modified coding and reporting of procedural services that include moderate sedation as an inherent part of the service, including for screening colonoscopies. For dates of service calendar years 2027-2029, the reduced coinsurance is 10%.

Medical Billing 52

Medical Billing Medical Billing Outsourcing ACA Medicare 52

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

Innovaare Compliance

JUNE 28, 2024

How M3P Payments are Calculated Under M3P, payments are calculated using a formula defined by the Centers for Medicare and Medicaid Services (CMS). Sponsors need to track participant behavior, adherence, and overall impact on cost-sharing. monthly rather than $2,000 upfront.

Medicare 94

Medicare Medicare Prescription Drug Pricing Compliance 94

Healthcare IT News - Telehealth

AUGUST 28, 2023

The Acute Hospital Care at Home waiver program from the Centers for Medicare & Medicaid Services has grown to 125 health systems and 289 hospitals in 37 states in less than three years. For those who don't know, please describe the Acute Hospital Care at Home waiver program from the Centers for Medicare & Medicaid Services.

Hospitals 110

Hospitals Medicaid Medicaid COVID-19 110

HIT Consultant

FEBRUARY 21, 2024

Most immediately, CMS is requiring that by January 1, 2026, affected plans (MA plans, Medicaid/CHIP programs, QHPs on the FFE) need to answer “expedited” prior auth requests within 72 hours and “standard” requests within 7 days, and provide an explicit reason for any denials.

Medicare 52

Medicare Medicare Doctors Medicaid 52

Healthcare IT Today

JUNE 7, 2023

In the comments that we will submit to ONC on HTI-1, we’ll also be encouraging ONC and the Centers for Medicare and Medicaid Services (CMS) to work more closely together to address the misalignments that frequently occur between when ONC tells software developers to deploy new certified versions and when CMS requires providers to be using them.

FDA 97

FDA Compliance Regulatory Compliance Medicaid 97

Hall Render

NOVEMBER 18, 2022

The debate about the CON law also has held up legislative negotiations over Medicaid expansion in North Carolina. The hospital is estimating that the center will see an increase of 6% in patient volume between 2022 and 2026. billion in health care investment over the past decade.

Hospitals 40

Hospitals Medicaid Medicaid 40

Hall Render

MAY 10, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) announced its plan to implement the Transforming Episode Accountability Model (“TEAM”), a new mandatory alternative payment model unveiled as part of the 2025 Hospital Inpatient Prospective Payment System proposed rule.

Medicare 40

Medicare Medicare Hospitals Medicaid 40

Healthcare Law Blog

FEBRUARY 22, 2023

With respect to the Part D Rebate Program, CMS is also soliciting comments on (i) the extent to which CMS should consider rebatable drugs that are not covered under the Medicaid Drug Rebate Program, and (ii) penalties for manufacturers who fail to pay rebates. The thirty-day public comment period ends on March 11, 2023. 9, 2023). [2]

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Health Populi

JUNE 13, 2018

Even with moderating medical trend growth, the Centers for Medicare and Medicaid Services (CMS) expect that healthcare spending will account for 20% of the U.S. economy by 2026. As with public sector healthcare spending (“entitlements” in the form of Medicare and Medicaid), healthcare spending crowds out U.S.

Medicaid 63

Medicaid Medicaid Health Insurance Medicare 63

CMS.gov

OCTOBER 2, 2018

Administrator, Centers for Medicare & Medicaid Services. economy, and by 2026 the CMS Office of the Actuary projects that one in every five dollars spent in America will be spent on healthcare. Jeremy.Booth@c…. Tue, 10/02/2018 - 13:57. Seema Verma. Modernizing Medicare to Take Advantage of the Latest Technologies.

Medicare 44

Medicare Medicare Payment Systems FDA 44

HIT Consultant

DECEMBER 8, 2021

between now and 2026. In 2018, the Centers for Medicare and Medicaid Services kicked off its first AI Health Outcomes Challenge , a cross-industry competition to innovate how AI can be implemented in current and future healthcare models.

FDA 52

FDA Medicaid Medicaid Health Outcomes 52

Health Care Law Brief

APRIL 3, 2023

On Friday, March 31, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies ( Rate Announcement ). In addition, the risk score trend for dual-eligibles is 4.67% higher than for non-dual eligible beneficiaries.

Medicare 52

Medicare Medicare Overpayments Overpayment 52

Hall Render

NOVEMBER 28, 2023

On November 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) posted a pre-publication copy of the Calendar Year (“CY”) 2024 Home Health Prospective Payment System Rate Update Final Rule (“2024 Final Rule”), which has since been filed in the Federal Register. CMS proposed to change this to six months of inactivity.

Medicare 40

Medicare Medicare Payment Systems Medicaid 40