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

NOVEMBER 10, 2021

Centers for Medicare and Medicaid Service (CMS) approved dozens of new telehealth services last year, and payers are beginning to offer virtual-first health plans, where patients first see a virtual provider before making an in-person appointment. . – Finally, estimates say U.S. The insurance side is jumping on board, too.

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COVID-19 Telemedicine Medicaid Medicaid 105

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% In total, gross spending under Medicare Part D was $240 billion in 2022; Ozempic accounted for 2% of this amount, before rebates [5]. billion [4].

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Medicare Medicare COVID-19 Medicaid 59

Hall Render

MARCH 20, 2024

The Final Rule also imposes additional reporting requirements under the Medicare Promoting Interoperability Program for eligible hospitals and critical access hospitals and for eligible clinicians reporting under the Promoting Interoperability performance category of the Merit-Based Incentive Payment System.

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Healthcare IT Today

DECEMBER 9, 2024

Earlier in 2024, the Centers for Medicare & Medicaid Services (CMS) issued the Interoperability and Patient Access Final Rule (CMS-0057-F)requiring impacted payers to implement and maintain an ePA-specific API to automate the process for providers.

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Compliance Medicaid Medicaid Public Health 81

NY Health Law

FEBRUARY 13, 2024

On January 9, 2024, the federal Centers for Medicare and Medicaid Services (CMS) finally approved New York State’s 1115 waiver amendment to establish the New York Health Equity Reform (NYHER) Program. Workforce: Workforce investments with a goal of equitable and sustainable access to care in Medicaid.

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Medicaid Medicaid Nurses Medicare 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% In total, gross spending under Medicare Part D was $240 billion in 2022; Ozempic accounted for 2% of this amount, before rebates [5]. billion [4].

Medicare 52

Medicare Medicare COVID-19 Medicaid 52

Healthcare IT Today

DECEMBER 12, 2023

The latest policy update from The Centers for Medicare and Medicaid Services (CMS) adds key provisions to the December 2022 proposed rule requiring adoption of a new NCPDP SCRIPT standard version. The proposed deadline for adopting the new CMS SCRIPT standards is January 1, 2027.

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Compliance Doctors Medicaid Medicaid 90

Medisys Compliance

JULY 27, 2022

For dates of service calendar years 2027-2029, the reduced coinsurance is 10%. For dates of service on or after calendar year 2030, Medicare waives the coinsurance. Background for Reduced Co-Insurance. These provisions are effective for services furnished on or after January 1, 2011.

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Medical Billing Medical Billing Outsourcing ACA Medicare 52

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.

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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.

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Nurses COVID-19 Vaccine COVID-19 Payment Systems 40

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. By FY 2027, these changes will increase IPPS spending by $459 million.

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Hospitals Payment Systems Medicare Medicare 40

Matt Kinley

OCTOBER 22, 2024

Other health facilities will start at $21 per hour in 2024, reaching $25 per hour by 2027 for community clinics and by 2028 for other facilities. 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%

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Compliance Hospitals Medicaid Medicaid 40

HIT Consultant

OCTOBER 23, 2023

Significant swings in recent years One key example in healthcare is outsourcing, a market expected to be worth $488 billion by 2027. By looking back over the history of this phenomenon, healthcare organizations have the opportunity to take a more reasoned, long-term approach to technology investment and shorten the time to realize the value.

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Medicaid Hospitals Medicaid Medicare 64

Health Populi

OCTOBER 8, 2019

The Centers for Medicare and Medicaid Services (CMS) forecasts that prescription drug spending will be the fastest-growing cause of rising health spending by 2027. Pricing failure, the second big waste factor, is predominantly challenged by pharmaceutical/prescription drug pricing based on this research. patients).

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Prescription Drug Pricing Medicare Medicare ACA 108

Healthcare Law Blog

AUGUST 25, 2022

The expansive legislation includes key health care provisions, including drug pricing reforms, inflationary rebates, Medicare Part D benefit redesign, as well as myriad other updates. Medicare Drug Price Negotiation Program. The Inflation Reduction Act (“IRA”) was signed into law by President Biden on August 16, 2022.

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Medicare Medicare Medicaid Medicaid 52

Hall Render

SEPTEMBER 20, 2024

NATIONAL 80 hospitals sue HHS over Medicare Advantage Days payment rule AHA op-ed in Medical Economics sets the record straight on 340B program growth and the role of drug companies As hospitals close obstetric units, maternity care deserts become more common At Catholic hospitals, a mission of charity runs up against high care costs for patients Bill (..)

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US Department of Health and Human Services Nurses Hospitals Nursing Homes 40

Health Populi

FEBRUARY 21, 2019

every year from 2020 to 2027, the actuaries at the Centers for Medicare and Medicaid Services forecast in their report, National Health Expenditure Projections, 2018-2927: Economic And Demographic Trends Drive Spending And Enrollment Growth , published yesterday by Health Affairs. National health spending in the U.S.

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Medicare Medicare Medicaid Medicaid 91

Healthcare Law Blog

JANUARY 5, 2023

Just in time for the holidays, the Centers for Medicare and Medicaid Services (“CMS”) issued the Contract Year 2024 Proposed Rule for Medicare Advantage organizations (“MAOs”) and Part D sponsors (the “Proposed Rule”). Health Equity in Medicare Advantage. We’ve summarized some of the key changes in the Proposed Rule.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

NOVEMBER 17, 2023

million Staff shortages hit Medicare Advantage stars, Kaiser exec says Sutter Health slips to 0.1% million Staff shortages hit Medicare Advantage stars, Kaiser exec says Sutter Health slips to 0.1% million patients stolen during ransomware attack MINNESOTA CFO of the Year 2023: Penny Cermak, HealthPartners Inc.

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Nursing Homes Nurses Hospitals Doctors 40

Hall Render

AUGUST 9, 2024

Louis Mercy Hospital opens new clinic for patients 65 years old and older Centene to exit Medicare Advantage market in 6 states Pediatric mental health hospital may be coming to Webster Groves State of Missouri releases preliminary health insurance rates for 2025 MONTANA Health care in the middle of nowhere U.S. Sanders releases $5.2

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

Hall Render

SEPTEMBER 27, 2024

million to help others replicate Kentucky’s lung cancer screening success SUN Behavioral will provide Clark County schools mental health $5.7 headcount among top 10 biopharma employers shrinks New Mass. million to help others replicate Kentucky’s lung cancer screening success SUN Behavioral will provide Clark County schools mental health $5.7

Nurses 40

Nurses Hospitals Nursing Homes Medicare 40

Hall Render

AUGUST 23, 2024

hospital, university working to fight ambulance staff shortage Purchase of Wadley Regional Medical Center in Hope, Ark., Vincent Heart Center ranked No. 1 in Indiana, No. million impact on local economy Proposal: Nursing home would have 10-plus years to pay $1 million owed to the state of Iowa This Des Moines hospital was rated 5 stars by CMS.

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

Hall Render

AUGUST 26, 2024

hospital, university working to fight ambulance staff shortage Purchase of Wadley Regional Medical Center in Hope, Ark., Vincent Heart Center ranked No. 1 in Indiana, No. million impact on local economy Proposal: Nursing home would have 10-plus years to pay $1 million owed to the state of Iowa This Des Moines hospital was rated 5 stars by CMS.

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

Hall Render

JUNE 28, 2024

less than MU Health projected Lutheran Family and Children’s Services Expands Services in Kansas City Kansas City groups support designating gun violence as public health crisis Fitch downgrades Missouri hospital MONTANA Organizations request Montana health department investment following Medicaid redetermination Montana offers $15.8M

US Department of Health and Human Services 40

US Department of Health and Human Services Nurses Nursing Homes Hospitals 40

Hall Render

OCTOBER 27, 2023

Ransomware attacks against hospitals put patients’ lives at risk, researchers say States, FTC continue to target noncompetes: 3 updates The best hospital in each state, per Newsweek What to know about Stark law’s $9.2M Here’s why Grady Health System recognized as health care I.T.

US Department of Health and Human Services 40

US Department of Health and Human Services Nurses Nursing Homes Hospitals 40

Hall Render

AUGUST 16, 2024

Medicaid fraud scheme Union leaders say payroll problems persist for home care workers CT universities embrace holistic care as a way to teach the new generation of health care workers Thousands of CT residents to lose HUSKY coverage, health group says. Therapist pleads guilty to $1.6M Therapist pleads guilty to $1.6M What’s causing it?

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Hospitals Nurses 40

Hall Render

AUGUST 16, 2024

Medicaid fraud scheme Union leaders say payroll problems persist for home care workers CT universities embrace holistic care as a way to teach the new generation of health care workers Thousands of CT residents to lose HUSKY coverage, health group says. Therapist pleads guilty to $1.6M Therapist pleads guilty to $1.6M What’s causing it?

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Hospitals Nurses 40

Bill of Health

MARCH 28, 2023

As bad as this seems, it is worth noting that the patents run through 2027, and the FDA has already given tentative approval to two generic versions of enzalutamide. In 2021, the Medicare program spent nearly $7 million per day on Xtandi, or $2.4 billion in one year , and this does not include the non-Medicare sales in the U.S.,

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Licensing Governance Medicare Medicare 264

Hall Render

DECEMBER 6, 2024

Medicare fraud scheme California system CEO to retire California system posts $165M annual operating loss, -18.5% Medicare fraud scheme HCA to acquire Prime Florida hospital HHS Office for Civil Rights Imposes a $1.19 A lawmaker has a new plan to help them California city approves $1.2B million for violating False Claims Act Ga.

Nursing Homes 40

Nursing Homes US Department of Health and Human Services Hospitals Nurses 40

Hall Render

NOVEMBER 22, 2024

million grant to tackle physician shortage CBRE: Folsom sale shows resilience of medical office building values Cedars-Sinai COO reflects on healthcare tech failures Dignity California hospital CEO retires How safe is your hospital? case of emerging mpox strain; risk to public ‘very low’ California medical office building sells for $14.4M

US Department of Health and Human Services 40

US Department of Health and Human Services Nursing Homes Nurses Hospitals 40

Hall Render

JANUARY 12, 2024

area to watch in 2024 DELAWARE Bayhealth now requires masks at hospitals, healthcare practices ChristianaCare drops top rated Medicare Advantage insurer. NATIONAL 60% of health systems considering ASC joint ventures 9% of hospitals had ‘vulnerable’ cash on hand levels in 2022 $3.7B region hard Development projects in the D.C.

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Nursing Homes US Department of Health and Human Services COVID-19 Nurses 40