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.

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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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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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Health Care Law Brief

FEBRUARY 2, 2024

The Waiver Amendment was approved on January 9, 2024, by the Centers for Medicare & Medicaid Services (“CMS”) under Section 1115(a) of the Social Security Act and will expire on March 31, 2027. The rates must be at least 80% of Medicare rates. billion in Medicaid investments over the next three years.

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Healthcare IT Today

SEPTEMBER 26, 2024

The rollout of the Centers for Medicare & Medicaid Services (CMS) Health Equity Index (HEI) further underscores this shift by integrating several Star measures and Social Determinants of Health (SDOH) into its evaluation criteria. Investing in AI and analytics gives health plans insights beyond traditional claims and medical data.

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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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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. CMS sees this as a 3.7%

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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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Healthcare IT Today

AUGUST 11, 2024

Inovalon launched Converged Stars Health Equity Analytics to help Medicare Advantage (MA) plans align with the new CMS Health Equity Index framework. Cybersecurity vendor TRIMEDX was recertified for Medical Device Quality Management System (MD QMS) certification ISO 13485 through the end of August 2027.

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Medicare Medicare 71

Health Care Law Brief

FEBRUARY 16, 2024

Existing contract terms that conflict with newly proposed network pharmacy contract restrictions would be voided and superseded by the draft regulations after January 1, 2027. ERISA/self-insured plans are not expressly excluded from the scope of the draft rules, unlike the Medicare Advantage and Worker’s Compensation plans that are excluded.

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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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Healthcare Law Blog

FEBRUARY 12, 2024

CMS indicates in the Demonstration Amendment that, effective in April 2024, HRSN benefits will be put into action through non-risk arrangements in managed care, with the intent to integrate such benefits in full risk managed care programs by March 2027.

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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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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. The State is also required to invest approximately $199 million in rate increases, even if no Medicaid rates are below 80% of Medicare rates.

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HIT Consultant

MAY 1, 2023

And while some may have caught wind of RPM reimbursement, we’re coming across other providers who have the misconception that only Medicare reimburses for RPM. In reality, there are dozens of private payors covering RPM, with some reimbursing at even higher levels than Medicare. billion in 2027. billion in 2020 to nearly $16.3

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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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Healthcare Law Blog

APRIL 6, 2022

On April 1, 2022 , the Centers for Medicare & Medicaid Services (“CMS”) announced states may seek to extend Medicaid postpartum coverage from 60 days to one year through a new state plan option offered by the American Rescue Plan Act (“ARPA”). This option is available for five years and ends on March 31, 2027.

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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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Hall Render

JANUARY 12, 2022

This client alert is Part 5 of our series providing insight into Medicare graduate medical education (“GME”) reimbursement changes that occurred in 2021. Each year between federal fiscal year (“FY”) 2023 and FY 2027, CME will award up to 200 new FTE cap slots to eligible hospitals who submit timely applications.

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Healthcare IT Today

JANUARY 5, 2023

The 2023 final Medicare Physician Fee Schedule (PFS) eased supervisory requirements for care delivered by a licensed professional counselor or licensed marriage and family therapist. health expenses by 2027, thanks to rising labor and supply costs. Almost 75% say that this impacts patient care moderately to severely.

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HIT Consultant

SEPTEMBER 18, 2024

That’s when the Biden administration announced its new mandate — the CMS Interoperability and Prior Authorization Final Rule — designed to effectively speed up the process for Medicare Advantage patients, providers and health plans. Speed is only one of many inefficiencies surrounding prior authorization.

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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

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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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.

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Medicare Medicare Medicaid Medicaid 52

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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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

HIT Consultant

JANUARY 17, 2024

– Public reporting: Similar to Medicare FFS, impacted payers must report prior authorization metrics, increasing transparency and accountability. – Clearer communication: All payers must provide specific reasons for denial, allowing for easier resubmissions or appeals.

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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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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

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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.

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Hall Render

AUGUST 26, 2024

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. hospitals Gov. hospitals Gov.

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

Hall Render

AUGUST 23, 2024

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. hospitals Gov. hospitals Gov.

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US Department of Health and Human Services Nursing Homes Nurses 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 with historic building purchase MICHIGAN Bronson raises capital campaign goal to $4.5M

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Hall Render

JUNE 28, 2024

Pritzker joins health officials, advocates to redouble HIV/AIDS prevention efforts Illinois Man Indicted on Several Fraud Charges Linked to COVID Pandemic INDIANA Franciscan Alliance sued by Indy physician for breach of contract, interfering in practice Hamilton County hospital surge comes amid closings elsewhere IU Health’s $2.3B

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US Department of Health and Human Services Nurses Nursing Homes Hospitals 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 265

Hall Render

AUGUST 16, 2024

Check list of latest federal quality ratings Obesity rates are skyrocketing in NJ post-COVID. What’s causing it? Davis Medical Center, a state-run hospital in Dinwiddie County, is closing WASHINGTON 1,100 workers at Providence hospital plan 8-day strike How Providence, Northwell are handling a blood culture bottle shortage Introducing St.

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

Check list of latest federal quality ratings Obesity rates are skyrocketing in NJ post-COVID. What’s causing it? Davis Medical Center, a state-run hospital in Dinwiddie County, is closing WASHINGTON 1,100 workers at Providence hospital plan 8-day strike How Providence, Northwell are handling a blood culture bottle shortage Introducing St.

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