In proposing a mandatory, episode-based payment model for certain hospitals, the Centers for Medicare & Medicaid Services (CMS) has provided a window into how value-based care might be addressed under a possible second Biden Administration. At issue is the Transforming Episode Accountability Model (TEAM), which was included within the fiscal year (FY) 2025 Hospital Inpatient [...] Read More
On April 11 and 12, 2024, the Medicare Payment Advisory Commission (MedPAC) held a virtual public meeting, which included the following sessions: Considering approaches for updating the Medicare physician fee schedule; Telehealth in Medicare: Status report; Alternative approaches to lowering Medicare payments for select conditions in inpatient rehabilitation facilities; Assessing consistency between plan-submitted data sources [...] Read More
On April 10, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2025 Hospital Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals and the Long-Term Care Hospital (LTCH) Prospective Payment System proposed rule. See the press release here. The rule included a proposal for a mandatory payment model called [...] Read More
Under the inpatient prospective payment system (IPPS), firms that own new and expensive technologies can apply for these technologies to receive new technology add-on payments (NTAPs.) The NTAP program was created in 2001 after Congress, concerned that the existing IPPS reimbursement structure did not incentivize the use of new technologies, passed a law[1] requiring the [...] Read More
On April 10, 2024 the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year (FY) 2025 Hospital Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals and the Long-Term Care Hospital (LTCH) Prospective Payment System proposed rule. See the press release here. CMS released a fact sheet accompanying the rule. The rule proposes [...] Read More
On April 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released its Announcement of Calendar Year (CY) 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies that would update program policies for Medicare Advantage and Medicare Part D beginning in 2025. CMS also issued its Final Calendar Year [...] Read More
The counterpart to Medicaid’s Disproportionate Share Hospital (DSH) program, Medicare’s DSH program was established with the shared objective of providing financial support to hospitals that serve a large number of low-income patients. Yet, despite this common purpose, the two programs differ significantly in terms of operational frameworks, eligibility criteria, and policy issues. Background The impetus [...] Read More
Each March, the Medicare Payment Advisory Commission (MedPAC) is required to report to Congress on the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage (MA) program, and the Medicare prescription drug program (Medicare Part D). In this report, MedPAC provides payment update recommendations for Medicare FFS payment systems, status updates on ambulatory surgical centers (ASCs), [...] Read More
On March 7 and 8, 2024, the Medicare Payment Advisory Commission (MedPAC) held a virtual public meeting, which included the following sessions: Assessing data sources for measuring health care utilization by Medicare Advantage enrollees: Encounter data and other sources; Preliminary analysis of Medicare Advantage quality; Rural hospital and clinical payment policy: A workplan for 2024-2025; [...] Read More
For suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS, herein referred to as DME, except when referenced by a federal authority) included in Medicare’s competitive bidding program (CBP), the first quarter of 2024 has been defined by continuing regulatory and economic uncertainty. Following the expiration of its contracts for off-the-shelf (OTS) [...] Read More