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Archive Category: Navigating CMS Rules

For 2025, CMS Finalizes Changes Resulting in a 3.7% Increase in Plan Payments and Implements Inflation Reduction Act Provisions on Part D Benefit Redesign

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 Medicare DSH Program

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

MACPAC Releases March 2024 Report to Congress

Each March, the Medicaid and CHIP (Children’s Health Insurance Program) Payment and Access Commission (MACPAC) is required to report to Congress on the Medicaid program. In this report, MACPAC discusses engaging beneficiaries through Medical Care Advisory Committees to inform Medicaid policymaking, denials and appeals in Medicaid managed care, and its annual analysis of Medicaid disproportionate [...] Read More

MedPAC Releases March 2024 Report to Congress

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

MACPAC Holds March 2024 Meeting

On March 7 and 8, 2024, the Medicaid and CHIP Payment and Access Commission (MACPAC) held a virtual public meeting, which included the following sessions: Proposed recommendation for improving the transparency of Medicaid financing; Themes from an expert roundtable on physician-administered drugs; and Panel discussion on authorities and state Medicaid approaches for covering health-related social [...] Read More

MedPAC Holds March 2024 Meeting

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

Competitive Bidding: A Primer

    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

CMS Finalizes Disproportionate Share Hospital Third-Party Payer Rule

On February 20, 2024, the Centers for Medicare & Medicaid Services (CMS) released the final “Medicaid Program: Disproportionate Share Hospital Third-Party Payer Rule” to address legislative provisions in the Consolidated Appropriations Act, 2021 (CAA 2021), which makes changes to the hospital-specific limit on Medicaid disproportionate share hospital (DSH) payments.[1] The rule aims to provide more [...] Read More

CMS Releases Proposed Rule Increasing Oversight of Accrediting Organizations

On February 8, 2024, the Centers for Medicare & Medicaid Services (CMS) issued the proposed rule,  Strengthening Oversight of Accrediting Organizations and Preventing Accrediting Organization Conflict of Interest, and Related Provisions. A Fact Sheet for the rule can be found here. Accrediting Organizations (AOs) are responsible for determining compliance for over 9,000 Medicare and Medicaid […]

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