Section 216 of the Protecting Access to Medicare Act of 2014 (PAMA) was intended to reduce Medicare spending on lab testing by implementing a market-based fee schedule and was prompted by the recognition that Medicare was paying higher rates for many tests than were private payers.[1] - Next phase in of up to 15 percent [...] Read More
On the evening of December 17, 2021, the Centers for Medicare & Medicaid Services (CMS) released a follow-up to its final rule, Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Final Policy Changes and Fiscal Year 2022 Rates,[1],[2] which addresses policies that were proposed but [...] Read More
Two years ago, in my role as Chairman of the Board of the Alliance for Aging Research, I wrote about the failure of CMS to adequately reimburse for the use of PET amyloid scans to help diagnose Alzheimer’s disease. At that time, I noted that with the appropriate use of PET scans, which can detect [...] Read More
On July 9, 2021, the Biden Administration issued an executive order (EO), “Promoting Competition in the American Economy,” to address corporate consolidation, lack of competition and high prices for consumers, and low wages.[i] The health care portion of the EO focuses on improving competition to address health care prices and access to care in four [...] Read More
On June 15, 2021, the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) released one of their two annual Reports to Congress.[1],[2] The June report addresses high-cost specialty drugs in the Medicaid program; access to mental health services for Medicaid and Children’s Health Insurance Program (CHIP) enrollees; the use of EHR [...] Read More
On the evening of April 27, 2021, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule, Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Final Policy Changes and Fiscal Year 2022 Rates (link), which updates the FY 2022 payment systems and [...] Read More
On April 8th, 2021, the Centers for Medicare & Medicaid Services (CMS) released a fact sheet and unpublished proposed rule, Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2022, which updates payment rates and policies for these facilities: Increase [...] Read More
On the evening of April 8th, the Centers for Medicare & Medicaid Services (CMS) released the fiscal year (FY) 2022 proposed rule for hospices. This proposed rule includes the annual payment and quality reporting updates, a request for feedback on hospice utilization, and a proposal to make certain blanket waivers permanent that were adopted in [...] Read More
On the evening of April 7th, the Centers for Medicare & Medicaid Services (CMS) released the fiscal year (FY) 2022 proposed rule for inpatient psychiatric facilities (IPFs), which includes proposed policies for payment and quality reporting in these facilities. Comments on the proposed rule are due on June 7, 2021. CMS Predicts Increase in IPF [...] Read More
On April 7, 2021, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule for inpatient rehabilitation facilities (IRFs) for fiscal year (FY) 2022. CMS proposes updates related to payment and the IRF Quality Reporting Program. Comments on this proposed rule are due June 7, 2021. Inpatient Rehabilitation Facilities to Get a $160m [...] Read More