CMS proposes reductions in Medicaid allotments to states for hospitals’ uncompensated care

On July 28, 2017, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to implement $43 billion in reductions in federal Medicaid allotments to state Medicaid agencies for payment adjustments to hospitals serving a disproportionate share of low-income persons. The reductions in such allotments under the proposed rule will apply to federal fiscal years 2018-2025. Reductions nationwide will start at $2 billion in FY 2018 and will reach $8 billion per year in FY 2024 and FY 2025. [More]

CMS finalizes new Medicaid drug reimbursement rules

On February 1, 2016, the Centers for Medicare and Medicaid Services (CMS) published final regulations in the Federal Register on Medicaid upper payment limits (UPLs) for covered outpatient drugs, as well as rebates that drug manufacturers must provide to states. State Medicaid agencies must take into account “average manufacturers’ prices” (AMPs) and other factors in calculating state Medicaid payments for covered outpatient drugs and dispensing fees to pharmacies that purchase medications, usually from wholesalers. Based on data in reports generated by state Medicaid agencies, drug manufacturers must calculate rebates to states under methods specified in the rule. [More]

CMS and ONC update health IT goals

On January 19, 2016, the U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) released a joint statement which defines guiding principles on promoting “meaningful use” of electronic health records (EHRs) for purposes of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). [More]

CMS Finalizes New Medicare ACO Rules

The U.S. Department of Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS) published final rules in the June 9, 2015 Federal Register on accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) under section 3022 of the Affordable Care Act (ACA). Medicare providers and suppliers that participate in a qualifying ACO under the MSSP receive traditional Medicare Part A and Part B fee-for-service payments but the ACO has an opportunity to earn “shared savings” bonus payments if it achieves MSSP savings targets and quality benchmarks. [More]

Pioneer ACO Model Approved for Potential Expansion

The U.S. Department of Health and Human Services (HHS) reported on May 4, 2015 that it has obtained actuarial certification that expansion of the Pioneer ACO model would reduce net Medicare spending. Actuarial certification of this “pay-for-performance” pilot is a prerequisite under the Affordable Care Act for HHS to expand the model to a larger group of Medicare beneficiaries. [More]

President Obama Signs H.R. 4302

On April 2, President Obama signed into law H.R. 4302, the “Protecting Access to Medicare Act of 2014,” which averts a 24 percent reduction in Medicare Part B physician payment rates until at least March 31, 2015. As in many prior years, Congress set aside Medicare payment reform proposals that would have repealed the “sustainable growth rate” (SGR) formula (in Medicare law since 1997) but postponed for another year the payment reductions that the SGR formula would have imposed. Instead, physician payment rates will increase 0.5 percent as a result of the new legislation. H.R. 4302 also postpones from October 1, 2014 to October 1, 2015 the date upon which the Centers for Medicare and Medicaid Services (CMS) can require health care providers and health plans to transition from ICD-9-CM to ICD-10-CM coding on claims, a five-fold increase in diagnostic coding specificity. [More]