Fierce Healthcare

APRIL 1, 2024

Insurers will feel resentful Monday as the feds opted to not reverse its decision to decrease Medicare Advantage benchmark payments by 0.16%, the Centers for Medicare and Medicaid announced. | Benchmark payments will still decrease 0.16% but the feds expect it will still pay up to $600 billion in payments to plans in 2025.

Medicare 143

Medicare Medicare Medicaid Medicaid 143

Health Care Law Brief

FEBRUARY 2, 2024

On Tuesday, January 16, 2024, Governor Kathy Hochul released the SFY 2025 New York State Executive Budget (“Executive Budget”). While still subject to legislative approval, the Executive Budget incorporates the recently approved amendment (“Waiver Amendment”) to New York’s Medicaid Section 1115 Demonstration that includes $7.5

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Fierce Healthcare

APRIL 2, 2024

States now can add routine adult dental services as an essential health benefit, the Centers for Medicare & Medicaid Services announced in its 2025 Notice of Benefit and Payment Parameters fina | In its annual Notice of Benefit and Payment Parameters final rule, CMS prioritized dental and prescription drug benefits, network adequacy standardization (..)

ACA 110

ACA Medicaid Medicaid Medicare 110

Health Care Law Brief

FEBRUARY 8, 2024

This year’s Health and Mental Hygiene Bill (“HMH Bill”) (part of the Governor’s FY 2025 Executive Budget) proposes a $233 billion balanced budget, which includes $35.5 billion to fund Medicaid, $4.8 The Department of Health (“DOH”) would establish Medicaid reimbursement rates for such off-site services.

Medicaid 52

Medicaid Medicaid Nurses Licensing 52

Hall Render

MARCH 21, 2024

The Centers for Medicare & Medicaid Services (“CMS”) recently announced the ACO Primary Care Flex Model (“Flex Model”), a new voluntary model within MSSP for low-revenue ACOs, that begins January 1, 2025. ACOs currently participating in the MSSP may also participate in the Flex Model by applying to the MSSP as a renewal applicant.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Fierce Healthcare

AUGUST 21, 2023

The Centers for Medicare & Medicaid Services (CMS) released new draft guidance Monday on how it plans to roll out a program that allows Medicare members to spread out monthly payments for presc | New draft guidance gives a blueprint for pharmacies to begin offering monthly payments on prescription drugs starting in 2025.

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Hanys

FEBRUARY 23, 2024

Our new fact sheets explain why the final SFY 2024-2025 budget must: Close the Medicaid gap. Reject Medicaid cuts. We're telling legislators to stabilize New York's hospitals and nursing homes and protect New Yorkers' access to care. Provide low- and no-cost relief.

Nursing Homes 52

Nursing Homes Medicaid Medicaid Nurses 52

Innovaare Compliance

NOVEMBER 29, 2023

On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. The Readiness List is comprehensive and touches on all aspects of administering a Medicare Advantage plan (MA), a Prescription Drug Plan (PDP), an 1876 Cost Plan, and a Medicare-Medicaid Plan (MMP).

Medicare 52

Medicare Medicare Compliance Medicaid 52

Natalia Mazina

OCTOBER 30, 2022

The Act – at its core – gives CMS ability to negotiate drug prices for Medicare and Medicaid plans. I will only focus on what the Act has in store for pharmacies and will highlight the most important provisions for the pharmacy industry. By 2026, CMS will directly negotiate prices for selected drugs (initially the 10 most expensive drugs ).

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Healthcare Law Blog

APRIL 24, 2023

On April 17, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the U.S. Beginning plan year 2025, the four-option limit will drop to two. The new rule requires that consumers be given 90 days after the loss of Medicaid or CHIP coverage to select a plan for Marketplace coverage in a Special Enrollment Period.

Medicaid 52

Medicaid Medicaid Compliance Health Insurance 52

Healthcare IT Today

DECEMBER 24, 2023

Among those organizations not using automation, 80% plan to by the end of 2025. Arizona-based VBCare Network selected Spatially Health for identifying barriers to health equity in Medicare and Medicaid beneficiaries. Chicago-area RML Specialty Hospital chose ScImage to support cloud-based PACS.

Hospitals 100

Hospitals Medicaid Medicaid Medicare 100

Health Law Advisor

FEBRUARY 2, 2023

On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. million per year starting in 2025 for PY 2018 from extrapolated recoveries. This total includes $41.1

Medicare 98

Medicare Medicare Overpayments Overpayment 98

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.

Nurses 40

Nurses COVID-19 Vaccine COVID-19 Medicare 40

Healthcare IT Today

APRIL 24, 2023

In a few years, MedArrive has built an impressive list of customers – especially with managed Medicaid health plans – demonstrating a significant ability to improve the health of very at-risk populations while also lowering costs.

Medicaid 69

Medicaid Medicaid Health Insurance Telemedicine 69

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.

Nurses 40

Nurses COVID-19 Vaccine COVID-19 Payment Systems 40

HIT Consultant

JANUARY 23, 2023

On the other hand, the outlook for some segments has worsened compared with previous analysis, including general acute care and post-acute care within providers and Medicaid within payers. Previously, in July 2022, it was estimated that provider profit pools would grow at a 7 percent CAGR from 2021 to 2025.

COVID-19 52

COVID-19 Medicaid Medicaid Public Health 52

Hall Render

JULY 7, 2023

The Centers for Medicare & Medicaid Services (“CMS”) just released its Proposed Rule for repaying hospitals that were affected by the 340B OPPS payment cuts from 2018 through 2022. decrease to the OPPS conversion factor beginning in 2025. billion of repayments will be offset by a 0.5%

Hospitals 40

Hospitals Medicaid Medicaid Medicare 40

Hall Render

NOVEMBER 29, 2023

On November 2, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2024 Medicare Physician Fee Schedule Final Rule (“Final Rule”) for calendar year (“CY”) 2024.

Medicare 40

Medicare Medicare Nurses Payment Systems 40

HIT Consultant

DECEMBER 12, 2023

In fact, by 2025, more than 70 million U.S. patients – more than 26% of the population – will benefit from some kind of RPM.

Patient Satisfaction 119

Patient Satisfaction COVID-19 Payment Systems Doctors 119

MedTrainer

NOVEMBER 17, 2023

Regulations unique to Illinois include those around the state’s Medicaid program and also encompass telehealth licensure, reimbursement, and practice standards for healthcare providers delivering care remotely. Illinois joins a growing number of states (including California and New York) in requiring additional transparency.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

HIT Consultant

AUGUST 17, 2021

In 2018, 36% of spending was via alternative payment models and by 2025, CMS has targeted 100% of Medicare and 50% of Commercial and Medicaid spending.4 Empowering The Data Science Team. The push toward value-based care is significant.

COVID-19 98

COVID-19 Health Outcomes Medicaid Medicaid 98

HIT Consultant

FEBRUARY 15, 2022

billion by 2025. Medicaid, Medicare Advantage). public Medicaid, private PPO, Medicare Advantage). Medicaid seniors), delivered in the way the cohort prefers (e.g., One telling sign of this is that the global predictive analytics healthcare market, which was valued at $1.8 – Geographic location. – Patient age.

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Healthcare IT News - Telehealth

SEPTEMBER 15, 2021

Research firm Frost & Sullivan forecasts a sevenfold growth in telehealth by 2025 – a five-year compound annual growth rate of 38%. The Centers for Medicare and Medicaid Services (CMS) began to allow for reimbursement for videoconferencing between healthcare provider and patient.

Telemedicine 176

Telemedicine COVID-19 Medicare Medicare 176

Healthcare IT Today

JUNE 7, 2023

In the comments that we will submit to ONC on HTI-1, we’ll also be encouraging ONC and the Centers for Medicare and Medicaid Services (CMS) to work more closely together to address the misalignments that frequently occur between when ONC tells software developers to deploy new certified versions and when CMS requires providers to be using them.

FDA 81

FDA Compliance Regulatory Compliance Medicaid 81

Innovaare Compliance

MARCH 11, 2024

The Centers for Medicare & Medicaid Services (CMS) has been processing Part D drug claim data via the Drug Data Processing System (DDPS) since inception of Part D in 2006. PDE provide the foundation for revenue reconciliation with drug plan sponsors (Sponsors) at the end of a contract year [1].

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Health Care Law Brief

DECEMBER 15, 2021

On November 2, 2021, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (“Final Rule”) that advances the shift from paying for Medicare home health services based on volume to a system that pays based on value. CY 2023 will be the first performance year with payment adjustments occurring in CY 2025.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”). Additional Opportunities for Integration through State Medicaid Agency Contracts (§ 422.107).

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare IT Today

MAY 25, 2023

More practices are adopting RPM programs because of the increasing patient acceptance of virtual care models, widespread reimbursement from CMS as well as private payers and Medicaid plans , and decreased cost of connected devices. And, by 2025, more than 70 million U.S. patients – 26.2%

Electronic Medical Records 88

Electronic Medical Records Doctors COVID-19 Medicaid 88

Hall Render

AUGUST 10, 2023

On August 1, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued its Final Hospital Inpatient Prospective Payment System (“IPPS”) and Long-Term Care Hospital (“LTCH”) PPS rule for fiscal year (“FY”) 2024 (“Final Rule”). The Final Rule increases the rate for IPPS payments by 3.3% in FY 2024 but applies a 0.2%

Hospitals 40

Hospitals Medicare Medicare Medicaid 40

Hall Render

APRIL 12, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”).

Medicare 40

Medicare Medicare Payment Systems Hospitals 40

Innovaare Compliance

MARCH 4, 2024

Until the enactment of the Medicare Modernization Act (MMA) in 2006 [1] , the Centers for Medicare & Medicaid Services does not cover most outpatient prescription drugs under Part B (“Part B drugs”). However, some drugs self-administered by Medicare beneficiaries at home are Part B eligible.

Medicare 52

Medicare Medicare Nurses Medicaid 52

HIT Consultant

AUGUST 15, 2022

Approximately 42% of Medicare beneficiaries are enrolled in Medicare Advantage plans—a segment projected to reach 46% by 2025. – Innovation-driven initiatives from the Centers for Medicare & Medicaid Services (CMS). . – Innovation-driven initiatives from the Centers for Medicare & Medicaid Services (CMS).

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

FEBRUARY 23, 2024

CT’s Medicaid reimbursement rates lower than peer states: report Better safety training, reporting, escorts for CT home health care workers focus of new legislation D.C. Mary’s unveils new name, but mission remains unchanged UCHealth sues thousands of patients every year. What they say sets them apart.

Nursing Homes 40

Nursing Homes Nurses Hospitals Medicaid 40

Health Populi

JULY 13, 2020

For health care, the data portrayed in the next chart will be concerning: the Medicare and Social Security Trust Funds are expected to hit “zero” (the X-access) by 2025 and just after 2030, respectively. gross domestic product in 2020, the Centers for Medicare and Medicaid Services calculated. of the U.S.

COVID-19 106

COVID-19 Medicare Medicare Hospitals 106

Hall Render

DECEMBER 18, 2023

New Reporting Requirements Starting January 1, 2024, any Reporting Company existing or registered before January 1, 2024, must file an initial report with FinCEN by January 1, 2025. Any Reporting Company created or registered after January 1, 2024, must file an initial report 90 days after its creation or registration.

Governance 40

Governance Compliance Licensing Medicaid 40

Hall Render

MAY 9, 2022

Banner plans to double the number of ASCs in its network to 50 by 2025 per Healthcare Dive: Healthcare and Health IT News. The state of Delaware proposed legislation that would require SNF and senior housing employees to receive flu vaccinations as a condition of employment.

COVID-19 40

COVID-19 Nurses Hospitals Medicaid 40

Healthcare IT News - Telehealth

AUGUST 9, 2023

In 2025, it will become mandatory for hospitals under the Hospital Inpatient Quality Reporting (IQR) program to collect and report patient-reported outcomes, risk variables, matching variables and patient-reported outcomes-related variables for at least one-half of eligible total hip and total knee patients.

Hospitals 115

Hospitals Doctors COVID-19 Health Outcomes 115