CMS

ACOs Flock to CMS Shared Savings Program, NSA Averts Surprise Billing

January 31, 2024 - The CMS Medicare Shared Savings Program (MSSP) saw an uptick in accountable care organization (ACO) involvement. The agency announced that 480 ACOs are participating in the MSSP and 245 organizations are involved in two CMS Innovation Center ACO models. As a result of these and other efforts, nearly half of all Traditional Medicare...

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Providers Laud Prior Authorization Rule, EHRs Can Lower Provider Burnout

by Editorial Staff

Providers were encouraged by the new CMS rule on prior authorizations, which holds payers to a higher standard on prior authorization denials, transparency, and timing. The new rule, which CMS...

CMS Starts Maternal Health Program, 2022 National Spending Normalizes

by Editorial Staff

CMS announced an initiative to improve maternal health outcomes for Medicaid and CHIP beneficiaries. The new initiative, called the Transforming Maternal Health model, will last ten...

CMS Cuts Medicare Pay, AHA Sues HHS on Tracking Technology Policy

by Editorial Staff

In its calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS), CMS announced it will slash Medicare payments by 1.25 percent. Primary care and direct patient care providers received an...

CMS Reinstates Original IDR Fee, HHS Launches Heat-Related Illness Tracker

by Hayden Schmidt

In healthcare policy news this week, CMS was sued by the Texas Medical Association after hiking independent dispute resolution fees by 600 percent in December. Meanwhile, HHS is launching a...

House Passes $1.9B Budget for VA EHRM, Uninsured Rate Drops During COVID

by Hayden Schmidt

In healthcare policy news this week, an appropriations act aims to overhaul the VA’s Oracle Cerner EHR implementation. Meanwhile, HHS data showed that 6.3 million people gained healthcare...

CMS Pauses Medicaid Redeterminations, $44M Telehealth Fraud Scheme

by Hayden Schmidt

In healthcare policy news this week, CMS is pausing several state coverage redeterminations in light of procedural challenges that have resulted in millions losing their health insurance. Meanwhile, a...

CMS to Cut Medicare Payment Rates, FDA Approves OTC Birth Control

by Hayden Schmidt

In healthcare policy news this week, the Opill, a progestin-only daily birth control pill, will be available without a prescription in early 2024. Meanwhile, CMS plans to cut payment rates for some...

CMS Pitches New Value-Based Care Model, Medicare Spending Rises Fast

by Hayden Schmidt

In policy news this week, CMS will test a new value-based care model in eight states. The model offers participants additional revenue to improve their primary care services. Meanwhile, research from...

Officials Probe Google for Data Practices, CMS Withdraws Vaccine Mandate

by Hayden Schmidt

In policy news this week, elected officials are pushing Google to get stricter with its health data-sharing policy. Meanwhile, CMS rescinded its health worker vaccine mandate. Senators Ask Google to...

VA Deals with Another EHR Outage, CMS to Enforce Price Transparency Rules

by Hayden Schmidt

This week in policy news, politicians are preparing legislation to reign in the VA EHR modernization program while CMS gears up to fine hospitals that still haven’t complied with transparency...

CMS Underreported Nursing Home Quality Issues, New $5B Vaccine Project

by Hayden Schmidt

In healthcare policy news this week, an inspector general report found massive underreporting of quality issues at nursing homes by CMS. Meanwhile, the Biden Administration is launching a $5 billion...

CDC Warns of Deadly Fungus, CMS to Reimburse for Virtual Reality

by Hayden Schmidt

In healthcare policy news, a warning was issued by the CDC last week about a deadly fungal infection spreading in US healthcare facilities. Meanwhile, CMS is creating a reimbursement pathway for...

Humana’s Shift to Public Insurance, CMS Proposes Changes to DSH Program

by Hayden Schmidt

This week, CMS proposed a rule that would update requirements for the Disproportionate Share Hospital (DSH) program following the Consolidated Appropriations Act of 2021. And insurance giant Humana...

CMS Pauses Payment Determinations, Senators Introduce SAFER Health Act

by Hayden Schmidt

This week CMS decided to pause all payment determinations from certified independent dispute resolution (IDR) entities following a Texas district court decision. Meanwhile, a bill recently debuted in...

HHS Posts Timeline for Drug Negotiations, FDA Approves Alzheimer’s Drug

by Hayden Schmidt

In this week’s policy roundup, the Department of Health and Human Services (HHS) released its detailed timeline for drug pricing negotiations that will begin next year. Meanwhile, the FDA granted...

CDC Finds 3,500 Long COVID Deaths, Healthcare Spending Reaches $4.3T

by Hayden Schmidt

In this week’s policy roundup, the annual CMS accounting report found that healthcare expenditures slowed compared to 2020 but still reached $4.3 trillion in 2021. And a CDC study looking at...

States Look to Repeal Vaccine Mandate and Ask Apple to Improve Data Privacy

by Hayden Schmidt

A group of 10 state attorneys general wrote a letter to Apple’s Tim Cook asking the CEO to improve health data privacy in its app store in the wake of Roe v. Wade’s undoing. Meanwhile,...

CMS Settles Physician Fee Schedule, FDA Urged to Recall Dry Shampoos

by Hayden Schmidt

The FDA is being pressured to force a recall of popular dry shampoos from the market after it was found that many contain benzene, a carcinogenic chemical. Meanwhile, CMS released its physician fee...

DOD Awards Grant for Dementia Treatment, FDA Issues Rare Disease Grants

by Hayden Schmidt

The Department of Defense and FDA announced new grants that will be used to create treatments and therapies for several debilitating diseases. The grants, worth over $40 million, will address dementia...

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