Policy & Regulation

CMS sets minimum staffing standards for nursing homes

April 23, 2024 - A new final rule from CMS establishes minimum staffing standards for nursing homes at a national level for the first time in history. The rule states that nursing homes participating in Medicare and Medicaid must provide residents with a minimum of 3.48 hours of nursing care per day. The new staffing standard includes at least 0.55 hours of care...

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Portal allows public reporting of anti-competitive behaviors

by Jacqueline LaPointe

A new online portal allows the public to report any anti-competitive behaviors they see in the healthcare sector that may be impacting quality of care and affordability. The Federal Trade Commission...

HHS finalizes 340B Administrative Dispute Resolution process

by Jacqueline LaPointe

A new rule from HHS finalizes a revised Administrative Dispute Resolution (ADR) process under the 340B Drug Pricing Program (340B), which will allow covered entities to address disputes with...

CMS proposes payment increases for IPPS hospitals and LTCHs

by Victoria Bailey

CMS has proposed a 2.6 percent payment rate increase for acute care hospitals paid under the inpatient prospective payment system (IPPS) in FY 2025. The payment update reflects a hospital market...

CMS proposes FY 2025 Medicare payment rates for hospice, IPFs

by Jacqueline LaPointe

CMS proposes a 2.6% hospice payment update for the fiscal year (FY) 2025, which would add about $705 million to payments versus this year. The newly proposed rule (CM-1810-P) states the update comes...

Skilled nursing facility proposed rule updates payment rates, VBP program

by Victoria Bailey

CMS has released the Skilled Nursing Facility Prospective Payment System (SNF PPS), proposing a payment rate increase, revisions to nursing home enforcement authority, and updates to the quality...

CMS proposes 2.8% payment rate boost for inpatient rehabilitation facilities

by Victoria Bailey

CMS has proposed to increase payment rates for inpatient rehabilitation facilities (IRFs) by 2.8 percent in 2025. The payment update in the IRF Prospective Payment System (PPS) reflects a market...

CMS announces new ACO model focused on primary care

by Jacqueline LaPointe

CMS will test a new accountable care organization (ACO) model that focuses on primary care providers starting next year. A recent announcement states that CMS will launch a five-year voluntary ACO...

Little progress made with hospital price transparency compliance

by Jacqueline LaPointe

Hospitals have made little progress with implementing federal price transparency requirements that took effect in 2021. The latest semi-annual “Hospital Price Transparency Report” from...

$460B spending bill averts shutdown, some physician pay cuts

by Jacqueline LaPointe

Congress narrowly avoided a partial government shutdown, sending a $460 billion spending bill to the President’s desk over the weekend. The bipartisan deal, passed by the House 339-85 last...

Hospital Groups Rally Against HHS’ Interpretation of DSH Payments Formula

by Victoria Bailey

The American Hospital Association (AHA) and five other hospital groups are calling on the Supreme Court to challenge the Department of Health and Human Services’ (HHS) interpretation of...

Provider Groups Say Final Rule Will Relieve Prior Authorization Burdens

by Victoria Bailey

Provider groups are commending CMS for finalizing patient data-sharing policies and prior authorization requirements. The CMS Interoperability and Prior Authorization Final Rule requires Medicare...

Feds Finalizes $115 Participation, Other Fees for IDR Process

by Jacqueline LaPointe

The Departments of Health and Human Services, Labor, and the Treasury (the Departments) have updated the amount each party must pay to resolve surprise medical bills through the federal independent...

House Bill Addresses Price Transparency, Site-Neutral Payment Policies

by Victoria Bailey

The US House of Representatives has passed a bill to improve healthcare price transparency and establish site-neutral payment policies for drug administration. The Lower Costs, More Transparency Act...

Hospitals Concerned About Medicaid State-Directed Payment Changes

by Jacqueline LaPointe

Eight leading healthcare industry groups are urging CMS to abandon proposed restrictions on provider-based Medicaid funding sources, citing coverage and cost consequences if the proposals are...

How Nursing Homes Can Prepare for Staffing Standards, Gaps

by Victoria Bailey

After experiencing the brunt of the COVID-19 pandemic, long-term care facilities have prioritized strategies to improve staffing levels and care quality. The federal government has taken action, too, proposing minimum staffing standards...

Optum Faces Allegations of Anti-Competitive Practices from CA Health System

by Victoria Bailey

California-based health system Emanate Health has filed a lawsuit alleging that UnitedHealth Group’s Optum violated antitrust laws and engaged in anti-competitive practices regarding physician...

WA Non-Profit Health System Will Reimburse Patients in Charity Care Agreement

by Victoria Bailey

PeaceHealth, a Washington-based non-profit health system, has agreed to pay $4 million to 4,000 patients after it failed to disclose charity care policies before collecting payments. The agreement...

Regulatory Burdens in Healthcare Take Away from Patient Care

by Jacqueline LaPointe

Regulatory burdens in healthcare, such as prior authorizations, surprise billing requirements, and audits and appeals, are taking resources away from patient care as practices face more...

CMS Finalizes 1.25% Cut To Medicare Physician Fee Schedule

by Jacqueline LaPointe

CMS has released the Medicare Physician Fee Schedule (PFS) final rule for calendar year (CY) 2024, finalizing a 1.25 percent overall reduction for physician services next year. The federal agency...

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