Policy & Regulation News

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

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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

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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 FY 2025 Medicare payment rates for hospice, IPFs

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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...

Provider Groups Say Final Rule Will Relieve Prior Authorization Burdens

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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

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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...

Hospitals Concerned About Medicaid State-Directed Payment Changes

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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...

Regulatory Burdens in Healthcare Take Away from Patient Care

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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 Will Issue OPPS Providers Lump-Sum Payments to Remedy 340B Losses

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Hospital Outpatient Prospective Payment System (OPPS) providers participating in the 340B drug pricing program will receive a one-time lump-sum payment to offset losses between calendar years (CYs)...

CMS Finalizes 1.25% Cut To Medicare Physician Fee Schedule

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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...

CMS Finalizes a $140M Increase to Medicare Home Health Payment Rates

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After initially proposing a decrease, CMS has finalized a 0.8 percent increase in Medicare payment rates for home health agencies in 2024, boosting reimbursement by $140 million compared to 2023. The...

CMS Boosts End-Stage Renal Disease Medicare Rates by 2.1%

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CMS recently released the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) final rule for 2024, which includes a 2.1 percent Medicare rate hike for renal dialysis services furnished to...

AHA Calls for Easier On-Ramp for Bundled Payments, Episode-Based Payments

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The American Hospital Association wants it to be easier for hospitals nationwide to begin adopting episode-based payment models, such as bundled payments, the trade association wrote in a recent letter...

Inpatient Providers Will Receive 3.1% Reimbursement Increase in FY24

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CMS has increased Medicare payment rates for inpatient providers and long-term care hospitals (LTCHs) in the fiscal year (FY) 2024 Medicare hospital inpatient prospective payment system (IPPS) and LTCH...

CMS Increases 2024 Skilled Nursing Facility Payments by 4%

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CMS has finalized a 4.0 percent increase in Medicare Part A payments to skilled nursing facilities (SNFs) in fiscal year (FY) 2024. The payment boost translates to $1.4 billion and is slightly higher...

CMS Boosts FY24 Payment Rates for Inpatient Psychiatric and Rehab Facilities

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CMS has finalized payment increases for inpatient psychiatric facilities (IPFs) and inpatient rehabilitation facilities (IRFs). IPF Prospective Payment System The IPF prospective payment system (PPS)...

CMS Proposes Payment Cuts in CY24 Medicare Physician Fee Schedule

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CMS has proposed payment cuts in its calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS), including a 3.34 percent decrease to the conversion factor that would reduce payment rates by 1.25...

OPPS Rule to Update Outpatient Payments, Hospital Price Transparency

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CMS proposes in the Outpatient Prospective Payment (OPPS) rule to increase Medicare outpatient payments by 2.8 percent next year while bolstering hospital price transparency enforcement. The OPPS rule...

CMS to Resolve 340B Payment Mixup With $9B Lump-Sum Fix

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CMS has proposed to pay $9 billion to hospitals impacted by payment cuts to the 340B Drug Pricing Program between 2018 and 2022. The proposal is CMS’ remedy to cutting 340B payments from the...

CMS Proposes $375M Cut to Medicare Home Health Payments

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CMS has released the calendar year (CY) 2024 Home Health Prospective Payment System (HH PPS) Rate Update proposed rule, which includes a 2.2 percent, or $375 million, cut to Medicare home health...

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