The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2026 hospice payment rate update proposed rule (fact sheet). What it is. The proposed rule addresses the hospice wage index, payment rates, and aggregate cap amount for FY 2026, along with updates from the hospice quality reporting program. Why it’s important for you. CMS proposes a 2.4… (Colocho, April 14, 2025) #End of Life and Palliative Care, #Health Equity, #Hospice, #Nutrition, #Wellness

The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2026 inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule (fact sheet), which applies to acute care hospital and LTCH payments beginning Oct. 1, 2025. Under the proposed rule, acute care hospitals would receive a 2.4 percent increase ($4 billion including the… (Testa, April 11, 2025) #Critical Access Hospitals, #Demonstration Programs, #Disproportionate Share Hospitals (DSH), #Hospitals, #Long-Term Care Hospitals, #Nutrition, #Quality, #Readmissions, #Workforce

The Medicaid and CHIP Payment and Access Commission (MACPAC) held a panel session focused on the use of automation and artificial intelligence (AI) in the Medicaid prior authorization process. The discussion explored how these technologies are currently being implemented, their potential to improve efficiency, and the implications for payers, providers, and beneficiaries. Panelists included Dr. Sanmi Koyejo of Stanford University,… (Colocho, April 11, 2025) #Health Information Technology

The Medicare Payment Advisory Committee (MedPAC) convened a session to assess the utilization and delivery of supplemental benefits in Medicare Advantage (MA). This meeting followed a session in October focused on the background and plan financing of supplemental benefits (Impact summary). The staff presentation highlighted that it is difficult to assess the value provided by spending on supplemental benefits because of the limitations… (McClurg, April 11, 2025) #Medicare Advantage

Today, the Medicare Payment Advisory Committee (MedPAC) convened its third session this cycle about the long-stay nursing home population. The Commission previously reviewed its workplan for the topic in October (Impact summary) and discussed Institutional Special Needs Plans (I-SNPs) in March (Impact summary). Today’s session focused on long-standing concerns about the quality of care this population receives in nursing homes…. (Testa, April 11, 2025) #Long-Term Care, #Quality, #Readmissions, #Skilled Nursing Facilities, #Workforce

The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a session to review a draft chapter for the June 2025 Report to Congress on the Program of All-Inclusive Care for the Elderly (PACE) – a fully integrated Medicare-Medicaid program that serves adults ages 55 and older with nursing facility level of care needs while allowing them to live in… (Llamas, April 10, 2025) #Dual Eligibles

CMS issued a press release describing the new Administrator for the Center for Medicare & Medicaid’s vision and his role in the “Make America Healthy Again” agenda. The release describes a focus on modernizing Medicare, the Marketplaces, and Medicaid, including empowering Americans with personalized health solutions and greater cost transparency, as directed by the President’s Executive Order. Under Dr. Mehmet Oz’s leadership, CMS… (Testa, April 10, 2025) #Chronic Diseases, #Costs, #Nutrition, #Prevention, #Program Integrity, #Transparency, #Wellness

The Government Accountability Office (GAO) released a study addressing ongoing drug shortages in the United States, which have been significantly exacerbated by the COVID-19 pandemic. Although the types of drugs in shortage remain consistent with pre-pandemic patterns, the report underscores how the pandemic deepened existing supply chain vulnerabilities, particularly in essential areas like oncology and injectable drugs. While the number… (Eisen, April 9, 2025) #Drug Pricing, #Food and Drug Administration

The House Ways and Means (W&M) Health Subcommittee convened a hearing on the health of the biosimilar market and how increased access to such products can lower prescription drug costs for patients. The following witnesses spoke to the market distortions that impact the biosimilar market, including the tendency for insurers and pharmacy benefit managers (PBMs) to provide preferential formulary placement… (Slifer, April 8, 2025) #Biosimilars, #Prescription Drugs

the Centers for Medicare and Medicaid Services (CMS) announced the Calendar Year (CY) 2026 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (Rate Announcement) (press release and fact sheet) and the Final CY 2026 Part D Redesign Program Instructions (fact sheet). What it is. The Rate Announcement addresses a wide array of MA and Part… (Slifer, April 7, 2025) #Demonstration Programs, #Medicare Advantage, #Medicare Part D, #Prescription Drugs, #Risk Adjustment