The Medicare Payment Advisory Commission (MedPAC) convened a session to discuss the issue of Medicare’s coverage limits for inpatient psychiatric care in freestanding inpatient psychiatric facilities (IPFs). MedPAC staff presented recent data that underscores the negative impact of these limits on Medicare beneficiaries, especially those with chronic and severe mental health conditions. Based on their analysis, MedPAC staff recommended eliminating… (Eisen, November 8, 2024) #Inpatient Rehabilitation Facilities, #Mental and Behavioral Health

The Medicare Payment Advisory Commission (MedPAC) convened a session to discuss a policy option to update Medicare physician fee schedule (PFS) rates as well as an option to improve the accuracy of these rates. Principal Policy Analysts Brian O’Donnell and Geoff Gerhardt reviewed Commissioners’ primary concerns with the current fee schedule updates, specifically that Medicare Economic Index (MEI) growth is projected to exceed… (Testa, November 7, 2024) #Costs, #Physicians

The Medicare Payment Advisory Commission (MedPAC) convened a session on structural differences between the Part D standalone prescription drug plan (PDP) and the Medicare Advantage prescription drug plan (MA-PD) markets. In the presentation, Senior Analyst Tara Hayes and Principal Policy Analysts Shinobu Suzuki and Andy Johnson detailed how enrollment has shifted to MA-PDs and the stability of the PDP market… (Slifer, November 7, 2024) #Medicare Advantage, #Medicare Part D

The Centers for Medicare & Medicaid Services (CMS) released its calendar year (CY) 2025 end-stage renal disease (ESRD) prospective payment system (PPS) final rule (fact sheet). Details follow. What it is. This final rule outlines ESRD PPS payment policies applying to dialysis facilities beginning on or after Jan. 1, 2025. The rule also includes an update to acute kidney injury… (Marceno, November 5, 2024) #Coverage Decisions, #Drug Pricing, #End-Stage Renal Disease

The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a session focused on the challenges of transitions of care for children and youth with special health care needs (CYSHCN) as they move from pediatric to adult health care services. The presentation included insights from a recent study involving stakeholder interviews and beneficiary focus groups, building on findings from earlier… (Colocho, November 4, 2024) #Care Coordination, #Insurance Coverage, #Pediatrics

The Centers for Medicare and Medicaid Services (CMS) released the calendar year (CY) 2025 Medicare Physician Fee Schedule (MPFS) final rule (fact sheet; MSSP fact sheet), which addresses a wide range of reimbursement-related policies under Medicare Part B and the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program (QPP).  What it is. CMS’ major proposed rule affects payments… (Testa, November 1, 2024) #Care Coordination, #Chronic Diseases, #Clinical Labs, #Delivery Reform, #Mental and Behavioral Health, #Mid-Level Practitioners, #Opioids, #Physicians, #Primary Care, #Quality, #Social Determinants of Health

The Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2025 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule (press release, fact sheet). What it is. CMS’ wide-ranging final rule affects payments to approximately 3,500 hospitals paid under the OPPS, including hospital outpatient departments (HOPDs) and 6,100 ASCs, beginning on… (Colocho, November 1, 2024) #Ambulatory Surgical Centers, #Critical Access Hospitals, #Health Equity, #Hospitals, #Mental and Behavioral Health, #Opioids, #Program Integrity, #Transparency, #Women’s Health

The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a panel to discuss policies and considerations for state Medicaid and CHIP multi-year continuous eligibility (CE) approaches. The session started with a quick background of CE and its goal to mitigate churn, which is when individuals disenroll and re-enroll in coverage within a short period of time. Beginning January 1,… (Eisen, October 31, 2024) #Coverage Decisions, #Delivery Reform, #Insurance Coverage

The Medicaid and CHIP Payment and Access Commission (MACPAC) convened a session to examine how Medicaid facilitates access to intensive residential services for children and youth with serious behavioral health conditions. This session aimed to deepen the Commission’s understanding of barriers to appropriate access to these services. Staff presented findings from a sample of publicly available state and federal reports… (Eisen, October 31, 2024) #Mental and Behavioral Health, #Pediatrics, #Public Health

The Department of Agriculture (USDA) Food and Nutrition Service (FNS) released a final rule to improve access and parity in food distribution programs (final rule; press release). Impacted programs include the Commodity Supplemental Food Program (CFSP), Food Distribution Program on Indian Reservations (FDPIR), The Emergency Food Assistance Program (TEFAP), and USDA foods disaster response. FNS finalizes changes with the following aims: Increasing… (McClurg, October 30, 2024) #Nutrition