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

The Centers for Medicare and Medicaid Services (CMS) released an information collection request (ICR) on the Medicare Transaction Facilitator (MTF) to be used in 2026 and 2027 in the Medicare Drug Price Negotiation Program. What is it. The notice indicates CMS’s intent to collect information from manufacturers of selected drugs (Primary Manufacturers) and dispensing entities through the MTF to facilitate… (Slifer, October 29, 2024) #Drug Pricing, #Medicare Part D, #Prescription Drugs

The U.S. Preventive Services Task Force (USPSTF) released a draft recommendation statement and evidence review on behavioral counseling interventions to support breastfeeding, and a draft recommendation and evidence review focusing on screening for intimate partner violence (IPV) and caregiver abuse of older or vulnerable adults. Both drafts are open for public comment, providing health care professionals and the public an… (Colocho, October 29, 2024) #Coverage Decisions, #Prevention, #Public Health, #Wellness, #Women’s Health

The Centers for Medicare & Medicaid Services (CMS) is seeking nominations for a Technical Expert Panel (TEP) to support the development and evaluation of Physician Cost Measures and Patient Relationship Codes (PCMP). This initiative aims to enhance the effectiveness and relevance of cost measures used in healthcare, ultimately improving patient care and resource utilization. Details about the TEP follow. Title: Physician… (Eisen, October 28, 2024) #Costs, #Physicians

The Biden-Harris Administration issued a National Security Memorandum (NSM) on Artificial Intelligence (AI), directing federal agencies to adopt AI responsibly in national security and intelligence work, while building guardrails to mitigate misuse risks (fact sheet). The NSM, the first of its kind, represents a pivotal step toward establishing a coordinated approach to AI’s integration into national defense, advancing U.S. leadership,… (Colocho, October 28, 2024) #Health Information Technology, #Privacy, #Transparency