December 24, 2019

Congress Continues to Develop Surprise Billing Legislation

On Dec. 11, the House Ways and Means Committee issued an outline of that panel’s bipartisan proposal for addressing surprise medical bills. Some details are vague, and it could be after the holidays before we see legislative language. Nonetheless, the committee’s approach offers significant differences from the recently issued agreement reached between the House Energy & Commerce Committee and the Senate Health, Labor, Education, and Pension (HELP) Committee. Like other proposals, the Ways & Means plan would limit patients’ out-of-pocket costs to the amounts they would have owed if they had the opportunity to choose in-network physicians and facilities to provide their care. An independent dispute resolution (IDR) system is also included.  However, unlike other proposals, Ways & Means does not restrict […]
December 24, 2019

CMS Issues Proposed Rule on Medicaid Oversight

On Nov. 12, 2019, CMS released a proposed rule aimed at strengthening oversight and fiscal integrity in the Medicaid program. The proposal was published in the Federal Register on Nov. 18. The proposed rule seeks greater transparency and accountability in Medicaid fee-for-service provider payments; disproportionate share hospital payments; Medicaid program financing; supplemental payments; and health care-related taxes and provider-related donations. Comments on the proposed rule are due on Jan. 17, 2020. The last several years have seen a rapid increase in Medicaid spending from $456 billion in 2013 to an estimated $576 billion in 2016. Much of this growth came from the federal share that grew from $263 billion to an estimated $363 billion during the same period. Supplemental payments, […]
December 1, 2019

CMS Issues Final Rule for Hospital Price Transparency

On Nov. 1, as part of the OPPS/ASC Final Rule, CMS also finalized policies on price transparency. These policies follow directives in President Trump’s Executive Order, “Improving Price and Quality Transparency in American Healthcare to Put Patients First,” and are intended to establish a foundation for a patient-driven healthcare system by making prices for items and services provided by all hospitals in the United States more transparent for patients so that they can be more informed about what they might pay for hospital items and services. The final rule requirements would apply to each hospital operating in the United States. The rule implements Section 2718(e) of the Public Health Service Act and improves upon prior agency guidance that required hospitals […]
December 1, 2019

CMS Issues Final Rule for 2020 OPPS/ASC Payment System

On Nov. 1, CMS issued a final rule for the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. In accordance with Medicare law, CMS is updating OPPS rates for hospitals that meet applicable quality reporting requirements by 2.6 percent. This update is based on the projected hospital market basket increase of 3.0 percent minus a 0.4 percentage point adjustment for Multi-Factor Productivity (MFP). Using the hospital market basket, CMS is finalizing an update to the ASC rates for CY 2020 equal to 2.6 percent. The update applies to ASCs meeting relevant quality reporting requirements. This change is based on the projected hospital market basket increase of 3.0 percent minus a 0.4 percentage point adjustment […]