Archive for Medicare
The moratorium on the two percent sequestration of Medicare payments could be extended under a bill the U.S. House of Representatives may consider this week. If adopted, the bill would extend the sequester delay for nine months, providing financial relief that many health care providers seek as they continue to deal with the financial challenges posed by COVID-19. The sequester delay was implemented early in the pandemic as a means of providing additional Medicare revenue to hospitals and other health care providers at a time when many people were delaying seeking medical attention out of fear of contracting COVID-19. Without action by Congress, the current delay of the Medicare sequester will expire at the end of March. SNAP has urged … Read More
The next federal COVID-19 relief bill should include more resources for the Provider Relief Fund, SNAP has told members of Pennsylvania’s congressional delegation. The bill also should include additional targeted funding for safety-net hospitals, help with staffing, an extension of the current moratorium on the Medicare sequestration, and forgiveness for safety-net hospitals for loans they received under the Medicare Accelerated and Advance Payment Program. This was the message the Safety-Net Association of Pennsylvania conveyed last week in a letter to members of Pennsylvania’s congressional delegation. See that letter here.
Unless Congress intervenes, hospitals will soon begin repaying massive federal loans they received to help them cope with the COVID-19 public health emergency. The loans, authorized by the federal CARES Act, were made through the Accelerated and Advance Loan Program, and in all, Medicare made nearly $100 billion in such loans to providers. Under the legislation, Medicare was to begin recouping the loans 120 days after hospitals received them, with recoupment coming by Medicare ceasing to pay hospitals’ Medicare claims until the full amount of the loan was repaid. Now the loans are coming due but hospitals are saying they are not ready to forego all of their Medicare revenue. While some hospital groups have asked for 100 percent forgiveness … Read More
Coronavirus Update: March 31, 2020. COVID-19-related developments in Pennsylvania as of 4:00 p.m. on Tuesday, March 31. To receive this daily update directly, sign up for our mailing list at email@example.com. State Update Governor Wolf Today, Governor Wolf announced that the President approved part of his request for a major disaster declaration to support state, county, and local responses to COVID-19. Included in the approved requests are reimbursement of up to 75 percent of eligible expenses (staff overtime, supplies, equipment) related to COVID-19 response for all levels of state government and private non-profits that qualify and direct federal assistance for materials and supplies to state and local governments. Staff from the Pennsylvania Emergency Management Agency will be contacting potential applicants in … Read More
The Trump administration’s health care regulatory priorities for 2020 have been outlined by the Office of Management and Budget in a newly released “Statement of Regulatory Priorities for Fiscal Year 2020.” The statement, an annual OMB document, organizes the priorities as follows: Facilitating patient-centered markets Fixing health care financing through protecting private insurance and Medicare Fixing health care financing through reforming the individual market Fixing health care financing through making the ACA and Medicaid fiscally sustainable Bringing value to health care through price and quality transparency Bringing value to health care through patient-centered health IT Bringing value to health care through deregulation, especially for coordinated care Bringing value to health care through tackling the high cost of prescription drugs Bringing … Read More
Safety-net hospitals are among the leading beneficiaries of changes implemented this year in Medicare’s hospital readmissions reduction program. According to a new study, safety-net, academic, and rural hospitals have enjoyed improved performance under the program since Medicare began organizing hospitals into peer groups based on the proportion of low-income patients they serve rather than simply comparing individual hospital performance to that of all other hospitals. While the current fiscal year is still under way, it appears that safety-net hospitals will enjoy a collective decline of $22 million in Medicare readmissions penalties while 44.1 percent of teaching hospitals and 43.7 percent of rural hospitals will face smaller penalties than last year. Learn more about the readmissions reduction program and how changes … Read More
Providers can now see the maximum prices for 340B-covered drugs on a new web site established by the federal Health Resources & Services Administration. The web site, mandated by Congress after the U.S. Department of Health and Services’ Inspector General found that some providers are being overcharged, will enable 340B-eligible providers to identify the maximum price they can be charged for covered drugs. This, HRSA believes, will help providers avoid being overcharged in the future. Most Pennsylvania safety-net hospitals participate in the 340B program and consider it a vital tool in helping them serve their low-income communities. Learn more in the Becker’s Hospital Review article “HRSA launches 340B ceiling price website” and visit the new web site itself (registration required).
Non-safety-net hospitals are outperforming safety-net hospitals in the Medicare’s Comprehensive Care for Joint Replacement model, which was introduced in 2016. According to a new study published in Health Affairs, …in comparison to non-safety-net hospitals, 42 percent fewer safety-net hospitals qualified for rewards based on their quality and spending performance (33 percent of safety-net hospitals qualified, compared to 57 percent of non-safety-net hospitals), and safety-net hospitals’ rewards per episode were 39 percent smaller ($456 compared to $743). Continuation of this performance trend could place safety-net hospitals at increased risk of penalties in future years. What might be done to address this disparity? The study suggests that Medicare and hospital strategies such as those that reward high-quality care for vulnerable patients could enable safety-net hospitals to … Read More
A federal court has ruled that the Centers for Medicare & Medicaid Services overstepped its authority in reducing Medicare payments for prescription drugs covered by the section 340B prescription drug discount program. While the court conceded that CMS has the authority to address 340B payments, it found that CMS’s drastic payment cuts, introduced in FY 2018, “…fundamentally altered the statutory scheme established by Congress…” for determining 340B payment rates. The court suggested that CMS either change its methodology for determining 340B payments to justify the specific cuts it proposes or raise its objections with Congress, which created the program and has the authority to change it. According to documents submitted to the court by the parties that filed the suit, … Read More