Policy and Legislation

Stories on healthcare policy focus on subjects such as the financing and delivery of healthcare, quality of care, and access to care. Policy stories often deal with the federal, state and local institutions responsible for regulating the healthcare industry and setting reimbursement rates for providers.

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Medicare trust fund to be exhausted by 2017, report reveals
CMS releases final 2010 hospital inpatient payment rule
 

 
Last week the HHS Office of Inspector General and the Centers for Medicare & Medicaid Services published a joint notice continuing the effectiveness of fraud and abuse law waivers granted in 2011 in connection with the Medicare Shared Savings Program.
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Post date: October 20, 2014
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This week CMS launched an ACO Investment Model, which will provide up to $114 million in upfront investments, to up to 75 Medicare Shared Savings Program ACOs. The program aims to help ACOs succeed in the MSSP by providing upfront capital to cover startup and ongoing infrastructure costs.
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Post date: October 17, 2014
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The Centers for Medicare & Medicaid Services recent 10-year projection of national health expenditures includes retail spending on prescription drugs, but a more complete picture of pharma spending would include the nonretail segment.
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Post date: October 15, 2014
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With an improving fiscal climate, some states are paying their Medicaid providers more. More states are increasing fees to specialists, nursing homes and managed care organizations, but 31 states were cutting or freezing Medicaid hospital rates, compared to 19 that were increasing them.
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Post date: October 14, 2014
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The medical tourism industry must respond to the problems found in surrogacy tourism. The first is the need for medical tourism companies, brokers, clinics and even hospitals to hold patient funds in escrow. Abuse of patient trust by misappropriating funds should no longer be an issue.
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Post date: October 14, 2014
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Many Medicare beneficiaries treated at primarily rural "critical access" hospitals end up paying between two and six times more for outpatient services than do patients at other hospitals, according to a report released Wednesday by the HHS inspector general.
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Post date: October 9, 2014
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This week the Centers for Medicare & Medicaid Services expanded the agency's Five Star Quality Rating System for Nursing Homes, and proposed new conditions of participation for home health agencies.
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Post date: October 8, 2014
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The U.S. Supreme Court has agreed to hear a case brought by Idaho providers over an issue that has split many lower courts: whether Medicaid providers have a Constitutional right to sue states to enforce Medicaid funding regulations.
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Post date: October 7, 2014
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Are hospitals exploiting the 340B drug discount program? Critics of the federal government's program have some new evidence in the debate over healthcare subsidies.
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Post date: October 6, 2014
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Rural health providers may feel burdened by a confluence of policy and financing trends. But one opportunity, depending on the state, can help with sustainability.
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Post date: October 6, 2014
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Medicare is fining a record number of hospitals -- 2,610 -- for having too many patients return within a month for additional treatments, federal records released Wednesday show. Thirty-nine of those are receiving the largest penalty allowed.
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Post date: October 3, 2014
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In Massachusetts, the expansion of Partners HealthCare is offering a fractious case study of integration and health reform and begs the question: how big is too big?
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Post date: October 2, 2014
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An article published last week in the New England Journal of Medicine casts doubt that malpractice reform would reduce the use of supposed "defensive medicine."
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Post date: October 20, 2014
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The 2015 Medicare Part A deductible -- for inpatient hospital, skilled nursing facility and home healthcare services -- will increase by $44 in calendar year 2015 to $1,260, while the monthly Part A premium will decline by $19. Medicare Part B monthly premiums and deductibles will remain unchanged.
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Post date: October 13, 2014
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The HHS Inspector General continues to fault CMS for failing to issue final regulations to enforce the location requirements for rural health clinics. The agency's inaction is costing taxpayers millions.
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Post date: October 8, 2014
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The Centers for Medicare & Medicaid Services has published a final rule updating the hospice wage index and payment rate for Fiscal Year 2015. It adopts a number of payment reforms addressing concerns about program integrity, beneficiary protection and quality.
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Post date: September 22, 2014
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In its new rules, CMS places great emphasis on the physician's documentation regarding his or her expectation of a patient's need for hospital care and anticipated length of stay. Therefore, it is essential that all hospital physicians are educated about the heightened importance of documentation within the medical record.
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Post date: September 15, 2014
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In its new rules, CMS places great emphasis on the physician's documentation regarding his or her expectation of a patient's need for hospital care and anticipated length of stay. Therefore, it is essential that all hospital physicians are educated about the heightened importance of documentation within the medical record.
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Post date: September 15, 2014
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Congress returned on Monday with just a few weeks until they adjourn to campaign. The Senate is set to adjourn by September 23 while the House could be in session for as little as 2 weeks. Here's a look at what happened in healthcare while Congress was in recess.
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Post date: September 12, 2014
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While others have dispassionately made the point that there are unexplained variations in Medicare physician billing data that warrant careful consideration when using such data, one doctor thinks CMS has devious motives.
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Post date: September 4, 2014
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Last month the Centers for Medicare & Medicaid Services published its proposed rule to update the Medicare Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment System rates and policies for calendar year 2015. Here's what you need to know.
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Post date: August 6, 2014
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Medicaid beneficiaries deserve the same access to healthcare services and products as people with commercial insurance or Medicare. But since Medicaid pays doctors and hospitals 27 to 65 percent less than commercial health plans, it makes it awfully difficult for providers to be payer agnostic.
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Post date: July 23, 2014
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Business has a vital concern in the financing of healthcare. So why is there not an outcry to switch to a proven financing system that would serve their employees well?
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Post date: July 17, 2014
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One of the worst failures of the Affordable Care Act is that, even with subsidies, the premiums and out-of-pocket expenses are unaffordable for far too many people. Unfortunately, a new proposal for catastrophic plans with very high deductibles would make accessing healthcare truly unaffordable for even more people.
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Post date: June 16, 2014
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