Reimbursement
The proposed rule updates rates for intensive outpatient services at hospital outpatient departments and community mental health centers.
The rule expands hold harmless arrangements to prohibit providers from agreeing to redistribute Medicaid payments amongst themselves, says Zubin Khambatta, a healthcare attorney and partner at Holland & Knight.
The lawsuit was filed the same day the Supreme Court ended the Chevron doctrine, which protected federal regulations from legal challenges.
CFOs want value-based contracts with commercial plans as the payer mix changes to one more heavily dependent on Medicare and Medicaid.
The rule also proposes to extend Medicare payment to dialysis in the home setting for beneficiaries with acute kidney injury.
Akron Children's Hospital gets half its reimbursement from Medicaid, with all health systems facing a changing payer mix.
Final rule disincentives include hospitals not being able to earn three quarters of the annual market basket increase.
The increase counteracts some of the financial uncertainty caused by the California state budget deficit, CalOptima says.
CMS has paid over $2.5 billion to Part A hospitals and more than $717 million to Part B physicians, suppliers and others.
HIMSS24
In traditional FFS, clinicians see one patient, but in value-based care, the provider is responsible for a population of patients and needs to know where else they have received care, which brings in the necessity for interoperability, says Dr. Harm Scherpbier, HealthShare Exchange CMIO.