Medicare & Medicaid
The share of adults who reported delaying or forgoing medical care because of cost declined from 12.1% in 2019 to 9.7% in 2022.
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 entities agreed to maintain services, provide capital investments and protect competition in the healthcare market.
The rule also proposes to extend Medicare payment to dialysis in the home setting for beneficiaries with acute kidney injury.
The drugs will have a lowered Part B coinsurance rate, since each drug company raised prices faster than the rate of inflation.
"Plans continue to use AI tools to erroneously deny care and contradict provider assessment findings," lawmakers say.
Final rule disincentives include hospitals not being able to earn three quarters of the annual market basket increase.
Employment-based coverage will be the predominant source of health insurance, and Medicare enrollment will grow significantly.
CMS has paid over $2.5 billion to Part A hospitals and more than $717 million to Part B physicians, suppliers and others.
The decision comes after CMS lost two court cases, but the agency says it reserves the right to appeal.