Policy and Legislation
CMS is also proposing increases in payment for many visit services, such as primary care, and changes impacting cancer treatment.
The rule would cap copayments for all families to no more than 7% of their income, along with other measures.
The hospital group is proposing the Senate at least double the $385 million in annual funding for the HPP from 2024 through 2029.
The lawsuit argues that Medicare is required to institute the payment model changes in a budget neutral manner.
Non-comprehensive coverage, HHS says, can be harmful to low-income individuals and people with significant healthcare needs.
HIMSS23
Because health organizations are paid by capitation, incentives are aligned to keep the patient healthy, says Ran Balicer, chief innovation officer at Clalit Health Services.
The concern is that the QBP overpays MA organizations and does not encourage quality improvement or help beneficiaries select plans.
The move makes South Dakota the 39th state, along with Washington, D.C., to adopt the ACA's Medicaid expansion.
HIMSS23
Hospitals can adapt by rolling out FHIR APIs for patient access, says ZeOmega associate VP of interoperability strategy Michael Gould and VP of advanced analytics Pravin Pant.
If a healthcare provider is out of compliance with CMS requirements, OIG may refer the matter to CMS.