Continued 340B eligibility is at risk for hundreds of hospitals thanks to pandemic-related factors
Hospitals that rely on savings from the 340B Drug Pricing Program should examine the possibility that they’ll soon be rendered ineligible. Several factors are having an industrywide impact on the disproportionate share hospital (DSH) adjustment percentage, and if that tally drops below a certain threshold on a hospital’s Medicare cost report, the hospital cannot receive…
News Briefs: A new fee is set for using the No Surprises Act arbitration portal
Bringing out-of-network payment disputes to arbitration under the No Surprises Act in 2024 will be less expensive than previously proposed. In a final rule, the U.S. Departments of Health and Human Services, Labor and Treasury established the administrative fee for using the independent dispute resolution (IDR) portal at $115 per case, effective Jan. 22. That’s…
Limit financial risk from Medicaid redetermination
Medicaid redetermination isn’t going smoothly. As of late December 2023, the Kaiser Family Foundation found that 71% of Medicaid disenrollments nationwide were for procedural reasons. That means patients are losing coverage because they filled out a form incorrectly or missed a deadline, not because they’re truly ineligible for renewal. Provider organizations can play a pivotal…
In Congress, it’s status quo for Medicaid DSH payments and the Medicare physician fee schedule
Yet another short-term federal funding measure from Congress included yet another brief extension of full funding for Medicaid disproportionate share hospital (DSH) payments. With funding for much of the federal government set to expire Jan. 19, Congress agreed on a continuing resolution that keeps all agencies fully operational until March. Medicaid DSH payments are guaranteed…
An extended year-end policy update with Nick Hut and Shawn Stack
HFMA Senior Editor Nick Hut and HFMA Policy Director Shawn Stack discuss the most pressing end-of-year issues for 2023.
New data on national healthcare spending highlights the constraints facing hospitals
Recently published 2022 data indicates relatively restrained national healthcare spending as the COVID-19 pandemic faded, especially in the hospital sector. The increase in spending on hospital services slowed from 4.5% in 2021 to 2.2% in 2022, CMS actuaries reported Dec. 13 in Health Affairs. The increase was significantly less than in 2020 (6.2%) and the…
House passes bill to codify healthcare price transparency, expand site-neutral payment
The hospital industry saw reason for both relief and disappointment this week after a bill designed to promote price transparency took a major step toward becoming law. The House on Dec. 11 passed H.R. 5378, also known as the Lower Costs, More Transparency Act, by a 320-71 vote. Along with cementing price transparency as the…
With a new rule, CMS looks to crack down on states’ Medicaid disenrollment processes
In its latest effort to stem the ongoing wave of Medicaid disenrollments, CMS issued regulations describing its authority to penalize states for disregarding federal guidelines pertaining to the end of continuous-enrollment requirements. Published Dec. 6 in an interim final rule with comment period, the regulations took effect immediately and were based on provisions passed by…
Senate bill would give hospitals a big break from looming Medicaid disproportionate share hospital cuts (updated)
Nov. 15 update: On Nov. 14, the House passed legislation on a bipartisan basis to keep the government funded through Jan. 19. Medicaid disproportionate share hospital payments would be guaranteed to remain at their full amount through that date, and the bill similarly maintains short-term funding for graduate medical education, community health centers and the…
News Briefs: Medicaid DSH payment cut barely averted in September, still possible in November
Hospitals received a last-day reprieve from substantial cuts to Medicaid disproportionate share hospital (DSH) payments, with House leaders reversing course Sept. 30 and ushering through a six-week government funding package. Language in the bill ensured the start of a four-year Medicaid DSH cut amounting to $32 billion was pushed back from Oct. 1 to Nov.…