(Sept. 29, 2023) – CMS Announces Medicare Advantage and Medicare Part D 2024 Premiums
The Centers for Medicare & Medicaid Services announced the average monthly plan premium for all Medicare Advantage plans is projected to increase from $17.86 in 2023 to $18.50 in 2024. CMS stated, "If enrollees choose to stay in their plan, most will experience little or no premium increase for next year, with nearly 73 percent of beneficiaries not seeing any premium increase at all." CMS credits the Inflation Reduction Act for keeping prescription drug costs lower for those with Medicare Part D coverage.
CMS also announced the calendar year 2024 participants in the Medicare Advantage Value-Based Insurance Design Model. The VBID model is designed to test a "broad array of MA health plan innovations designed to enhance the quality of care for MA enrollees." The number of participants has increased from 52 percent in 2023 to 69 percent in 2024.
CMS Issues Interpretive Guidance for Nurse Midwives
The Centers for Medicare & Medicaid Services issued interpretive guidance for nurse midwives, which is part of the agency's efforts to improve maternal care by addressing workforce and access to care issues. CMS notes hospital regulations permit licensed practitioners, including nurse midwives or advanced practice registered nurses, as allowed by the state, to admit patients to a hospital. CMS does not require these practitioners be employed by, under the supervision of, or associated with an MD/DO, unless required by state law, regulations or facility policy. Additionally, a hospital is not precluded from credentialing and granting privileges to practitioners, such as nurse midwives, or from making them a part of the medical staff.
The guidance is somewhat different for Critical Access Hospitals. CMS states physician oversight is required for inpatients in a CAH, and the physician oversight requirement for outpatients is applicable if required by state law.
Agencies Propose Independent Dispute Resolution Process Fees
The Departments of Treasury, Labor and Health and Human Services released proposals to update sections of the No Surprises Act regulations. The rule would increase the administrative fee and the refundable certified independent dispute resolution entity fee. The administrative fee would increase from $50 to $150 beginning Jan. 1, 2024. The refundable IDR entity fee would be $200 to $840 for a single determination and a range of $268 to $1,173 for small-batch claim determinations.
MACPAC Studies Medicaid Managed Care Plan Denials
Medicaid and Children's Health Insurance Program Payment and Access Commission discussed the issue of managed care plan prior authorization denials in its meeting on Sept. 21. The commission is considering actions ranging from more robust reporting to requiring states to exercise specific oversight activities. It is expected to adopt recommendations as early as its meeting in November.
MLN Connects Provider eNews Available
The Centers for Medicare & Medicaid Services issued the following updates to MLN Connects Provider eNews:
Before You Go ...
- Hospitals participating in the Hospital OQR Program are invited to participate in a webinar at 1:00 p.m. Wednesday, Oct. 4, to review the CMS outpatient validation process, pertinent reports and common abstraction dilemmas. Registration is required.
- Now available on the Quality Reporting Center is an interactive Facility Compare Tool, which displays facility and state-specific data published as part of the Hospital Outpatient and Ambulatory Surgical Center Quality Reporting Programs. This tool allows users to compare their hospital’s specific rates to a single facility, group of facilities, city or state.