(April 5, 2024) – CMS Issues Final CY 2025 Medicare Advantage Capitation Rates and Part D Payment Policies
The Centers for Medicare & Medicaid Services released the final rule on Medicare Advantage capitation rates and Part D payment policy for the calendar year 2025. MA plans are estimated to receive an increase of more than $16 billion, or 3.7 percent, in 2025 compared to 2024. CMS also finalized improvements to the structure of the Medicare Part D drug benefit, resulting in lower drug costs for Medicare beneficiaries.
CMS Issues Marketplace Benefit and Parameters Final Rule for CY 2025
The Centers for Medicare & Medicaid Services released the calendar year 2025 Marketplace notice of benefit and payment parameters final rule. The rule includes several policies that impact the Medicaid program, Children's Health Insurance Program and Basic Health Program. CMS finalized certain network adequacy updates, extended the special enrollment period and streamlined the enrollment process.
CMS Issues Additional Guidance on Informed Consent
The Centers for Medicare & Medicaid Services issued additional guidance to clarify expectations around hospital informed consent. According to QSO-24-10-Hospitals, patients under anesthesia should only receive examinations that are medically necessary and for which informed consent was provided. Revisions to Appendix A related to consent will be forthcoming.
CMS Extends Special Enrollment Period for Individuals Losing Medicaid Coverage
The Centers for Medicare & Medicaid Services extended the Special Enrollment Period for individuals who have lost Medicaid coverage during the Medicaid "unwinding." These individuals will have until Saturday, Nov. 30 to apply for coverage through the federal marketplace at the Healthcare.gov website.
CMS Releases FFY 2025 Medicare Inpatient Rehabilitation Facility PPS Proposed Rule
The U.S. Departments of Health and Human Services, Labor, and the Treasury released a final rule regarding short-term, limited-duration insurance and independent, noncoordinated excepted benefits coverage. The final rule will affect STLDI sold or issued on or after Sunday, Sept. 1.
According to the agencies, "the Biden-Harris Administration is taking yet another action to lower health care costs and protect consumers from being scammed into purchasing lower quality insurance, or "junk insurance." The rule would amend the existing federal definition of STLDI to limit the length of the initial contract term to no more than three months and revise the maximum coverage period to no more than four months.
CMS Releases FFY 2025 Medicare Hospice, Psychiatric and Skilled Nursing Facility PPS Proposed Rule
The Centers for Medicare & Medicaid Services released the federal fiscal year 2025 Medicare Hospice, Inpatient Psychiatric Facility and Skilled Nursing Facility prospective payment system proposed rules.
Facilities paid under the Medicare hospice payment program are estimated to receive an increase of $705 million or 2.6 percent as compared to 2024.
The proposed skilled nursing facility PPS payment update is estimated to increase Medicare payment rates by $196.5 million or 4.1 percent. This new rate includes a market-basket update of 2.8 percent, plus 1.7 percent market-basket forecast error adjustment, less 0.4 percent mandated productivity adjustment.
The proposed inpatient psychiatric facility PPS payments are estimated to increase by $70 million or 2.6 percent.
Issue Brief Available on CMS FFY 2025 Medicare Inpatient Rehabilitation Facility PPS Proposed Rule
The Centers for Medicare & Medicaid Services released the federal fiscal year 2025 Medicare Inpatient Rehabilitation Facility prospective payment system proposed rule. CMS proposed to increase the market basket by 3.2 percent. After reducing the market basket by the mandated productivity factor and accounting for increases to outlier thresholds, the resulting overall gain is estimated to be 2.5 percent. The rule includes proposed updates for the wage index, updates to the Inpatient Rehabilitation Facility Quality Reporting Program and requests for information about the future measure concepts for the IRF QRP and creating an IRF QRP Star Rating System.
CMS Publishes EMTALA Guidance
The Centers for Medicare & Medicaid Services published guidance on the Emergency Medical Treatment and Active Labor Act related to procedures around the release of the Quality Improvement Organization's 60-day report. This report is requested when CMS refers an EMTALA case to the U.S. Department of Health and Human Services Office of the Inspector General and for OIG's investigation of the case. Specifically, the guidance states the 60-day report may not be released to the affected physician and/or hospital until after the OIG investigation is completed and the OIG closes the case.
CMS Set to Publish Rules to Streamline Medicaid Enrollment
The Centers for Medicare & Medicaid Services announced that rules streamlining certain Medicaid enrollment standards were slated to be published on Tuesday, April 2. Among the changes that can be expected are the elimination of lockout for nonpayment of Children's Health Insurance Program premiums, increased time for Medicaid applicants to respond to documentation data requests and more flexible rules for accounting for spend-down expenses.
Alcohol-Related ED Visits Short Report Available
The Drug Abuse Warning Network released an updated report focused on emergency department visits for alcohol-related concerns. The report shows the staggering number of ED visits nationwide — 8,566,725 — and outlines the reasons behind these visits, which range from intoxication to injury to chronic liver disease. The data continue to show the importance of accessible and equitable care for patients with alcohol and other substance-related disorders.
MLN Connects Provider eNews Available
The Centers for Medicare & Medicaid Services issued the following updates to MLN Connects Provider eNews:
Before You Go ...
The Health Resources and Services Administration opens funding opportunities and applications for loan repayment and scholarship programs.