April 28, 2023
Payers | Tea Leaves
  • The Centers for Medicare and Medicaid Services (CMS) proposed new reporting rules for Medicaid and the Children’s Health Insurance Programs health plans that would, among other things, set national standards for appointment wait times and require disclosure of provider payment rates.The rulemaking is a push from the administration to better serve the 92 million Americans enrolled in the low-income coverage programs, CMS officials said during a call with reporters. If the new rules are finalized, they would place new performance and reporting responsibilities on states as well as managed care plans, under which more than 70 percent of Medicaid and CHIP enrollees are covered. (Articles here, here, and here)
  • Momentum is building in Congress to address the way hospitals charge more for the same services private doctors deliver in their offices, a sign of broader lawmaker frustration with the industry. Lawmakers on the House Energy and Commerce Committee showed bipartisan interest Wednesday in changing Medicare payment policies to pay the same for some services, regardless of where they’re delivered.The idea tracks with past recommendations from MedPAC but is staunchly opposed by industry groups like the American Hospital Association, which says the policy change would be economically ruinous as facilities continue to manage the aftermath of the pandemic, along with workforce and supply chain issues. (Article here)