Our analysis of proposed site neutral payments for ambulatory services, which, if enacted, would have a meaningful impact on healthcare providers’ finances.
On January 9, 2024, the Centers for Medicare and Medicaid Services (CMS) approved the New York State (NY) 1115 Medicaid waiver “Medicaid Redesign Team” (MRT). The MRT is a long-standing waiver in NY that has continuously evolved to improve the administration, structure and financing of the NY Medicaid program; enhance Medicaid beneficiaries’ access to services; and improve health outcomes across the state. The recently approved waiver represents the next step in Medicaid redesign in NY and builds on the previous Delivery System Reform Incentive Payment (DSRIP) program.
On January 17, 2024, the Centers for Medicare & Medicaid Services (CMS) released a final rule that will require certain payers to automate their prior authorization processes and implement application program interfaces (APIs) to improve the exchange of health information among payers, providers and patients. The rule outlines these new requirements, exceptions to the requirements and implementation deadlines. It also adds a new electronic prior authorization measure that clinicians and hospitals must report as part of the Merit-based Incentive Payment System (MIPS) Promoting Interoperability Category and the Medicare Promoting Interoperability Program, respectively.
The final rule comes at a time when Congress has been active on prior authorization reform, including through legislation. This article compares the final rule with that legislation, highlights policies that are not included in the final rule and discusses next steps for prior authorization reform.
As we enter 2024, we welcome the start of a presidential and congressional election year and look ahead to the major health policy topics on the agenda for 2024.
Download our chart that tracks healthcare programs that require congressional action between now and 2032, and highlights related recent congressional action on each.
Pharmacy benefit managers (PBMs) remain in Congress’ crosshairs as legislators seek to lower drug prices. Download our updated chart comparing policies in the Lower Costs, More Transparency Act and the PBM bills considered by House and Senate committees.