OIG Says Hospitals Not Complying With Hospital Transparency Requirements
The Health and Human Services Office of Inspector General (HHS OIG) says many hospitals are not publishing their prices in accordance with the price transparency requirements. The HHS OIG analyzed data from 30 hospitals that were part of the country’s three largest health systems as well as a random sample of 5,504 facilities. Researchers reviewed hospital websites between Jan. 17, 2023 and March 14, 2023.
HHS OIG found that more than a third of the 100 hospitals did not post machine readable pricing data files correctly or at all. Most of the errors involved not disclosing rates with insurers, metadata errors, and outdated information.
The Centers for Medicare and Medicaid Services (CMS) says some entities have already corrected errors, but it shows just how lax CMS enforcement is years into the law.
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#hospitals #transparency #pricetransparency #cms
https://www.modernhealthcare.com/providers/hospital-price-transparancy-compliance-oig
More Post-Election Healthcare News
The healthcare news media are still busy publishing prognostications on what could happen with a second Trump presidency.
A new Kaiser Family Foundation (KFF) briefer discusses what Trump could do from a regulatory standpoint on healthcare, including encouraging work requirements in Medicaid and certain waivers, holding back or repealing rules as Biden did, and reducing Medicaid and Exchange regulatory investments.
NBC News has a discussion on the likely sunset of enhanced premium subsidies in the Exchanges.
Inside Health Policy says GOP Senator Bill Cassidy could take a more measured approach on drug pricing, including GLP-1 drugs, compared with current HELP Chairman Bernie Sanders.
Additional articles: https://www.nbcnews.com/health/health-news/millions-risk-losing-health-insurance-trumps-victory-rcna179146 and https://insidehealthpolicy.com/daily-news/if-cassidy-s-help-helm-approach-glp-1-pricing-may-change
(Some articles may require a subscription.)
#drugpricing #exchanges #aca #obamacare #medicaid
https://www.kff.org/policy-watch/what-administrative-changes-can-trump-make-to-medicaid/
MedPAC Concerned About Medicare Advantage Provider Directories
It is a long-standing problem that Medicare Advantage (MA) plans just have not gotten right. MedPAC, the congressional policy arm for Medicare, is concerned about inaccuracies in MA provider directories that are supposed to accurately list all in-network providers. It is also concerned that networks are overly narrow, especially for some specialties and services, and that the Centers for Medicare Services (CMS) do not have adequate oversight over directories or network adequacy.
#medicareadvantage #providers
https://www.medpagetoday.com/publichealthpolicy/medicare/112822
CMS Announces Premiums And Deductibles in Medicare for 2025
The Centers for Medicare and Medicaid Services (CMS) announced the Medicare Part B premium, and Part A and B deductibles for 2025, among other cost-sharing requirements.
The standard monthly premium for Medicare Part B will be $185.00, an increase of $10.30 from $174.70 in 2024. The annual deductible for Medicare Part B will be $257 in 2025, an increase of $17 from the annual deductible of $240 in 2024. The Part A inpatient deductible will increase from $1,623 in 2024 to $1,676 in 2025.
#cms #medicare
https://www.cms.gov/newsroom/fact-sheets/2025-medicare-parts-b-premiums-and-deductibles
Bipartisan Group Of Lawmakers Want Protections in Employer Coverage
A bipartisan group of House lawmakers is urging the Biden administration to issue new regulations aimed at preventing self-insured or large group employer plans from deeming certain expensive brand and specialty drugs as “non-essential health benefits” or “non-covered.” This would expand requirements beyond the small group and individual market. Lawmakers say the current rules require huge out-of-pocket costs for some medications.
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#aca #obamacare #drugpricing
— Marc S. Ryan
