Advocacy in Action

On January 1, 2022, many provisions of the No Surprises Act went into effect. This statute created provisions intended to protect patients from the costs of unexpected “surprise” bills for out-of-network services provided in certain facility settings.

At the December 2023 meeting of the Medicare Payment Advisory Commission (MedPAC), the staff and commissioners discussed potential recommendations for Medicare’s payment programs in 2025, including the Medicare Physician Fee Schedule

CMS recently released numerous resources to prepare clinicians for the 2024 Merit-Based Incentive Payment System (MIPS) performance year.

In August 2023, CMS released 2022 MIPS final scores and associated 2024 MIPS payment adjustment information to MIPS eligible clinicians. The 2024 MIPS payment adjustment, which is based on 2022 final performance scores, will affect payments made for services in calendar year 2024, also referred to as the 2024 MIPS payment year.

On November 16th, along with more than 100 national and state medical associations, HRS co-signed a letter to Congressional House of Representatives and Senate leaders calling for legislative action to avert the impending 3.37% cut to the 2024 Medicare Physician Fee Schedule. We also need your help to stop the cut!

On December 1st, a new bipartisan legislation, the Physician Fee Schedule Update and Improvements Act, H.R. 6545, was introduced in the House to make improvements to the physician fee schedule under the Medicare program will be part of the House Energy and Commerce Committee markup this week.

On November 6th, the Centers for Medicare & Medicaid Services (CMS) released its Contract Year 2025 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs proposed rule, which would revise the Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), Medicare cost plan, and Programs of All-Inclusive Care for the Elderly (PACE) regulations to implement changes related to Star Ratings, marketing and communications, agent/broker compensation, health equity, dual eligible special needs plans (DSNPs), utilization management, network adequacy, and other programmatic areas.

A new proposed rule recently released by CMS and the Office of the National Coordinator for Health Information Technology (ONC), titled “21st Century Cures Act: Establishment of Disincentives for Health Care Providers That Have Committed Information Blocking,“ outlines actions to hold health care providers accountable for information blocking under the 21st Century Cures Act (Cures Act).

CMS recently released updates to the regulations that obligate hospitals to publicly disclose their charges, including negotiated rates with commercial insurance plans.

During the November Medicare Payment Advisory Commission (MedPAC) meeting, staff and commissioners held a session titled, Medicare Coverage of and Payment for Software as a Medical Service: An Overview.