CMS has finalized updates for the Home Health Agencies payment rates for CY 2025, resulting in a 0.5% increase compared to 2024, alongside a 2.2% rise in payment rates. New measures focusing on social determinants of health and changes to the Home Health Quality Reporting Program were also introduced, emphasizing health equity and improved service transparency. Additionally, CMS will implement new respiratory illness reporting requirements starting January 1, 2025.
Nearly 1 million new customers have enrolled in the Affordable Care Act's exchanges since the open enrollment period began on Nov. 1, with a total of over 5.3 million sign-ups so far. The Centers for Medicare & Medicaid Services (CMS) reported that 4.4 million individuals have returned to marketplace plans for 2025, indicating a strong demand for affordable healthcare. The enrollment period continues until Jan. 15, with many eligible for premium tax credits, allowing 80% of enrollees to secure plans for $10 or less per month.
The Centers for Medicare & Medicaid Services (CMS) is proposing to cover anti-obesity medications under Medicare Part D and Medicaid, recognizing obesity as a disease. This move could make 7% of the Part D population eligible for coverage, with projected costs of $24.8 billion for Part D and $14.8 billion for Medicaid. However, critics warn that widespread use of GLP-1 drugs could strain the healthcare system, and the rule's finalization may face challenges if a new administration takes office.
In a potential second Trump administration, health care policy will likely focus on regulatory reform, including unwinding Biden-era regulations and emphasizing the "Make America Healthy Again" agenda. Key issues will include opposition to the Affordable Care Act, drug pricing reforms, and addressing the opioid crisis, alongside a commitment to domestic medical supply chains. The administration is expected to leverage budget reconciliation and appropriations to shape health policy amidst a challenging legislative environment.
The ACO Reach program saw significant growth in savings for 2023, with participants generating $1.64 billion in gross savings and $694.6 million in net savings for CMS. Nearly 75% of ACOs achieved positive savings, prompting NAACOS to advocate for the program's extension beyond 2026, highlighting its success in improving care quality and affordability. High-needs and new entrant ACOs outperformed standard ACOs, contributing to the overall positive results.
The Centers for Medicare & Medicaid Services (CMS) finalized its 2025 physician fee schedule, maintaining limited digital health policies amid ongoing telehealth flexibilities set to expire in 2024. While audio-only telehealth is now permanent, CMS emphasized the need for Congressional action to expand telehealth access and address payment methodologies for rural health clinics. New codes for digital mental health technologies were introduced, but CMS acknowledged the necessity for a new benefit category for broader digital therapeutics.
Elucid Bioimaging, Inc. announced that the US Centers for Medicare & Medicaid Services will double reimbursement for cardiac computed tomography angiography (CCTA) from $175 to $357.13, effective January 1, 2025. This change, resulting from six years of advocacy, aims to enhance access to CCTA, particularly in non-urban areas, and reflects its growing importance in cardiac care. The increase aligns with recent coverage decisions for AI-enabled plaque analysis, potentially improving early identification of high-risk cardiovascular conditions.
In the 2024 election, Vice President Kamala Harris aims to strengthen the Affordable Care Act and protect reproductive rights, promising to restore Roe v. Wade and support drug price negotiations. In contrast, former President Donald Trump opposes the ACA and emphasizes state control over abortion, while his stance on drug pricing remains unclear. Both candidates are vying for voter support on key health policy issues, including insulin copay caps and pharmacy benefit manager reform.
Emerald Advisers and F/m Investments have launched the F/m Emerald Life Sciences Innovation ETF (LFSC) on the Nasdaq, targeting innovative small and mid-cap companies in the life sciences sector, including biotech and medical technology. The ETF utilizes a proprietary 10-Step Research Process to identify high-potential firms, aiming to capitalize on the rapid growth in healthcare driven by an aging population and increased demand for medical advancements. With U.S. healthcare spending projected to rise significantly, LFSC offers investors diversified exposure to transformative developments in the industry.
In 2023, Accountable Care Organizations (ACOs) saved Medicare $2.1 billion, marking the largest annual savings in the program's history. This achievement follows a $1.8 billion savings in 2022 and highlights the critical role of primary care in enhancing quality measures and reducing costs for nearly 11 million beneficiaries. With 480 ACOs participating, 453 achieved shared savings, and CMS is proposing a new prepaid shared savings option to further support beneficiaries.
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