The Congressional Budget Office 2015 Long-Term Budget Outlook

On June 16, 2015, the Congressional Budget Office (CBO) released its long-term budget outlook. Under the assumption that currently relevant laws remain the same, this annual report provides extended baseline projections of future federal spending and revenues that focus on the upcoming 25-year period ending in 2040. This includes projections for major health care programs including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Importantly, the report is not a prediction of spending in the future, but rather a demonstration of the effects current policies will have on the economy over time if left unchanged.

House Medicare Advantage Bills: What You Need to Know

 
What bills are being discussed?
In May 2015, a bipartisan group of members of the House Ways and Means and Energy and Commerce Committees introduced four bills designed to support and strengthen the Medicare Advantage (MA) program.
 
H.R.2505: “Medicare Advantage Transparency Act of 2015”
H.R.2507: “Increasing Regulatory Fairness Act of 2015”
H.R.2570: “Value Based Insurance Design for Better Care Act of 2015”
H.R.2582: “Seniors’ Health Care Plan Protection Act of 2015”

What You Need To Know: The Cromnibus

The 1603-page cromnibus is a combination of a continuing resolution (CR) and an omnibus spending bill, hence its unique name. An omnibus typically combines a number of smaller appropriations bills into one large bill, whereas CRs are usually used to keep the government running for short periods of time while more permanent budget discussions are occurring. The current cromnibus funds most of the government through September 2015, though the CR portion funds the Department of Homeland Security through February 2015.

What You Need to Know: Medicare and Physician Pay

The Medicare Sustainable Growth Rate (SGR) is the formula currently used by the Centers for Medicare and Medicaid Services (CMS) to determine the appropriate fee schedule for payment to physicians that will keep costs to the program in line with Gross Domestic Product (GDP). The SGR was enacted as part of the Balanced Budget Act of 1997 as a means to control rising Medicare costs. The formula uses four factors to determine the SGR: changes in physicians’ service fees, percentage change in the number of Medicare beneficiaries, the 10-year average annual percentage change in GDP per capita, and any changes in the Medicare budget due to legislation.

What You Need To Know: Medicare Trustees 2015 Report

On July 22, 2015, the Trustees of the Social Security and Medicare Trust Funds released their annual report on the current and projected financial and actuarial status of the various trust funds supporting the two programs. These annual reports serve as important tools for the management of Social Security and Medicare. With regard to Medicare, the trustees report on the financial operations of two distinct trust funds: the Hospital Insurance (HI) Trust Fund and the Supplementary Medical Insurance (SMI) Trust Fund. (Click here to learn more about the HI and SMI Trust Funds and how Medicare is financed.)

What You Need To Know: CBO’s 2014 Long-Term Budget Outlook and Medicare

On July 15, 2014, the Congressional Budget Office (CBO) released its long-term budget outlook.[i] Under the assumption that relevant laws remain the same, this annual report projects 10 years and 25 years of future federal spending and revenues, including for the nation’s major health insurance programs – Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Importantly, the report is not a prediction of spending in the future, but rather a demonstration of the effects current policies will have on the economy over time if left unchanged.

What You Need To Know: Medicare + Hospital Readmissions

When a patient is admitted to a hospital, they receive care until deemed healthy enough for discharge, either to another care facility or their home.  Unless readmission is a predetermined part of a patient’s care plan, returning to the hospital is generally viewed as a result of poorly delivered care or inadequacies in transition or follow-up.  The Centers for Medicare and Medicaid Services (CMS) measure hospital readmissions within a 30-day window, known as the 30-day readmission rate, which includes hospital readmissions to any hospital, not just the hospital at which a patient was originally hospitalized. CMS’ measurement captures all readmissions in traditional Medicare for particular diagnoses, no matter the cause of readmission, excluding those who upon discharge were transferred to another hospital or those who left the hospital against medical advice.

 

 

What You Need to Know: Medicare + Sequestration

Sequestration, or “the sequester,” is a set of automatic spending cuts authorized by the Budget Control Act, which Congress passed and President Obama signed into law in August 2011.  Sequestration mandates $1.2 trillion in across-the-board spending cuts over the next 10 years, with roughly $85 billion slated for this year.

The $1.2 trillion in cuts will be applied evenly to both defense and discretionary domestic spending. The Department of Defense will face $550 billion in cuts, and domestic programs, including education, law enforcement, scientific research and many others will absorb the remainder of cuts.  However, the sequester does protect certain areas of spending from the cuts; spending on wars and military personnel, as well as money allocated for Medicaid, Social Security, Pell grants, veterans' benefits and certain low-income programs will be exempt.

What You Need To Know: CMS FY2015 Proposed Rule

As a federal agency with distinct regulatory and rule-making authority, the Centers for Medicare and Medicaid Services (CMS) issues many proposed rules and regulations each year that impact the programs it administers. These rules vary in scope and typically impact a set of limited, specific issues.

The proposed rule released in early July each year is particularly vast and impactful because it makes sweeping changes to payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS).

What You Need to Know: Medicare + State of the Union

On February 12, 2013, President Obama delivered his State of the Union address to Congress and the nation.  In this speech, he laid out his priorities for the next four years.  The following is a round-up of the President’s statements on Medicare, as well as those of Senator Marco Rubio, who delivered the GOP response speech, PFM’s response, and relevant media coverage of the State of the Union and its implications for Medicare.

 

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