Medicare, Medicaid, and SCHIP Payments

Monitor Medicare, Medicaid, and SCHIP Payments Easily

The Centers for Medicare & Medicaid Services (CMS) of the Department of Health and Human Services administers the Medicare program, and works in partnership with state governments to administer Medicaid and the State Children's Health Insurance Program (SCHIP). CMS establishes Medicare payment schedules to reimburse physicians and other health care providers serving the elderly, provides funding to states to partially cover the costs of the Medicaid program for lower income persons, and provides SCHIP funding to assist states in covering uninsured children in families with modest incomes.

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Ensuring compliance and staying abreast of the latest updates in Medicare, Medicaid, and SCHIP payments is crucial for various professionals, including healthcare administrators, policy makers, and financial planners. These programs are administered by the Centers for Medicare & Medicaid Services (CMS), and maintaining a proactive approach ensures not only compliance with federal guidelines but also opens up new funding opportunities.

Why Monitoring Medicare, Medicaid, and SCHIP Matters

The Medicare program provides payment schedules that affect physicians and healthcare providers. Understanding these changes allows healthcare professionals to adapt their billing practices promptly, which is critical for sustaining operations and ensuring that elderly patients continue to receive high-quality care.

As for Medicaid, it crucially supports lower-income individuals by covering healthcare costs that they might otherwise find unaffordable. State governments, in partnership with CMS, administer this program and allocate substantial funding to meet these needs. For state agency officials and policymakers, maintaining an up-to-date view of these payments helps in resource planning and ensuring that funding is used optimally.

SCHIP, also known as the State Children's Health Insurance Program, plays a pivotal role in enabling states to provide health coverage for children in families with modest incomes who do not qualify for Medicaid. Nonprofit directors and school district leaders often track SCHIP developments to better advocate for children’s health services.

By following the pertinent announcements in the Federal Register, professionals can:

  • Ensure Compliance: Avoid penalties and ensure ongoing eligibility for federal support by staying compliant with regulatory changes.
  • Seize Funding Opportunities: Access grants and funding designed to supplement state initiatives and healthcare services.
  • Plan Strategically for Industry Shifts: Align organizational goals with federal priorities to optimize service delivery.
  • Mitigate Risks from Rule Changes: Proactively address changes in federal rules to minimize risk and maintain continuity in operations.

Recent Trends and Regulatory Impacts

Recent trends indicate an increasing shift towards digital transformation in healthcare. New regulations and funding opportunities often favor telehealth services and remote patient monitoring solutions. Therefore, keeping track of CMS announcements helps healthcare providers and related industries stay competitive.

Industries and Interest Groups

  • Healthcare Providers: Need real-time information to adjust service charges and budgets.
  • State Agencies: Require updates to strategize budget allocations and improve public health services delivery.
  • Nonprofits and Advocacy Groups: Monitor regulatory updates to advocate effectively for underrepresented groups.
  • Policy Makers and Legal Advisors: Use the latest data to craft policies that align with federal regulations.

AI-Powered Monitoring with FedMonitor

At FedMonitor, we empower professionals with AI-powered monitoring tools, ensuring they not only receive updates, but also only receive the most relevant ones for their specific needs.

  • Quick Understanding: Alerts are concise, helping you quickly discern document relevance.
  • Custom Notifications: Receive real-time alerts in preferred platforms, e.g., Slack, Microsoft Teams, or Salesforce, in addition to traditional email and SMS.
  • Enhanced Filtering: Automatically filter updates to ensure they align with your industry’s requirements or specific interest areas.

Take control of your regulatory monitoring, enhance organizational agility, and maximize funding opportunities with FedMonitor. Reach out to explore our solutions: Contact us or Sign up today to get started.

Search Details

  • Description: The Centers for Medicare & Medicaid Services (CMS) of the Department of Health and Human Services administers the Medicare program, and works in partnership with state governments to administer Medicaid and the State Children's Health Insurance Program (SCHIP). CMS establishes Medicare payment schedules to reimburse physicians and other health care providers serving the elderly, provides funding to states to partially cover the costs of the Medicaid program for lower income persons, and provides SCHIP funding to assist states in covering uninsured children in families with modest incomes.

Related Agencies

Related Topics

Latest Documents

Title Type Published
Health and Human Services Department > CMS
Medicare and Medicaid Programs; Quarterly Listing of Program Issuances-October Through December 2024
This quarterly notice lists CMS manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published in the 3-month period, relating to the Medicare and Medicaid programs and other programs administere...
 Notice Feb 19, 2025
Health and Human Services Department > CMS
Medicaid and Children's Health Insurance Program (CHIP) Generic Information Collection Activities: Proposed Collection; Comment Request
On May 28, 2010, the Office of Management and Budget (OMB) issued Paperwork Reduction Act (PRA) guidance related to the "generic" clearance process. Generally, this is an expedited process by which agencies may obtain OMB's approval of collection of...
 Notice Jan 16, 2025
Health and Human Services Department > CMS
Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs, Including the Hospital Inpatient Quality Reporting Program; Health and Safety Standards for Obstetrical Services in Hospitals and Critical Access Hospitals; Prior Authorization; Requests for Information; Medicaid and CHIP Continuous Eligibility; Medicaid Clinic Services Four Walls Exceptions; Individuals Currently or Formerly in Custody of Penal Authorities; Revision to Medicare Special Enrollment Period for Formerly Incarcerated Individuals; and All-Inclusive Rate Add-On Payment for High-Cost Drugs Provided by Indian Health Service and Tribal Facilities; Correcting Amendment
This document corrects technical and typographical errors in the final rule with comment period that appeared in the November 27, 2024 Federal Register titled "Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Sur...
 Rule Jan 13, 2025
Health and Human Services Department > CMS
Medicare Program; Rural Community Hospital Disemonstration Program: Solicitation of Additional Participants
This notice announces a solicitation for up to 10 additional eligible hospitals to participate in the Rural Community Hospital Demonstration program, to run through June 30, 2028.
 Notice Dec 26, 2024
Health and Human Services Department > CMS
Agency Information Collection Activities: Proposed Collection; Comment Request
The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), Federal agencies are required to publ...
 Notice Dec 23, 2024
Health and Human Services Department > CMS
Medicare Program; Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin (IVIG) Items and Services Rate Update; and Other Medicare Policies; Correction
This document corrects technical errors in the final rule that appeared in the November 7, 2024, Federal Register titled "Medicare Program; Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update; HH Quality Reporting Prog...
 Rule Dec 20, 2024
Health and Human Services Department > CMS
Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly
This proposed rule would revise the Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), Medicaid, Medicare cost plan, and Programs of All-Inclusive Care for the Elderly (PACE) regulations to implement changes related to Star Rat...
 Proposed Rule Dec 10, 2024
Health and Human Services Department > CMS
Agency Information Collection Activities: Submission for OMB Review; Comment Request
The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), Federal agencies are required to publ...
 Notice Dec 09, 2024
Health and Human Services Department > CMS
Medicare and Medicaid Programs; CY 2025 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies; Medicare Shared Savings Program Requirements; Medicare Prescription Drug Inflation Rebate Program; and Medicare Overpayments
This final rule addresses: changes to the physician fee schedule (PFS); other changes to Medicare Part B payment policies to ensure that payment systems are updated to reflect changes in medical practice, relative value of services, and changes in th...
 Rule Dec 09, 2024
Health and Human Services Department > CMS
Medicare Program; Alternative Payment Model Updates and the Increasing Organ Transplant Access (IOTA) Model
This final rule describes a new mandatory alternative payment model, the Increasing Organ Transplant Access Model (IOTA Model), that will test whether performance-based upside risk payments or downside risk payments paid to or owed by participating k...
 Rule Dec 04, 2024
Health and Human Services Department > CMS
Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems; Quality Reporting Programs, Including the Hospital Inpatient Quality Reporting Program; Health and Safety Standards for Obstetrical Services in Hospitals and Critical Access Hospitals; Prior Authorization; Requests for Information; Medicaid and CHIP Continuous Eligibility; Medicaid Clinic Services Four Walls Exceptions; Individuals Currently or Formerly in Custody of Penal Authorities; Revision to Medicare Special Enrollment Period for Formerly Incarcerated Individuals; and All-Inclusive Rate Add-On Payment for High-Cost Drugs Provided by Indian Health Service and Tribal Facilities
This final rule with comment period revises the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Medicare Ambulatory Surgical Center (ASC) payment system for calendar year 2025 based on our continuing experience with these syste...
 Rule Nov 27, 2024
Health and Human Services Department > CMS
Agency Information Collection Activities: Proposed Collection; Comment Request
The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), Federal agencies are required to publ...
 Notice Nov 25, 2024
Health and Human Services Department > CMS
Medicare Program; CY 2025 Inpatient Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts
This notice announces the inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services furnished in calendar year (CY) 2025 under Medicare's Hospital Insurance Program (Medicare Part A). The Medicare stat...
 Notice Nov 14, 2024
Health and Human Services Department > CMS
Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, Conditions for Coverage for End-Stage Renal Disease Facilities, End-Stage Renal Disease Quality Incentive Program, and End-Stage Renal Disease Treatment Choices Model
This final rule updates and revises the End-Stage Renal Disease (ESRD) Prospective Payment System for calendar year 2025. This rule also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidn...
 Rule Nov 12, 2024
Health and Human Services Department > CMS
Agency Information Collection Activities: Submission for OMB Review; Comment Request
The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), Federal agencies are required to publ...
 Notice Nov 08, 2024
Health and Human Services Department > CMS
Medicare Program; Calendar Year (CY) 2025 Home Health Prospective Payment System (HH PPS) Rate Update; HH Quality Reporting Program Requirements; HH Value-Based Purchasing Expanded Model Requirements; Home Intravenous Immune Globulin (IVIG) Items and Services Rate Update; and Other Medicare Policies
This final rule will set forth routine updates to the Medicare home health payment rates; the payment rate for the disposable negative pressure wound therapy (dNPWT) devices; and the intravenous immune globulin (IVIG) items and services payment rate...
 Rule Nov 07, 2024
Health and Human Services Department > CMS
Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally- Facilitated Exchanges, Merit-Based Incentive Payment System (MIPS) Eligible Clinicians, and Eligible Hospitals and Critical Access Hospitals in the Medicare Promoting Interoperability Program; Correcting Amendment
This document corrects technical errors in the final rule that appeared in the February 8, 2024 Federal Register titled "Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Advancing Interoperability and Improving Prior Author...
 Rule Oct 25, 2024
Health and Human Services Department > CMS
Medicare Program: Appeal Rights for Certain Changes in Patient Status
This final rule implements an order from the Federal district court for the District of Connecticut in Alexander v. Azar that requires HHS to establish appeals processes for certain Medicare beneficiaries who are initially admitted as hospital inpati...
 Rule Oct 15, 2024
Health and Human Services Department > CMS
Agency Information Collection Activities: Submission for OMB Review; Comment Request
The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), Federal agencies are required to publ...
 Notice Oct 15, 2024
Health and Human Services Department > CMS
Medicare Program; Changes to the Fiscal Year 2025 Hospital Inpatient Prospective Payment System (IPPS) Rates Due to Court Decision
This interim final action with comment period (IFC) implements revised Medicare wage index values for FY 2025, establishes a transitional payment exception for low wage hospitals significantly impacted by those revisions, and makes conforming changes...
 Rule Oct 03, 2024

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        • vendor/laravel/framework/src/Illuminate/Cache/Repository.php:429
        • vendor/laravel/framework/src/Illuminate/Cache/CacheManager.php:456
        • app/Http/Controllers/SuggestedSearchController.php:64
        • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • SuggestedSearchController.php#67main5.26msselect "id", "name", "slug" from "agencies" where "agencies"."id" in (203, 44, 48, 247, 429, 434, 213, 226) and "agencies"."deleted_at" is null
        Backtrace
        • app/Http/Controllers/SuggestedSearchController.php:67
        • vendor/laravel/framework/src/Illuminate/Cache/Repository.php:429
        • vendor/laravel/framework/src/Illuminate/Cache/CacheManager.php:456
        • app/Http/Controllers/SuggestedSearchController.php:64
        • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • SuggestedSearchController.php#68main15.21msselect * from "related_entities" where "related_entities"."entity_type" = 'App\Models\SuggestedSearch' and "related_entities"."entity_id" = 81 and "related_entities"."entity_id" is not null and "related_entity_type" = 'App\Models\Topic' order by "common_documents_count" desc, "score" desc
        Bindings
        • 0: App\Models\SuggestedSearch
        • 1: 81
        • 2: App\Models\Topic
        Backtrace
        • app/Http/Controllers/SuggestedSearchController.php:68
        • vendor/laravel/framework/src/Illuminate/Cache/Repository.php:429
        • vendor/laravel/framework/src/Illuminate/Cache/CacheManager.php:456
        • app/Http/Controllers/SuggestedSearchController.php:64
        • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • SuggestedSearchController.php#68main5.68msselect "id", "name", "slug" from "topics" where "topics"."id" in (931, 489, 683, 8, 492, 450, 593, 678, 901, 940, 1145, 884, 838, 516, 491, 279, 604, 490, 1160, 488, 681, 255, 634, 101, 946, 799, 800, 2, 486, 16, 890, 191, 874, 158, 1174, 321, 889, 152, 1038, 974, 1169, 24, 1147, 928, 1021, 1139, 12, 1019) and "topics"."deleted_at" is null
        Backtrace
        • app/Http/Controllers/SuggestedSearchController.php:68
        • vendor/laravel/framework/src/Illuminate/Cache/Repository.php:429
        • vendor/laravel/framework/src/Illuminate/Cache/CacheManager.php:456
        • app/Http/Controllers/SuggestedSearchController.php:64
        • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • SuggestedSearchController.php#84main6.02msselect * from "suggested_searches" where "id" < 81 and "suggested_searches"."deleted_at" is null order by "id" desc limit 1
        Bindings
        • 0: 81
        Backtrace
        • app/Http/Controllers/SuggestedSearchController.php:84
        • vendor/laravel/framework/src/Illuminate/Cache/Repository.php:429
        • vendor/laravel/framework/src/Illuminate/Cache/CacheManager.php:456
        • app/Http/Controllers/SuggestedSearchController.php:82
        • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • SuggestedSearchController.php#85main6.62msselect * from "suggested_searches" where "id" > 81 and "suggested_searches"."deleted_at" is null order by "id" asc limit 1
        Bindings
        • 0: 81
        Backtrace
        • app/Http/Controllers/SuggestedSearchController.php:85
        • vendor/laravel/framework/src/Illuminate/Cache/Repository.php:429
        • vendor/laravel/framework/src/Illuminate/Cache/CacheManager.php:456
        • app/Http/Controllers/SuggestedSearchController.php:82
        • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      App\Models\RelatedEntity
      76RelatedEntity.php#?
      App\Models\Agency
      49Agency.php#?
      App\Models\Topic
      48Topic.php#?
      App\Models\SuggestedSearch
      23SuggestedSearch.php#?
      App\Models\Document
      20Document.php#?
          ClearShow all
          Date ↕MethodURLData
          #12025-04-15 21:06:57GET/searches/medicare-medicaid-and-schip-payments5212216