CMS Rules Archives - Page 11 of 15

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CMS Issues Rule to Protect Consumers from Surprise Billing & New Report on Surprise Bills for Maternal & Newborn Care

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CMS Proposed Rule: Updates to Home Health Care, Payment Rates and Value-based Models

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on Monday that will expand the home health value-based purchasing (HHVBP) model, which was originally developed by the Center for Medicare & Medicaid Innovation (CMMI) in 2016. The rule also includes updates to the Medicare Home Health Prospective Payment...

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CMS Delays Medicaid Best-Price Drug Rule

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule last Wednesday that delays the implementation of a Trump-era rule which would incentivize the use of value-based drug pricing agreements for the Medicaid program. The original version of the regulation was finalized in December 2021, but the Biden...

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AHCCCS Seeks Input on American Rescue Plan Act HCBS Spending

On June 7 at 5 p.m., AHCCCS is hosting an online community forum to solicit feedback from stakeholders about the American Rescue Plan Act home and community based services expenditure enhancement. AHCCCS will use the feedback to submit a spending plan to the Centers for Medicare and Medicaid Services by June 12 this year. Section...

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National Policy: 340b Drug Pricing, Price Transparency Rule, Public Charge Rule

Last week, President Joe Biden announced that he would roll back a controversial Trump-era rule that would have required green card applicants and other immigrants to demonstrate that they would have health insurance upon arrival to the U.S. The so-called "public charge" rule would have allowed the government to deny visa applications if...

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Medicare, MA: Medicare Beneficiaries Like Their Coverage, Prior Authorization, MCIT Delay

Medicare's older adults still like their coverage and report fewer cost-related problems than privately insured adults ages 50 to 64, despite receiving similar care to that age bracket. The study from Kaiser Family Foundation said that rapidly growing healthcare spending is of concern for consumers and the relatively high prices from...

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CMS Data Shows Vulnerable Americans Forgoing Mental Health Care During COVID-19 Pandemic

Health is both mental and physical health, and until we recognize this as a community, we will struggle to address the health of our community, according to TMC Healthcare. The U.S. Department of Health and Human Services estimates that one in five Americans over age 18 will experience a mental health problem in a regular year. The...

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Value-Based Care: Humana Enters DCM, ACOs Concerned about MSSP Changes

The Centers for Medicare and Medicaid Services (CMS) is deep into Medicare alternative payment model (APM) revision and adjustment. One such program undergoing review is the Medicare Shared Savings Program (MSSP) and the revisions include major changes to quality reporting methodologies, the crux of the program. CMS posted its final...

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CMS Rule: Rural Hospital Workforce, IPPS and LTCH Payment Changes

On Sunday, the Centers for Medicare & Medicaid Services (CMS) issued two proposed rules for inpatient and long-term care hospitals. The first aims to fund medical residency positions in hospitals in rural and underserved communities in order to address workforce shortages in those areas and would require hospitals to report COVID-19...

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CMS Announces CJR Final Rule, 3 Year Extension

The Centers for Medicare and Medicaid Services (CMS) issued a final rule making changes to the Comprehensive Care for Joint Replacement (CJR) payment model last week. The final rule extends the payment model for three performance years for participating hospitals and allows for CMS to test modifications to the model. The final rule...

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SNFs & Hospices See Increase in Payments & Decrease in Patients; Requirement to Report Vaccination Rates

After a 1.7 billion in nursing home payment increase, the federal government is mulling several options to recalibrate the Medicare payment structure for skilled nursing facilities as it seeks to achieve its intended goal of budget neutrality, with the aim of shutting off excess payments as soon as possible. SNF News According to the...

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MedPAC Recommends Reduced Number of APMs, No CHART ACO Yet

The Medicare Payment Advisory Commission (MedPAC) agreed that the Department of Health and Human Services (HHS) must put together a consolidated group of alternative payment models in order to improve demonstrations. From the commission's recommendation: The Secretary should implement a more harmonized portfolio of fewer spending...

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Medicaid News: Work Requirements Hearings Suspended by SCOTUS, Reporting Requirements Under Review

This week, the Supreme Court suspended hearings on Medicaid work requirements as other Trump era Medicaid policies come under fire. Plus, states aren't quite meeting reporting requirements and more reporting adjustments could be on the way. The U.S. Supreme Court suspended its review of the Medicaid work requirements and removed the...

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Stakeholders Confident Senate Will Avoid Sequester Cuts

Provider groups aren't too worried about the 2% Medicare payment cut that is scheduled to go back into effect on April 1st after being paused for the COVID-19 pandemic. The cuts originally went into effect in 2013 and were paused to protect providers like hospitals and doctor groups that are now confident that the cuts will continue to...

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Study: Medicare Shift to Outpatient Surgery Affects the Privately Insured

The American Journal of Managed Care published a study last Friday looking at the increase of outpatient knee replacement surgeries paid through private insurance after the Centers for Medicare and Medicaid Services' (CMS) decision to remove knee replacements from the Inpatient Only list. According to the AJMC study, there was an...

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Affordable Care Act Update: Subsidies, Navigator Funding, Special Enrollment Period

The newly installed Biden Administration and the ongoing turbulence of the pandemic have resulted in a flurry of recent changes in the world of the Affordable Care Act—all as an impending Supreme Court decision on its very existence looms in the background. Many Americans lost jobs due to the pandemic, and with them their...

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Hospital Price Transparency Rule: National & Arizona Compliance Check

The Centers for Medicare and Medicaid Services (CMS) price transparency rule went into effect on January 1st. The rule, which requires that hospitals disclose prices of basic procedures in searchable files or consumer-friendly interfaces, was met with uncertainty and criticism from hospitals and other stakeholders for being too strict a...

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CMS Releases Notice of Benefit and Payment Parameters and MA Rates for 2022

On January 14, the Centers for Medicare and Medicaid Services (CMS) released the Notice of Benefit and Payment Parameters for 2022. This included a finalized user fee of 2.25% of premiums for insurers on the federally facilitated exchange. The rule also allows states to enroll eligible patients in the individual marketplace. Insurers...

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CMS Finalizes Prior Authorization Rule

Last Friday, the Centers for Medicare and Medicaid Services (CMS) approved a final rule requiring payers to build application program interfaces to support data exchange and streamline prior authorization. Medicaid and the Children’s Health Insurance Program (CHIP); healthcare exchange plans are also required to comply with the...

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New Rule Gives Web-based Brokers Access to 2023 ACA Exchange Markets

Last Thursday, the Centers for Medicare & Medicaid Services proposed that states could use Section 1332 waivers to customize their Exchanges and allow web-based insurers to sell insurance by 2023; some stakeholders contend the changes undermine key tenets of the Affordable Care Act. The agency's final rule, Notice of Benefit and...

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