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...CMS Rules
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...CMS Rules
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...CMS Rules
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...CMS Rules
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...CMS Rules
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...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) released 20 new proposed measures for quality and efficiency measures under consideration. CMS reviews and updates all quality measures annually for its programs, reviewing and removing less relevant ones and proposing more innovative metrics.
From CMS Administrator Seema...CMS Rules
On Tuesday, the United States Court of Appeals for the District of Columbia ruled that the Department of Health and Human Services may continue with the hospital price transparency rule on January 1. The American Hospital Association requested an injunction against the 2019 final rule that will require hospitals to make their standard...CMS Rules
Last Wednesday, a United States District Court judge issued an injunction against the Centers for Medicare and Medicaid Services’ (CMS) Most Favored Nation drug pricing model for 14 days. The demonstration was set to begin on January 1, but the court ruled that the COVID-19 pandemic emergency was not sufficient to immediately finalize...CMS Rules
Through the last few weeks in office and in anticipation of the new calendar year, the Centers for Medicare and Medicaid Services (CMS) passed a slew of rules, deadline extensions and requests for participation in order to bolster cost-lowering initiatives and incentivize participation in value-based care programs.
The federal...CMS Rules
Last week, the Center for Medicare and Medicaid Innovation (CMMI) announced the Geographic track for the Direct Contracting model. This week, the Centers for Medicare and Medicaid Services (CMS) expounded on the program, announcing that the model could be extended to Medicare Managed Care Organizations (MCOs) serving dually eligible...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) proposed a new rule to streamline prior authorizations and improve electronic healthcare data transfers between doctors, patients and insurance companies. The rule will require payers involved in certain government programs to build apps for the purpose of this exchange and prior...CMS Rules
Across the board, providers are unhappy and vocal about the calendar year 2021 pay rule released by the Centers for Medicare and Medicaid Services (CMS) last week. Due to strict budget neutrality, the agency offset a pay increase for primary care providers by cutting payment to specialists by up to 10%.
Primary care doctors and nurses...CMS Rules
Last week, the Centers for Medicare and Medicaid Services (CMS) released a propose rule for 2022 Notice of Benefit and Payment Parameters. The proposed rule would lower the user fee or Affordable Care Act (ACA) insurers to 2.25% of the premium for the coverage year 2022 and also would enable states to partner directly with the private...CMS Rules
On Tuesday the Centers for Medicare and Medicaid Services (CMS) released the final rule for policy adjustments under the Physician Fee Schedule (PFS) for calendar year 2021. The rule confirmed changes to telehealth payments made during the COVID-19 pandemic, but will make cuts to specialty providers.
Last March, during the onset...CMS Rules
Last Friday, the Centers for Medicare and Medicaid Services announced a final rule that makes changes to the Physician Self-Referral Law, or Stark Law, which prohibits doctors from referring patients to services or providers owned or employed by the referring physician. The law has caused issues for participants in value-based...CMS Rules
Last Friday, the Trump administration announced two interim final rules in a last-ditch effort to fulfill the president’s campaign promises of lowering drug prices for seniors. Many of President Trump’s prior efforts were blocked by litigation or lost momentum during the rule making process. With eight weeks left in his presidency,...CMS Rules
On Oct. 20, CMS approved a waiver that allows adult Medicaid beneficiaries in Nebraska to receive additional benefits, including vision and dental, if they participate in work requirements. The program is set to go into effect in April 2021.
Nebraska’s new Medicaid Section 1115 demonstration called “Heritage Health Adult" is...CMS Rules
Value-based care continues to be a focus in the news this week, as the Centers for Medicare and Medicaid Services Administrator Seema Verma penned an op-ed in Modern Healthcare about the Centers’ support for models driven by the Center for Medicare and Medicaid Innovation. These programs have on the whole lost more money than they’ve...CMS Rules
Last week CMS said it has taken steps to advance a package of state-led reforms that could result in thousands of uninsured Georgians gaining access to coverage. Specifically, CMS announced the approval of Georgia's new Medicaid section 1115 demonstration called "Pathways to Coverage."
CMS began implementing work requirements for...
