Archive for: Rulemaking

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Prescription Drug: Regulation

CMS Releases Final Part D Rule

On May 16, 2018, CMS released the final Part D and Medicare Advantage rule aimed at lowering drug prices.

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Prescription Drug: Regulation

CMS Issues Final Rule on Drug Pricing Transparency

The Centers for Medicare and Medicaid Services (CMS) released the Final Rule on requiring list prices to be included in direct-to-consumer television advertisements for prescription drug that are reimbursable under Medicare or Medicaid. List price is defined as the wholesale acquisition cost (WAC) for a “typical 30-day regimen or for a typical course of treatment”…

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Payment Innovation: Other

CMS Releases FY 2020 IPPS Proposed Rule

CMS calls for increased payments to rural hospitals and for new technologies in the recently released proposed rule.

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Diagnostics: Regulation

CMS Extends Comment Period on Proposed Changes to Proficiency Testing

The Centers for Medicare and Medicaid Services has extended the comment period on proposed changes to proficiency testing to June 4.

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Prescription Drug: Regulation

CMS Issues Pair of Rules on Line Item Extension Drugs

CMS issues pair of final rules addressing line item extension drugs.

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Payment Innovation: Other

CMS Hosts Listening Session on Interoperability and Patient Access Proposed Rule

CMS will host a listening session on the Interoperability and Patient Access Proposed Rule.

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Payment Innovation: Other

ONC Releases Proposed Rule to Advance Interoperability

ONC releases proposed rule to implement certain provisions of the 21st Century Cures Act.

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Diagnostics: Regulation

CMS Proposes Rule on Proficiency Testing

On February 4, 2019 CMS released the “Clinical Laboratory Improvement Amendments of 1988 (CLIA) Proficiency Testing Regulations Related to Analytes and Acceptable Performance” proposed rule on.

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Insurance Coverage: Regulation

Administration Releases Marketplace Proposed Rule

On January 24, 2019, the Centers for Medicare and Medicaid Services issued a proposed rule on payment parameters for the Health Insurance Marketplaces.

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Payment Innovation: Regulation

CMS Releases Final Rule Overhauling Medicare ACO Program

CMS has released its final rule redesigning the Medicare Accountable Care Organization Program.

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Payment Innovation: Other

CMS Proposes Changes for MA and Part D Plans: Coverage Changes for Protected Class Drugs, Step Therapy Requirements and Greater Price Transparency for Medicare Beneficiaries

On November 26, 2018, CMS released a proposed rule that would allow for changes in 2020 to coverage of protected class drugs, establish new requirements for when MA plans may apply step therapy as a utilization management tool for Part B drugs and implement electronic tools to increase drug price transparency for Medicare beneficiaries.

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Insurance Coverage: Regulation

Exchange Program Integrity Proposed Rule

The Centers for Medicare and Medicaid Services issued a proposed rule on the Health Insurance Exchanges.

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Payment Innovation: Other

CMS Releases Proposed Rule on Medicare Advantage, Medicare Part D, PAC and Medicaid

CMS releases proposed rule implementing certain provisions of the Bipartisan Budget Act of 2018.  Under this proposed rule, MA plans would be able to offer telehealth benefits beyond what is currently allowable under the traditional Medicare telehealth benefit.

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Payment Innovation: Regulation

CMS Releases Proposed Rule Overhauling Medicare Shared Savings Program

On August 9th, CMS released the Medicare Shared Savings Program proposed rule.

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Insurance Coverage: Regulation

Short-term Plans Final Rule

The Centers for Medicare and Medicaid Services issued a final rule on short-term limited duration plans.

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Diagnostics: Regulation

Frequently Asked Questions, CMS 1621 F, Medicare Program

Frequently Asked Questions, CMS 1621 F, Medicare Program – Medicare Clinical Diagnostic Laboratory Tests Payment System, Final Rule.

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Insurance Coverage: Regulation

Association Health Plans Proposed Rule

The Centers for Medicare and Medicaid Services issued a proposed rule on Association Health Plans.

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Payment Innovation: Regulation

CMS Releases CY 2018 Quality Payment Program (MACRA) Final Rule

Register Today for a Live Webinar – Overview and Analysis of the CY 2018 QPP Final Rule

ORIGINAL ANALYSIS

Payment Innovation: Regulation

2018 Quality Payment Program Proposed Rule Lands at OMB

This week the Centers for Medicare Medicaid Services (CMS) sent the 2018 Quality Payment Program (QPP) Proposed Rule (CMS-5522-P) to the Office of Management of Budget (OMB) for review. Established through the Medicare Access and CHIP Reauthorization Act (MACRA), the QPP established two tracks for Medicare physician payment: the Merit-Based Incentive Payment System (MIPS) and…

ORIGINAL ANALYSIS

Payment Innovation: Regulation

CMS Finalizes Policies for New Mandatory Cardiac and Orthopedic Models, Adjustments to CJR; Previews Details of Medicare Track One Plus ACO Model

On Tuesday, December 20, 2016 the Centers for Medicare and Medicaid Services (CMS) finalized several new Innovation center models expanding the agency’s footprint in the value based payment model space.

ORIGINAL ANALYSIS

Diagnostics: PAMA

Codes subject to reporting during the first reporting period.

Codes subject to reporting during the first reporting period (January 1 – March 30, 2017) (File requires WinZIP to open).

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Payment Innovation: Regulation

CMS Drops 2018 MACRA Proposed Rule – Proposes Continuing Flexibilities for Year 2

On July 25, 2016 the Centers for Medicare and Medicaid Services (CMS) released a Proposed Rule for a new mandatory bundled payment model for cardiac care, an expansion of the Comprehensive Care for Joint Replacement (CJR) model and a Cardiac Rehabilitation (CR) incentive payment model. CMS also indicated that these proposed bundled payment models could…

ORIGINAL ANALYSIS

Payment Innovation: Regulation

Getting Lost in the MACRA Proposed Rule? M+ Table of Contents Can Help

On May 9, 2016 the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 Proposed Rule was published in the Federal Register.

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Payment Innovation: Regulation

MACRA Proposed Rule Posted (Updated)

CMS posted the proposed rule to implement the Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

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