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Archive Tag: Centers for Medicare & Medicaid Services

CMS Proposes Further Updates for Exchange Health Plans Starting 2022, Including Fees, Enrollment, and 1332 Waivers (CMS-9906-P)

On the evening of June 28, 2021, the Centers for Medicare & Medicaid Services and the Department of the Treasury put a proposed rule on display[1] that includes rules and policies designed to promote greater access to comprehensive health insurance coverage through the Exchanges, consistent with applicable law and recent Presidential executive orders.[2],[3],[4] The proposed [...] Read More

CMS Extends & Modifies Comprehensive Care for Joint Replacement Model (CMS-5529-F)

On April 29, 2021, the Centers for Medicare & Medicaid Services (CMS) posted the final rule Comprehensive Care for Joint Replacement Model Three-Year Extension and Changes to Episode Definition and Pricing to the inspection desk of the Federal Register (link). This final rule extends the Comprehensive Care for Joint Replacement (CJR) model through December 31, [...] Read More

CMS Finalizes Long-Awaited Rule that Provides Additional Flexibility for States with Medicaid & CHIP Managed Care (CMS-2408-F)

On the morning of November 9, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a press release, fact sheet, and a final rule that updates the regulations for Medicaid and Children’s Health Insurance Program (CHIP) managed care programs to address the following policy areas: Setting Actuarially Sound Capitation Rates (Medicaid); Pass-Through Payments (Medicaid); [...] Read More

CMS Issues Waivers & Interim Final Rule (CMS-1744-IFC) to Address COVID-19

On the evening of March 30th, the Centers for Medicare and Medicaid Services (CMS) announced a series of additional blanket waivers under section 1877(g) and section 1135 of the Social Security Act and an interim final rule (IFC) aimed at addressing the ongoing COVID-19 public health emergency.   Below are many of the new flexibilities and capabilities included in the waivers and rule:   Increasing Hospital Capacity Allow ambulatory [...] Read More

Medicaid Preadmission Screening and Resident Review (PASRR): CMS Proposes to Modernize and Streamline the Process

On February 14, 2020, the Centers for Medicare and Medicaid Services (CMS) released its proposed rule and fact sheet for Medicaid’s required Preadmission Screening and Resident Review (PASRR). In this proposed rule, CMS intends to update the PASRR regulations for the first time since 1992 and incorporate statutory changes, update diagnostic criteria for mental illness [...] Read More

CBO Underestimates Medicare Part D savings by $4 Billion Due to Oversight Lapse

In the Bipartisan Budget Act of 2018 the Congressional Budget Office underestimated – by $4 billion – the amount Medicare would save due to changes in Medicare Part D. Instead of saving $7.7 billion, Medicare will actually save $11.8 billion. The savings come from an increase in the government mandated discount that drug manufacturers must offer enrollees [...] Read More

Biosimilar Access and Savings: Ensuring a Reliable Reimbursement System

Here are some reimbursement related reasons why access to biosimilars has been slower than hoped, even though patient out-of-pocket costs are lower. Current System Is an Improvement Over Earlier System, But Could Be Better Part B Is For Biologics (and Some Drugs) When I was working at the Senate Legislative Counsel’s office drafting the Average [...] Read More

Medicare Should Help Patients Avoid the Angst of an Incorrect Alzheimer’s Diagnosis

Every year, thousands of Americans hear the devastating news that they have Alzheimer’s disease.  This diagnosis carries with it a certain future of declining mental and behavioral capabilities, and the eventual need for round-the-clock end-of-life care. The financial costs can be staggering, and the emotional costs immeasurable. While the impact of Alzheimer’s can be slowed, […]

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