Centers for Medicare & Medicaid Services Archives

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 Updates Physician Self-Referral Regulations to Reflect Medicare’s Transition Toward Value-Based Payment Systems

On November 20, 2020, the Centers for Medicare & Medicaid Services’ (CMS) issued a fact sheet and final rule to modernize and clarify regulations that interpret and implement the physician self-referral law. The intent of the final rule is to balance the reduction of unnecessary physician burden with the goal of removing a physician’s financial [...] 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 Completes Price Transparency Reform by Issuing Long-Awaited Final Rule for Health Plans

On the morning of October 29, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a press release, fact sheet, and an unpublished final rule on its website that implements the group health plan (“plan”) and health insurance issuer (“issuer”) portions of the Administration’s Executive Order on Improving Price and Quality Transparency (E.O. 13877).[1] [...] 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

CMS Finalizes Administrative Updates to MA & Part D, Expands Access to Telehealth Benefits, Refines Prescriber Preclusion List

On April 5, 2019, the Centers for Medicare and Medicaid Services released a final rule of administrative and technical changes to Medicare Advantage and Medicare Part D. Many of the changes in this rule were mandated by the Bipartisan Budget Act of 2018 (BBA). Most of the provisions in this final rule will go into [...] Read More

Proposals for 2020 Medicare Advantage and Part D Plans Released, Opioids and Generic Access Continue to be a Focus

The Center for Medicare and Medicaid Services (CMS) has released the plan year 2020 Draft Call Letter outlining proposed changes to policies impacting Medicare Advantage (MA) and Part D prescription drug plans (PDPs). The agency is continuing to focus on changes that will modernize the MA and PDP benefits to make the plans operate closer [...] Read More

HHS Identifies Goals and Strategies to Reduce Administrative Burden Associated with Health IT Use, Improve EHR Usability, and Increase Clinical Workflow

The Department of Health and Human Services (HHS) has released a Draft Strategy titled “Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs.” As required by the 21st Century Cures Act, the draft strategy identifies an overall goal of reducing burden related to the use of EHRs and Health IT [...] Read More

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Archive Tag: Centers for Medicare & Medicaid Services