Section 216 of the Protecting Access to Medicare Act of 2014 (PAMA) was intended to reduce Medicare spending on lab testing by implementing a market-based fee schedule and was prompted by the recognition that Medicare was paying higher rates for many tests than were private payers.[1] - Next phase in of up to 15 percent [...] Read More
On June 15, 2021, the Medicare Payment Advisory Commission (MedPAC) released one of their two annual Reports to Congress.[1],[2] The report includes recommendations to revise Medicare Advantage (MA) benchmark policy, streamline the portfolio of alternative payment models (APMs), replace the existing skilled nursing facility value-based purchasing program, revise indirect medical education (IME) payments, and improve [...] Read More
The Biden administration, via the Health Resources and Services Administration (HRSA) and the Department of Health and Human Services (HHS), released a proposed rule which seeks to rescind a previous final rule related to 340B discounts for insulin and injectable epinephrine that was adopted in the final months of the Trump administration. Comments on the [...] Read More
On April 8th, 2021, the Centers for Medicare & Medicaid Services (CMS) released a fact sheet and unpublished proposed rule, Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2022, which updates payment rates and policies for these facilities: Increase [...] Read More
In late December 2020, the Trump Administration released a final rule designed to promote the use of value-based purchasing (VBP) arrangements between drug manufacturers and payers, including Medicaid. The final rule, released by the Centers for Medicare & Medicaid Services (CMS), also contains policies related to line extensions and copay accumulators. The incoming Biden Administration [...] Read More
On November 2, 2020, the Centers for Medicare & Medicaid Services (CMS) released the final rule that updates the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year (CY) 2021. This rule finalizes changes related to the ESRD PPS, the ESRD Quality Incentive Program (ESRD-QIP), payment for acute kidney injury (AKI), and other [...] Read More
On September 24, 2020, the Health Resources and Services Administration (HRSA) released a proposed rule, Implementation of Executive Order 13937, “Executive Order on Access to Affordable Life-saving Medication.” This Executive Order (EO) directed HHS to take action to ensure that future grants under the Public Health Service Act are conditioned upon a Federally Qualified Health [...] Read More
On September 18, 2020, the Centers for Medicare & Medicaid Services (CMS) released its long-awaited Specialty Care Models to Improve Quality of Care and Reduce Expenditures final rule (link) and the Health Resources and Services Administration (HRSA) released its Removing Financial Disincentives to Living Organ Donation final rule (link) and updated guidelines (link). These rules [...] Read More
On the evening of September 2, 2020, the Centers for Medicare & Medicaid Services (CMS) released its final rule, Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Final Policy Changes and Fiscal Year 2021 Rates (link), which updates the FY 2021 payment systems for [...] Read More
On the morning of August 4, 2020, the Centers for Medicare and Medicaid Services (CMS) released the Hospital Outpatient Prospective Payment System (OPPS) calendar year (CY) 2021 proposed rule. The rule also includes updates to the ambulatory surgical center (ASC) payment system and other specified policies: Update and refine the requirements for the Hospital Outpatient [...] Read More