Hall Render

MARCH 21, 2024

The Centers for Medicare & Medicaid Services (“CMS”) recently announced the ACO Primary Care Flex Model (“Flex Model”), a new voluntary model within MSSP for low-revenue ACOs, that begins January 1, 2025. The application process for the MSSP is split into two phases.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Center for Health Insurance Reform

MAY 15, 2024

The Centers for Medicare & Medicaid Services have recently finalized rules and standards governing health plans and Marketplaces under the Affordable Care Act.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

C&M Health Law

JANUARY 25, 2023

Telehealth Section 4113 of the Act extends certain Medicare telehealth flexibilities that were allowed during the COVID-19 PHE for two years, through 2024. The section ensures that telehealth flexibilities under Medicare are extended for two years, regardless of the status of the PHE.

Medicaid 104

Medicaid Medicaid Medicare Medicare 104

Fierce Healthcare

APRIL 2, 2024

States now can add routine adult dental services as an essential health benefit, the Centers for Medicare & Medicaid Services announced in its 2025 Notice of Benefit and Payment Parameters fina | In its annual Notice of Benefit and Payment Parameters final rule, CMS prioritized dental and prescription drug benefits, network adequacy standardization (..)

ACA 108

ACA Medicaid Medicaid Medicare 108

Health Care Law Brief

FEBRUARY 2, 2024

On Tuesday, January 16, 2024, Governor Kathy Hochul released the SFY 2025 New York State Executive Budget (“Executive Budget”). While still subject to legislative approval, the Executive Budget incorporates the recently approved amendment (“Waiver Amendment”) to New York’s Medicaid Section 1115 Demonstration that includes $7.5

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Fierce Healthcare

AUGUST 21, 2023

The Centers for Medicare & Medicaid Services (CMS) released new draft guidance Monday on how it plans to roll out a program that allows Medicare members to spread out monthly payments for presc | New draft guidance gives a blueprint for pharmacies to begin offering monthly payments on prescription drugs starting in 2025.

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Health Care Law Brief

FEBRUARY 8, 2024

This year’s Health and Mental Hygiene Bill (“HMH Bill”) (part of the Governor’s FY 2025 Executive Budget) proposes a $233 billion balanced budget, which includes $35.5 billion to fund Medicaid, $4.8 The Department of Health (“DOH”) would establish Medicaid reimbursement rates for such off-site services.

Medicaid 52

Medicaid Medicaid Nurses Licensing 52

Health Law Advisor

FEBRUARY 2, 2023

On February 1, 2023, the Centers for Medicare & Medicaid Services (CMS) published a final rule outlining its audit methodology and related policies for its Medicare Advantage (MA) Risk Adjustment Data Validation (RADV) program. million per year starting in 2025 for PY 2018 from extrapolated recoveries.

Medicare 98

Medicare Medicare Overpayments Overpayment 98

Hall Render

NOVEMBER 29, 2023

On November 2, 2023, the Centers for Medicare & Medicaid Services (“CMS”) issued the 2024 Medicare Physician Fee Schedule Final Rule (“Final Rule”) for calendar year (“CY”) 2024. These changes become effective on January 1, 2024. CMS anticipates the changes will increase MSSP participation by 10% to 20%.

Medicare 40

Medicare Medicare Nurses Payment Systems 40

Natalia Mazina

OCTOBER 30, 2022

The Act – at its core – gives CMS ability to negotiate drug prices for Medicare and Medicaid plans. By 2026, CMS will directly negotiate prices for selected drugs (initially the 10 most expensive drugs ). CMS does not anticipate that these new prices will result in lower pharmacy reimbursements. .

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Healthcare Law Blog

NOVEMBER 13, 2023

On November 6, 2023, the Centers for Medicare and Medicaid Services (“CMS”) released the contract year 2025 proposed rule for Medicare Advantage (“MA”) organizations and Part D sponsors (the “Proposed Rule”). The UM committee was established in April 2023 in the 2024 Medicare Advantage and Part D Final Rule (CMS-4201-F).

Medicare 59

Medicare Medicare Medicaid Medicaid 59

Kaiser Health News

AUGUST 12, 2022

First, it would give the federal government the ability to negotiate prices of some drugs purchased by Medicare beneficiaries, a tool that has long been opposed by the drug industry. ” The bill extends the enhanced subsidies, which will expire this year if they are not continued, through 2025. “It’s historic. .

Medicare 88

Medicare Medicare Prescription Drug Pricing Governance 88

Healthcare Law Blog

JANUARY 10, 2022

On January 6, 2022 , the Centers for Medicare and Medicaid Services (“CMS”) issued the proposed rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Proposed Rule”).

Medicare 98

Medicare Medicare COVID-19 Medicaid 98

Healthcare Law Blog

FEBRUARY 22, 2023

The Rebate Programs are administered as part of the prescription drug affordability provisions of the Inflation Reduction Act (the “IRA”), which is aimed at “lower[ing] out-of-pocket drug costs for people with Medicare and improv[ing] the sustainability of the Medicare program for current and future generations.” [1]

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Innovaare Compliance

NOVEMBER 29, 2023

On October 13, 2023, the Centers for Medicare & Medicaid Services (CMS) published the Readiness List for CY 2024. This has been a very useful tool for Medicare Advantage Organizations (MAO) to check their readiness to fulfill requirements in the new contract year. CERT Testing is planned to begin on July 1, 2024.

Medicare 52

Medicare Medicare Compliance Medicaid 52

Health Law Advisor

SEPTEMBER 1, 2023

On August 29, 2023, the Centers for Medicare & Medicaid Services (CMS) announced the ten (10) Medicare Part D drugs selected for the first round of negotiations of the Medicare Drug Price Negotiation Program (Program)—a few days before the September 1, 2023, statutory deadline imposed by the Inflation Reduction Act (IRA).

Medicare 69

Medicare Medicare Licensing Medicaid 69

Healthcare Law Blog

MAY 16, 2022

On April 29, 2022 , the Centers for Medicare and Medicaid Services (“CMS”), issued the final rule on Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs (the “Final Rule”).

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

MAY 10, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) announced its plan to implement the Transforming Episode Accountability Model (“TEAM”), a new mandatory alternative payment model unveiled as part of the 2025 Hospital Inpatient Prospective Payment System proposed rule.

Medicare 40

Medicare Medicare Hospitals Medicaid 40

Healthcare Law Blog

JANUARY 5, 2023

Just in time for the holidays, the Centers for Medicare and Medicaid Services (“CMS”) issued the Contract Year 2024 Proposed Rule for Medicare Advantage organizations (“MAOs”) and Part D sponsors (the “Proposed Rule”). Health Equity in Medicare Advantage.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare Law Blog

JANUARY 6, 2023

In addition to funding, the Act modifies certain telehealth provisions, expands and extends components of the Medicare and Medicaid programs, and supports initiatives within the behavioral health and substance use treatment spaces. Medicare Extension & Adjustments. The Act provides for nearly $1.7 Audio-Only Telehealth.

COVID-19 52

COVID-19 Medicaid Medicaid Medicare 52

Innovaare Compliance

MARCH 4, 2024

Until the enactment of the Medicare Modernization Act (MMA) in 2006 [1] , the Centers for Medicare & Medicaid Services does not cover most outpatient prescription drugs under Part B (“Part B drugs”). However, some drugs self-administered by Medicare beneficiaries at home are Part B eligible.

Medicare 52

Medicare Medicare Nurses Medicaid 52

HIT Consultant

DECEMBER 12, 2023

In fact, by 2025, more than 70 million U.S. Its use has increased over the past decade, but still, only about 13% of dialysis patients currently take advantage of in-home dialysis , despite studies showing that it has similar outcomes to in-patient treatment, greater patient satisfaction and reduced Medicare costs.

Patient Satisfaction 119

Patient Satisfaction COVID-19 Doctors Payment Systems 119

Hall Render

MAY 30, 2023

On April 4, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a proposed rule (“Proposed Rule”) that would update Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for fiscal year 2024.

Nurses 40

Nurses COVID-19 Vaccine COVID-19 Medicare 40

Healthcare Law Blog

AUGUST 25, 2022

The expansive legislation includes key health care provisions, including drug pricing reforms, inflationary rebates, Medicare Part D benefit redesign, as well as myriad other updates. Medicare Drug Price Negotiation Program. The Inflation Reduction Act (“IRA”) was signed into law by President Biden on August 16, 2022.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare Law Blog

DECEMBER 11, 2023

Permitting states to expand Medicaid eligibility by disregarding more income and resource threshold standards for individuals that are excepted from the application of the Modified Adjusted Gross Income financial methodology. Reducing the risk adjustment user fee for 2025 from $0.21 for Medicare & Medicaid Servs.

Medicaid 52

Medicaid Medicaid ACA Medicare 52

HIT Consultant

FEBRUARY 15, 2022

billion by 2025. Given CMS’ recent decision to double the weight of experience-based quality measures used to calculate Medicare Advantage Star Ratings, harnessing the power of these two types of analytics applications together could become a key determinant of success in 2022 and beyond. Medicaid, Medicare Advantage).

Medicare 98

Medicare Medicare Medicaid Medicaid 98

Hall Render

AUGUST 11, 2023

On August 7, 2023, the Centers for Medicare & Medicaid Services (“CMS”) released a final rule (“Final Rule”) that updated Medicare payment policies and rates for skilled nursing facilities (“SNFs”) under the Skilled Nursing Facility Prospective Payment System (“SNF PPS”) for fiscal year (“FY”) 2024.

Nurses 40

Nurses COVID-19 Vaccine COVID-19 Payment Systems 40

Hall Render

APRIL 12, 2024

On April 10, 2024, the Centers for Medicare & Medicaid Services (“CMS”) released the 2025 Inpatient Prospective Payment System (“IPPS”) Proposed Rule (“Proposed Rule”). Background Medicare classifies hospitals by rural and urban status for a variety of payment purposes.

Medicare 40

Medicare Medicare Payment Systems Hospitals 40

Healthcare IT Today

DECEMBER 24, 2023

Among those organizations not using automation, 80% plan to by the end of 2025. Arizona-based VBCare Network selected Spatially Health for identifying barriers to health equity in Medicare and Medicaid beneficiaries. Chicago-area RML Specialty Hospital chose ScImage to support cloud-based PACS.

Hospitals 93

Hospitals Medicaid Medicaid Medicare 93

Healthcare Law Blog

DECEMBER 12, 2022

The Centers for Medicare & Medicaid Services (CMS) Innovation Center continues to move forward with its “strategic refresh” initiative. Through this shift, CMS aims to examine and enhance payments for specialty care provided to Medicare beneficiaries. Value-Based Care and ACOs.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Healthcare Law Blog

APRIL 24, 2023

On April 17, 2023 , the Centers for Medicare & Medicaid Services (“CMS”) released the U.S. Beginning plan year 2025, the four-option limit will drop to two. Additionally, CMS has finalized a risk adjustment user fee of $0.21

Medicaid 52

Medicaid Medicaid Compliance Health Insurance 52

Healthcare IT News - Telehealth

SEPTEMBER 15, 2021

Research firm Frost & Sullivan forecasts a sevenfold growth in telehealth by 2025 – a five-year compound annual growth rate of 38%. The Centers for Medicare and Medicaid Services (CMS) began to allow for reimbursement for videoconferencing between healthcare provider and patient.

Telemedicine 178

Telemedicine COVID-19 Medicare Medicare 178

Health Care Law Brief

DECEMBER 15, 2021

On November 2, 2021, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule (“Final Rule”) that advances the shift from paying for Medicare home health services based on volume to a system that pays based on value. CY 2023 will be the first performance year with payment adjustments occurring in CY 2025.

Medicare 40

Medicare Medicare Medicaid Medicaid 40

Medisys Compliance

AUGUST 4, 2022

The Centers for Medicare & Medicaid Services (CMS) on June 21, 2022, issued a proposed rule that proposes to update payment rates and policies under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2023.

Medical Billing 59

Medical Billing Medical Billing Outsourcing Payment Systems Medicare 59

Innovaare Compliance

MARCH 11, 2024

The Centers for Medicare & Medicaid Services (CMS) has been processing Part D drug claim data via the Drug Data Processing System (DDPS) since inception of Part D in 2006. Author Yvonne Tso, PharmD SVP, Integritas Medicare [1] Revenue reconciliation for Part D usually takes place in September for the prior contract year. [2]

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Hall Render

JULY 7, 2023

The Centers for Medicare & Medicaid Services (“CMS”) just released its Proposed Rule for repaying hospitals that were affected by the 340B OPPS payment cuts from 2018 through 2022. decrease to the OPPS conversion factor beginning in 2025. billion of repayments will be offset by a 0.5%

Hospitals 40

Hospitals Medicaid Medicaid Medicare 40

Hall Render

MAY 17, 2024

NATIONAL A deep dive into health system and health plan Q1 earnings Amazon building ‘modern pharmacy’ of the future: Medical Officer Breaking down the FTC noncompete ban, its impact on healthcare CISA, HHS warn healthcare of Black Basta ransomware attacks CMS extends Medicaid waivers to 2025 Could providers be liable in Change outage?

Nurses 40

Nurses Nursing Homes Hospitals Ransomware 40