article thumbnail

CMS Includes MAOs in Data Exchange and Prior Authorization Requirements

Healthcare Law Blog

Specifically, CMS proposes that, beginning January 1, 2026, impacted payers would be required to: Implement and maintain a FHIR PARDD API using technology conformant with certain standards and implementation specifications in 45 CFR 170.215. CMS is not proposing to apply these requirements to drugs that are covered by the MAO.

article thumbnail

Health Provider News – January 27, 2023

Hall Render

NATIONAL Amazon launches $5-a-month unlimited prescription plan CMS begins publicizing disputed nursing home deficiencies CMS Readies Nursing Home Staffing Mandate Proposal, Reviews Study Recommendations Healthcare workers are unhappy with their pay Kroger Health launches clinical trial site network Local anesthetic drug supply: 132 in shortage, 13 (..)

article thumbnail

CMS BLOG: Medicare for All? Just another name for a government-run, single payer system

CMS.gov

What’s worse, Medicare actually fuels higher drug prices, by paying doctors and hospitals an add-on fee for drugs that is set at a percentage of the cost of the drug. It is certainly not because the ACA has worked. After the ACA took effect, premiums skyrocketed and choice dwindled. percent from 2011-2016, from $17.6 billion.