Health Care Law Brief

FEBRUARY 2, 2024

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 billion in Medicaid investments over the next three years. Services will be delivered via a two-tiered system.

Medicaid 52

Medicaid Medicaid Medicare Medicare 52

Hall Render

MARCH 20, 2024

The improved information requirements apply to the following payers, including: Medicare Advantage plans; Medicaid and Children’s Health Insurance Program (“CHIP”) managed care plans; State Medicaid and CHIP fee-for-service payers; and Qualified Health Plans only in the Federally Facilitated Exchanges.

Medicare 40

Medicare Medicare Health Insurance Medicaid 40

Healthcare Law Blog

JANUARY 26, 2024

On December 13, 2022, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule, titled Advancing Interoperability and Improving Prior Authorization Processes (“Proposed Rule”), to improve patient and provider access to health information and streamline processes related to prior authorizations for medical items and services.

US Department of Health and Human Services 52

US Department of Health and Human Services Medicare Medicare Medicaid 52

Healthcare IT Today

DECEMBER 12, 2023

The latest policy update from The Centers for Medicare and Medicaid Services (CMS) adds key provisions to the December 2022 proposed rule requiring adoption of a new NCPDP SCRIPT standard version. The proposed deadline for adopting the new CMS SCRIPT standards is January 1, 2027.

Compliance 83

Compliance Doctors Medicaid Medicaid 83

Innovaare Compliance

APRIL 7, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% Even if the GLP-1 agents are selected for price negotiation, negotiated price will not come to fruition until 2027. The cost to Medicare Part D would be $26.8

Medicare 59

Medicare Medicare COVID-19 Hospitals 59

Innovaare Compliance

APRIL 7, 2024

The Centers for Medicare & Medicaid Services (CMS) officially announced capitation rates for Medicare Advantage (MA) plans for CY 2025 – average increase of 3.7% Even if the GLP-1 agents are selected for price negotiation, negotiated price will not come to fruition until 2027. The cost to Medicare Part D would be $26.8

Medicare 52

Medicare Medicare COVID-19 Hospitals 52

Medisys Compliance

JULY 27, 2022

For dates of service calendar years 2027-2029, the reduced coinsurance is 10%. In the CY 2017 PFS Final Rule, the Centers for Medicare & Medicaid Services (CMS) modified coding and reporting of procedural services that include moderate sedation as an inherent part of the service, including for screening colonoscopies.

Medical Billing 52

Medical Billing Medical Billing Outsourcing ACA Medicare 52