18 recent CMS moves

These are 18 recent policy changes made by CMS that have been reported by Becker's since Jan. 1:

Provider/Clinical 

1. CMS said that on Feb. 27 certified independent dispute resolution entities could resume issuing No Surprises Act payment determinations involving out-of-network services and items furnished before Oct. 25, 2022. That announcement came after CMS on Feb. 10 instructed certified IDR entities to hold all payment determinations following a Feb. 6 court ruling found revised arbitration process "continues to place a thumb on the scale" in favor of insurers and "that the challenged portions of the final rule are unlawful and must be set aside."

2. CMS said Feb. 22 it "is not reconsidering" its coverage plan for Alzheimer's drugs that target amyloids — meaning its Aduhelm-era decision will stay true for Leqembi.

3. CMS has issued nearly 500 warnings and 230 requests for corrective action to hospitals not complying with price transparency laws as of January 2023. 

4. CMS began accepting applications Feb. 21 for its Bundled Payments for Care Improvement Advanced model. 

5. The Biden-Harris administration and CMS said Jan. 18 they are enacting new rules aimed at reducing the inappropriate use of antipsychotic medications and increasing transparency about nursing home citations to families.

6. CMS on Jan. 11 unveiled key dates for the first year of the Medicare Drug Price Negotiation Program under the Inflation Reduction Act, a $739 billion package that aims to lower drug costs. By Sept. 1, 2023, the agency will post the first 10 Medicare Part D drugs selected for the program, which will allow Medicare — the largest buyer of prescription drugs in the U.S. — to negotiate how much it pays for certain medications. 

7. CMS said Jan. 9 it is funding the creation of 200 new residency spots at 100 U.S. teaching hospitals located in underserved communities. The goal is to help bolster the healthcare workforce in these areas and increase patients' access to care.

8. CMS rolled out a new telehealth indicator on Jan. 5 that helps beneficiaries and caregivers find clinicians who provide telehealth services.

9. CMS made several changes to the Medicare cost report for hospitals that include uncompensated care, Medicare disproportionate share hospital, bad debt and graduate medical education. Transmittal 18, which CMS posted to its website Dec. 29, is likely to significantly affect hospital reimbursement for providers that are unprepared. The changes took effect for cost reporting periods beginning Oct. 1, 2022. 

10. CMS proposed a rule Dec. 19 that could save a projected $454 million a year in administrative costs by adopting standards for "healthcare attachments" transactions, such as medical charts, X-rays and provider notes that document physician referrals and office or telemedicine visits.

Payer

11. CMS has launched more than 50 savings model programs since the agency's innovation center was created in 2010, and the agency told Congress in February that six models have led to statistically significant savings, two have led to significant improvements in care quality, and four have led to gross savings.

12. CMS said Feb. 1 it is looking to create a "universal foundation" of quality measures across all its programs, such as Medicare and Medicaid. The universal foundation will function as a base for which programs can add additional aligned or program- and population-specific measures over time. No timeline has been provided for implementation.

13. CMS will implement stricter audits of Medicare Advantage plans for contracts dated 2018 and up, a move that could leave payers on the hook for up to $4.7 billion in repayments to the federal government. In the final rule issued Jan. 30, the agency said it will strike the fee-for-service adjuster from risk adjustment data validation audits, which insurers had pushed to include.

14. CMS said Feb. 1 it is expecting a small revenue bump of 1.03 percent on average for Medicare Advantage and Part D plans in 2024 as part of a slate of potential risk adjustment and star ratings changes. Insurers disagree and say the changes will lead to a decrease in reimbursements and higher costs for members.

15. CMS is opening an ACA special enrollment period from March 31, 2023, to July 31, 2024, for those losing healthcare coverage after the end of Medicaid's continuous enrollment provision. 

16. CMS released guidance in January on how states can work with Medicaid managed care plans to prepare for the return to regular eligibility and enrollment operations in April.

17. On Jan. 11, CMS laid out the process it intends to take when implementing the first negotiated prices for drugs paid for by Medicare. Medicare will begin negotiating the prices for 10 drugs in 2026, and CMS will select those drugs in September. 

18. CMS said Jan. 26 it will allow Medicaid/CHIP funds to be used for treating people in prisons, jails and youth correctional facilities for the first time ever in California.


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