From proposed price transparency requirements under Medicaid to a new No Surprises Act website, these are 13 CMS moves reported by Becker's since April 1:
Payers
- CMS is projecting a 7.7 percent increase in private health insurance spending in 2023 and a 2.1 decrease in Medicaid spending in 2024 because of redeterminations, according to an analysis published June 14 in Health Affairs.
- CMS and the FDA are discussing how to handle obesity drugs in Medicare, Bloomberg Law reported June 7. The agencies are in talks over "what to do about obesity drugs," FDA Commissioner Robert Califf said publicly. Mr. Califf's comments indicate CMS could expand weight loss drug benefits, according to the report.
- CMS said June 1 that Medicare will cover drugs to treat Alzheimer's disease if they receive full FDA approval.
- With Medicaid redeterminations underway nationwide, CMS urged states May 30 to ensure they do not terminate coverage for eligible individuals because "a substantial portion" of April terminations were due to procedural reasons.
- CMS proposed a new rule May 23 for drug manufacturers, pharmaceutical benefit managers and managed care plans to increase transparency by requiring manufacturers to disclose some pricing information through a price survey and requiring PBMs to disclose more pricing details to managed care plans.
- CMS proposed two new rules April 27 that would establish national standards of care provided through fee-for-service Medicaid/CHIP and managed care plans, along with a requirement to publicly disclose provider payment rates online.
- CMS' Office of Minority Health and RAND Corp. published a report in April that found Medicare Advantage enrollees across racial and ethnic groups have similar responses to self-reported patient experience measures, but disparities persist in clinical outcomes.
- CMS approved Illinois' proposal to expand Medicaid payments for school-based healthcare services April 18, becoming the 12th state to use Medicaid funding for school care services.
- CMS increased its proposed number of non-standard ACA plans payers can offer in each region from two to four in a final rule published April 17, along with increasing the cap on non-standard plans, added new special exchange enrollment periods for people who have lost Medicaid coverage, and establishing more stringent network requirements for plans.
Providers
- CMS launched a No Surprises Act website June 15 for consumers that outlines the rights patients have regarding surprise medical bills.
- CMS said June 8 it will pilot a new value-based primary care model in eight states for 10 years through the Center for Medicare and Medicaid Innovation that will seek to create more coordinated care for rural and underserved populations, starting in July 2024.
- CMS made changes April 26 to the hospital price transparency enforcement process in an effort to increase compliance. The agency said the changes will shorten the average time that hospitals have to comply with price transparency requirements to no more than 180 days. Read five more details here.
- CMS released its annual Inpatient Prospective Payment System proposed rule April 10, which proposes a 2.8 percent reimbursement boost for acute care hospitals that report quality data and are meaningful users of EHRs. Read 10 details here.