20 recent CMS moves

From publishing several new proposed rules targeting prior authorization processes to releasing its annual payment updates for physicians, these are 20 recent CMS moves reported by Becker's since Sept. 29:

Payer

1. CMS proposed a new rule Dec. 12 to streamline options on ACA marketplaces and add more provider network requirements. 
   
   
2. CMS issued a proposed rule Dec. 6 that it says will streamline the prior authorization process through electronic requirements and more regulation around denials and data access. 
   
   
3. On Dec. 14, the agency proposed a rule to overhaul prior authorization and marketing practices around Medicare Advantage and Part D plans, along with adding health equity measures to star ratings and boosting behavioral health network adequacy requirements.
   
   
4. CMS released audits showing Medicare Advantage plans overbilled the federal government by millions between 2011 and 2013, with some plans overbilling an average of more than $1,000 per patient per year, Kaiser Health News reported Nov. 21. 
   
   
5. CMS wants all traditional Medicare beneficiaries and most Medicaid beneficiaries in accountable care organizations by 2030. In a strategy report published Nov. 7, CMS detailed its plans to reach this goal.
   
   
6. A CMS rule finalized Oct. 28 aims to reduce gaps in Medicare enrollment for new enrollees and adds special enrollment periods for extenuating circumstances. 
   
   
7. CMS will no longer allow Medicare Advantage or Part D prescription drug plans to advertise on television without agency approval first. The new policy is effective Jan. 1 and was discussed in an Oct. 19 memo from CMS to MA and Part D providers.
   
   
8. CMS is considering adding more qualifying conditions for Medicare-covered dental treatment, Kaiser Health News reported Oct. 17. In July, CMS officials proposed adding more conditions that qualify for dental treatment and asked for public comment on the proposed rule change.
   
   
9. CMS said Oct. 14 that Arizona can test Medicaid program initiatives to address housing insecurity through an approved waiver program.
   
   
10. CMS released its 2023 Medicare Advantage plan ratings Oct. 6. This year, 57 Medicare Advantage Part D plans earned five star designation, a decline from 2022, when 74 plans earned the designation. The ratings are based on 38 quality measures.
    
    
11. CMS' Value-Based Insurance Design program for Medicare Advantage plans is growing for 2023, expanding to 52 participating organizations and 6 million members, the agency said Sept. 29. 

Provider/Clinical

1. CMS solicited comment through Dec. 6 on a proposed national healthcare provider directory that would make it easier for Americans to find physicians and other providers.
   
   
2. CMS on Nov. 28 issued a memorandum reminding hospitals of their obligation under Medicare's conditions of participation to ensure patients and staff have an environment that prioritizes their safety and the effective delivery of care.
   
   
3. A Nov. 10 CMS report found that, while much progress has been made, inconsistent or incomplete data collection approaches in the past have hamstrung attempts to more closely define and quantify health equity metrics.
   
   
4. CMS unveiled on Nov. 1 its final rules from the new rural emergency hospital designation, which is set to go into effect Jan. 1, 2023. The designation aims to curb rural hospital closures by offering them a chance to close infrequently used inpatient beds and focus on providing outpatient and emergency department services.
   
   
5. CMS published on Oct. 31 and Nov. 1 its annual payment updates for physicians, the Medicare shared savings program and outpatient and home health services for 2023.  
   
   
6. CMS evaluated two and a half years of readmission cases for Medicare patients through the Hospital Readmissions Reduction Program and penalized 2,273 hospitals that had a greater-than-expected rate of return.
   
   
7. CMS said Oct. 21 it is increasing oversight and scrutiny of the nation's poorest-performing nursing homes with updates to its Special Focus Facilities program.
   
   
8. CMS will pay 340B hospitals at average sales price plus 6 percent — rather than average sales price minus 22.5 percent — for all calendar year 2022 drug claims with modifier "JG," the American Hospital Association said Oct. 20. The announcement comes after a federal judge ruled Sept. 28 that HHS must immediately cover 340B drug costs rather than wait until 2023. 
   
   
9. CMS said Oct. 13 it is extending Bundled Payments for Care Improvement Advanced by two years, and it will now run through Dec. 31, 2025. BPCI Advanced tests whether linking payments for an episode of care will "incentive healthcare providers to invest in practice innovation and care redesign to improve care coordination and reduce expenditures while maintaining or improving the quality of care for Medicare beneficiaries."