The Final Rule is effective on January 1, 2025, and, unless otherwise specified, applies to rebate calculations for applicable periods beginning on or after January 1, 2023, for Part B rebatable drugs and October 1, 2022, for Part D rebatable drugs. Medicare Part...
CMS has released itsfinal rulefor Contract Year 2022 Medicare Advantage and Part D which requires Part D plans to offer a real-time benefits comparison tool. The agency estimated that the rule’s alterations would save the federal government $75.4 million over the course of th...
Here are five of the new provisions CMS adopted through the second rule: 1. Limits on cost-sharing CMS is setting the final required contribution percentage for 2022 at 8.09%. Concurrently, the maximum out-of-pocket costs for consumers have been limited to $8,700 for individual coverage and...
CMS decided not to finalize a provision that would have required PACE organizations to resolve grievances that could have an "imminent and significant" impact on the health or safety of the participant no later than 24 hours after receiving the grievance. Instead, the Final Rule notes that PACE...
(the Final Rule). The Final Rule stems from the CY 2025 Medicare Advantage and Part D proposed rules issued in November 2023 and CY 2024 Medicare Advantage and Part D proposed rules published on December 14, 2022. It continues the trend of regulatory enhancements to the Medicare Ad...
1, 2022, released the calendar year (CY) 2023 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule with comment period (CMS-1772-FC), which includes proposals to update payment rates, policies and regulations affecting Me...
(OPPS)/Ambulatory Surgery Center (ASC) Payment System final rule (OPPS Final Rule),1in which the agency finalized several of the policies it proposed in the 2022 OPPS/ASC Payment System proposed rule (OPPS Proposed Rule).2In summary, in the OPPS Final R...
CMS Final Rule Expands Medicare/Medicaid/CHIP Provider and Supplier Screening Requirements Under Affordable Care Act AuthorityCarol Colborn Loepere
CMS has finalized policies to increase access to marketplace coverage and expand essential health benefits (EHBs) in the HHS 2025 Notice of Benefit and Payment Parameters final rule.
The 2024 Notice of Benefit and Payment Parameters final rule aims to enhance affordability, accessibility, and choice for consumers, strengthen consumer protections, improve program integrity, and support state innovation in implementing the Affordable Care Act. These goals are accomplished through the var...