It notes that the new regulations adopt changes to the Programs proposed by CMS in May as well as changes implemented by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).Ankur J. GoelAnne W. Hance
The Centers for Medicare & Medicaid Services (“CMS”) has announced its proposed rules for theHospital Outpatient Prospective Payment (“OPPS”) and Ambulatory Surgical Center (“ASC”) Payment Systems, as well as its calendar year (CY)2024 proposed Physician Fee Schedule(“PFS”), (colle...
2023, revising the regulations governing marketing by Medicare Advantage plans (MAPs) and Medicare Part D plans (PDPs). These changes follow CMS’s October 2022memoexpressing concern regarding MAP and PDP marketing practices, and theproposed rule issued on December 14, 2022. The changes...
Department of Health and Human Services (HHS), some agencies are required to regularly release payment regulations. CMS uses the regulatory process to annually release both proposed and final rules that dictate how providers will be paid through the Medicare program. These rules cover a wide ...
Every year, industry stakeholders anticipate the release of this annual regulation because it updates the rules governing Medicare’s value-based programs and physician payment system. The proposed rule is open for public comment through September 11. Following the close of the public comment period,...
CMS finalized regulations for rural emergency hospital (REH) provider type. A critical access hospital or rural hospital with no more than 50 beds is eligible to convert to an REH, if it has participated in Medicare as of the date of enactment of the Consolidated Appropriations Act (CAA) of...
utilization management (UM) techniques adopted by MA plans, including requirements for such plans to conduct and report detailed analyses on the use of prior authorizations. Notably, the Proposed Rule primarily modifies MA regulations, without direct application to the Medic...
for qualified patients as a lump sum reimbursement," said Scott Davis, Chief Executive Officer of Ekso Bionics. "We fully support the codifying of the proposal to further enhance potential access for Medicare beneficiaries and look forward to the CMS regulations expected later this year, including ...
CMS would also require insurers to report certain prior authorization metrics by posting them online each year. The proposed rules would apply to most Medicare and Medicaid patients. If finalized, these prior authorization policies would take effect January 1, 2026, with the initial set of metrics...
“SADPs”) and all Small Business Health Option Program plans across all Marketplace-types, to use a network of providers that comply with the standards set out in the network adequacy and essential community provider regulations. Further, the new rules remove the previous exception to the ...