CMS proposes an expansion of the regulations related to exclusion from the Medicare program. The proposed rule would allow CMS to revoke a provider’s or supplier’s Medicare enrollment if convicted of a federal or state misdemeanor within the previous 10 years. For exclusion to apply, CMS...
CMS Implements Final Regulations to Conform to Medicare Hospice AmendmentsLauren Tabak FassConnie A. RaffaDeborah A. RandallLauren B. Tabak
Notably, the Proposed Rule primarily modifies MA regulations, without direct application to the Medicare Part D prescription drug program. A summary of key provisions follows below. Proposed Guardrails for MA Plans Adopting AI and Automated Systems to Manage Patient Care CMS ...
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...
Chapter 9 of CMS’ Medicare Benefit Policy Manual provides regulatory information related to hospice service coverage, including: Certification and Election Requirements Timing and Content of Certification Election, Revocation, and Discharge Regulations Benefit Coverage and Covered Services Information This chapt...
The Centers for Medicare & Medicaid Services (“CMS”) has published its final rule (“Final Rule”) revising the Medicare Advantage (“MA”) and Part D regulations related to, inter alia, marketing and communications. In response to what CMS reports as a substantial increase in the number ...
Prior authorizations for medical care will become quicker and easier, while saving money, according to the Centers for Medicare & Medicaid Services.
”1Under the Medicare Act, “negotiated prices shall take into account negotiated price concessions” between Part D sponsors and pharmacies.2Under CMS policy, price concessions that are not included in the “negotiated prices” must be reported to CMS as Direct and Indirect...
CMS proposed a significant change to the definition of “marketing” for MA and Part D plans, intending to increase CMS oversight and address misleading marketing practices. Under the current regulations, “marketing” is a subset of communications materials and activitie...
The Centers for Medicare & Medicaid Services (CMS) published aFinal Ruleon April 4, 2024, that makes a number of changes to regulations governing the Programs of All-Inclusive Care for the Elderly (PACE). Among other things, the Final Rule gives CMS additional grounds on which to deny PACE...