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CY 2021 MPFS Final Rule Finalizes Permanent Expansion of Certain COVID-19 Telehealth Flexibilities; Also Includes Changes to QPP, E/M Code Valuation, and Providers’ Scope of Practice

On December 1, 2020, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2021 Medicare Physician Fee Schedule (MPFS) final rule (fact sheet), which addresses an array of policies under Medicare Part B and the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program (QPP). What it is. CMS’ major final rule affects payments to… (Slifer, December 2, 2020) #End-Stage Renal Disease, #Mental and Behavioral Health, #Mid-Level Practitioners, #Physicians, #Quality, #Telehealth, #Women’s Health

Agency Requests Information About COVID-19 Regulatory Flexibilities to Inform Permanent Changes; Comments Due Dec. 25

The Office of the Secretary within the Department of Health and Human Services (HHS) recently issued a request for information (RFI) seeking comments on the regulatory relief actions HHS has taken to respond to the COVID-19 pandemic’s impact on the health care industry. Of note, Appendix A of the RFI includes a list of 382 actions that have been taken…. (Testa, December 1, 2020) #COVID-19, #Hospitals, #Long-Term Care, #Mid-Level Practitioners, #Pharmacies, #Physicians, #Public Health, #Skilled Nursing Facilities, #Telehealth

OIG Follows Through on Rule Removing Safe Harbor Protection for Drug Rebates in Medicare Part D and Medicaid MCOs Beginning in 2022; New Safe Harbors for Point-of-Sale Discounts, PBM Services Fees Available in 60 Days

The Department of Health and Human Services Office of Inspector General (HHS OIG) issued a final rule (press release; HHS Secretary statement; fact sheet) that explicitly excludes drug rebates that manufacturers pay to pharmacy benefit managers (PBMs) and Medicare Part D plans from the current discount safe harbor, thereby eliminating their protection under the federal anti-kickback statute. The final rule… (Llamas, November 20, 2020) #Costs, #Generic Drugs, #Medicare Part D, #Pharmacy Benefit Managers, #Prescription Drugs

Mandatory, Nation-Wide Most Favored Nation Model Ties Payment for High Cost Part B Drugs to Prices Paid Internationally; Comments Due Jan. 26

Today, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule with comment period (IFC) to implement the Most Favored Nation (MFN) Model (press release, fact sheet), pursuant to President Trump’s executive order (EO) on Lowering Drug Prices by Putting America First. What is it. The MFN Model is a 7-year, mandatory model that will test a… (Slifer, November 20, 2020) #Chronic Diseases, #Costs, #Demonstration Programs, #Physicians, #Prescription Drugs

First Week of Open Enrollment Sees Over 800,000 Individual Plan Selections

The Centers for Medicare & Medicaid Services (CMS) released its first Federal Health Insurance Exchange Weekly Enrollment Snapshot, detailing Open Enrollment information for Nov. 1-7, 2020. As a reminder, this snapshot details Exchange information for states that use the HealthCare.gov platform, which includes all Federally-facilitated Exchanges and some State-based Exchanges. CMS states that a total of 818,365 individuals selected plans… (LaRosa, November 13, 2020) #Affordable Care Act

Agency Issues Final Rule on Medicaid and CHIP Managed Care Largely as Proposed; Network Adequacy, Quality Rating System, Rate Setting Addressed

This week, the Centers for Medicare and Medicaid Services (CMS) issued the 2020 final rule (press release; fact sheet) addressing managed care in Medicaid and the Children’s Health Insurance Program (CHIP). What it is. The final rule – first proposed in November 2018 (WHG summary) – seeks to “streamline” requirements finalized by CMS previously in a May 2016 final rule,… (Cowey, November 12, 2020) #Program Integrity, #Quality

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