CMS Round Up
CMS Roundup (July 14, 2023)
Today, the Centers for Medicare & Medicaid Services (CMS) provides an at-a-glance summary of news from around the agency.
CMS Releases Calendar Year 2024 Home Health Prospective Payment System Proposed Rule
June 30: CMS released the Calendar Year 2024 Home Health Prospective Payment System proposed rule to update Medicare payment policies and rates for home health agencies. This proposed rule includes the implementation of legislation, including a proposed decrease to the payment update percentage to account for differences between the new and old payment systems, policies for the home intravenous immune globulin benefit, and revising payment for disposable negative pressure wound therapy. CMS is also soliciting comment on access to home health aide services. Finally, CMS is proposing how we pay for compression garments, a new statutory benefit for beneficiaries with lymphedema, starting in January 2024. Information can be found in this fact sheet.
CMS Posts Program Year 2022 Open Payments Data to CMS.gov
June 30: CMS posted the Program Year 2022 Open Payments data to CMS.gov. The posting includes updated data submitted and attested to by applicable manufacturers and group purchasing organizations that are required to annually report payments or transfers of value made to certain health care providers. Information about the Open Payments Program can be found here.
CMS Opens National Patient Registry for New Alzheimer’s Drugs
July 6: With broader Medicare coverage now available for the recently FDA-approved Alzheimer’s drug lecanemab, CMS opened a Registry for Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease that is easily accessible online. To be eligible for Medicare payment for this new class of Alzheimer’s drugs, providers are required to submit data to a registry, as characterized in CMS’s National Coverage Determination issued in April. The CMS-facilitated registry is open for clinicians to access here. Additional background information is available for providers here and for patients here and on Medicare.gov.
CMS Releases Outpatient Prospective Payment System 340B Payment Policy Remedy Proposed Rule
July 7: CMS released the Outpatient Prospective Payment System Remedy for the 340B-Aquired Drug Payment Policy Proposed Rule, which details the proposed remedy for 340B-acquired drug payments for 2018 to 2022. This proposed rule has a 60-day comment period ending September 5, 2023. Details, including a link to the Federal Register for comment, are in this fact sheet.
Center for Program Integrity Implements Enhanced Oversight for New Hospices in Four States
July 11: CMS’ Center for Program Integrity announced implementation of a provisional period of enhanced oversight for newly enrolled hospice providers in Arizona, California, Nevada, and Texas. The oversight will focus on the medical review of claims of a sample of hospice beneficiaries in the four states. Additional information can be found here.
CMS Proposes National Coverage Determination for Percutaneous Transluminal Angioplasty of Carotid Artery Concurrent with Stenting
July 11: CMS posted, and comments are being accepted, on a proposed National Coverage Determination (NCD) for Percutaneous Transluminal Angioplasty of the Carotid Artery Concurrent with Stenting. Information on the proposed NCD, and the location of the public comments section, can be found here.
CMS Proposes National Coverage Determination for Pre-exposure Prophylaxis (PrEP) Using Antiretroviral Drugs to Prevent HIV
July 12: CMS posted, and comments are being accepted, on a proposed National Coverage Determination (NCD) for Pre-exposure Prophylaxis Using Antiretroviral Drugs to Prevent HIV Infection. Information on the proposed NCD, and the location of the public comments section, can be found here.
CMS Proposes Four-Year Extension of Medicare Diabetes Prevention Program Flexibilities
July 13: In the Calendar Year 2024 Physician Fee Schedule proposed rule, CMS proposed extending the Medicare Diabetes Prevention Program (MDPP) Expanded Model’s Public Health Emergency (PHE) flexibilities for four years. Currently, MDPP suppliers are required to resume in-person delivery of the MDPP set of services after December 31, 2023. In this rule, CMS aims to allow all MDPP suppliers to continue to use specific MDPP COVID-19 PHE flexibilities through December 30, 2027. The proposed flexibilities include the virtual delivery of MDPP services through distance learning. CMS also proposes simplifying MDPP’s current performance-based payment structure by allowing fee-for-service payments for attendance by people with Medicare. Additional information can be found in the Federal Register notice.
Other Recent Releases:
June 30: CMS Releases Revised Guidance on Historic Medicare Drug Price Negotiation Program
June 30: South Dakota Expands Medicaid, Bringing Health Coverage to More than 52,000 State Residents
July 7: HHS Announces Actions to Protect Consumers and Lower Health Care Costs
- Short-Term, Limited Duration Insurance (STLDI) Proposed Rule
- Request for Information (RFI) on Medical Credit Cards and Other Medical Payment Products
- No Surprises Act FAQs
July 10: Assessing Equity to Drive Health Care Improvements: Learnings from the CMS Innovation Center
July 13: Calendar Year 2024 Physician Fee Schedule Proposed Rule Advances Health Equity
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CMS, an agency within the U.S. Department of Health and Human Services, serves the public as a trusted partner and steward, dedicated to advancing health equity, expanding coverage, and improving health outcomes. The agency protects public health by administering the Medicare program and working in partnership with state governments to administer Medicaid, CHIP, and the Health Insurance Marketplace.
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