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CMS finalizes rule on the risk adjustment program for the 2018 benefit year

Today, the Centers for Medicare & Medicaid Services (CMS) issued the final rule, “Patient Protection and Affordable Care Act; Methodology for the HHS-operated Permanent Risk Adjustment Program for 2018.”
Press release

Contract Year (CY) 2020 Medicare Advantage and Part D Drug Pricing Proposed Rule (CMS-4180-P)

CMS is committed to implementing President Trump’s blueprint to lower drug costs and reduce out-of-pocket costs for patients. In line with the policies discussed in the President’s blueprint, CMS issued a proposed rule on November 26, 2018 that solicits public comments on potential policies that would remove administrative hurdles to offer lower cost options to seniors and provide support for private sector partners by providing them the tools to lower the cost of prescription drugs.
Fact sheet

CMS Takes Action to Lower Prescription Drug Costs by Modernizing Medicare

Today, the Centers for Medicare & Medicaid Services (CMS) proposed polices for 2020 to strengthen and modernize the Medicare Part C and D programs. The proposal would ensure that Medicare Advantage and Part D plans have more tools to negotiate lower drug prices, and the agency is also considering a policy that would require pharmacy rebates to be passed on to seniors to lower their drug costs at the pharmacy counter.
Press release

CMS Proposes Changes to Streamline and Strengthen Medicaid and CHIP Managed Care Regulations

Proposed Rule Continues Commitment to Promote Flexibility, Strengthen Accountability, and Maintain and Enhance Program Integrity in Medicaid and CHIP
Press release

Notice of Proposed Rulemaking (NPRM); Medicaid Program; Medicaid and Children’s Health Insurance Program (CHIP) Managed Care (CMS-2408-P)

In 2016, CMS issued a final rule that was a comprehensive rewrite of the Medicaid and CHIP managed care regulations to better align managed care rules with other health care coverage programs.
Fact sheet

CY19 ESRD/DME NPRM (CMS-1691-F) and DMEPOS Competitive Bidding Program Temporary Gap Period Announcement

On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2019. 
Fact sheet

Final Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for Calendar Year 2019

On November 1, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.
Fact sheet

CMS Finalizes Policies to Modernize and Drive Innovation in Durable Medical Equipment (DME) and End-Stage Renal Disease (ESRD) Programs

Today, the Centers for Medicare & Medicaid Services (CMS) finalized innovative changes to the Medicare payment rules for Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) and the End-Stage Renal Disease (ESRD) programs. The policies aim to increase access to items and services for patients, drive competition and increase affordability.
Press release

CMS Finalizes Changes to Advance Innovation, Restore Focus on Patients

Today, the Centers for Medicare & Medicaid Services (CMS) finalized bold proposals that address provider burnout and provide clinicians immediate relief from excessive paperwork tied to outdated billing practices.
Press release

CMS finalizes calendar year 2019 and 2020 payment and policy changes for Home Health Agencies and Home Infusion Therapy Suppliers

On October 26, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1689-F] setting out finalized Calendar Year (CY) 2019 Medicare payment updates, finalized quality reporting changes for home health agencies (HHAs), and finalized case-mix methodology refinements and a change in the home health unit of payment from 60 days to 30 days for CY 2020.
Fact sheet