Proposed Rule Archives - Applied Policy

CMS Proposes Further Updates for Exchange Health Plans Starting 2022, Including Fees, Enrollment, and 1332 Waivers (CMS-9906-P)

On the evening of June 28, 2021, the Centers for Medicare & Medicaid Services and the Department of the Treasury put a proposed rule on display[1] that includes rules and policies designed to promote greater access to comprehensive health insurance coverage through the Exchanges, consistent with applicable law and recent Presidential executive orders.[2],[3],[4] The proposed [...] Read More

Biden Administration Proposes Rescinding Trump Rule on Discounts for to Insulin and Injectable Epinephrine

The Biden administration, via the Health Resources and Services Administration (HRSA) and the Department of Health and Human Services (HHS), released a proposed rule which seeks to rescind a previous final rule related to 340B discounts for insulin and injectable epinephrine that was adopted in the final months of the Trump administration. Comments on the [...] Read More

CMS Proposes FY 2022 Payment Policies for Hospitals, Extending Add-on Payments, Adding GME Slots, and Repealing Market-Based Data Collection

On the evening of April 27, 2021, the Centers for Medicare & Medicaid Services (CMS) released its proposed rule, Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Final Policy Changes and Fiscal Year 2022 Rates (link), which updates the FY 2022 payment systems and [...] Read More

CMS Releases Proposed Rule for Skilled Nursing Facilities, Including Payment Updates & Changes to Quality Programs

On April 8th, 2021, the Centers for Medicare & Medicaid Services (CMS) released a fact sheet and unpublished proposed rule, Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities; Updates to the Quality Reporting Program and Value-Based Purchasing Program for Federal Fiscal Year 2022, which updates payment rates and policies for these facilities: Increase [...] Read More

CMS Releases CY 2021 DMEPOS Proposed Rule: Announces Changes to 2021 Competitive Bidding and Proposes to Classify All CGMs as DME [CMS-1738-P]

On the evening of October 27, 2020, the Centers for Medicare & Medicaid Services (CMS) released the unpublished version and fact sheet of its proposed CY 2021 Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) rule, which updates DMEPOS coverage and payment policy for CY 2021: Classifies/establishes payment amount for continuous glucose monitors (CGMs) as [...] Read More

CMS Releases Proposed Payment Policies for Skilled Nursing Facilities, Inpatient Psychiatric Facilities, and Hospices

On the evening of April 10th, the Centers for Medicare and Medicaid Services released three proposed rules. These rules include proposals related to payment, quality reporting, and other areas for skilled nursing facilities (SNFs), inpatient psychiatric facilities, and hospices. Comments on the proposed rules are due on June 9, 2020. Total Payments to SNFs to [...] Read More

CMS Proposes Adding Second Specialty Tier Option to Part D, Additional Opioid Drug Management Programs; Call Letter Includes Technical Updates

CMS has released a proposed rule that would update program policies for Medicare Advantage and Medicare Part D beginning in 2021, if finalized. CMS has also released the draft Call Letter for 2021; however, this year’s Call Letter is limited to standard benefit parameters, risk-sharing, and other technical details and does not feature any additional [...] Read More

Administration Releases Long-Awaited Updates to Physician Self-Referral Regulations

On October 9, 2019, the Centers for Medicare and Medicaid Services (CMS) released a long-awaited proposed rule making changes to physician self-referral regulations based off the Stark Law and Anti-Kickback Statute. The rule was released in conjunction with a similar rule from the HHS Office of the Inspector General (OIG). Comments on the proposed rule [...] Read More

CMS Proposes Enhanced Payments for New Dialysis Technology and Attempts to Streamline DME Pricing and Claims

Tweet On July 29, 2019, the Centers for Medicare & Medicaid Services (CMS) released its 2020 End Stage Renal Disease/Durable Medical Equipment Payment proposed rule. In addition to changes to payments under the end-stage renal disease (ESRD) and durable medical equipment (DME) programs, the rule proposes changes to payment for renal dialysis, the ESRD quality [...] Read More

OIG to Pharma: PBM Rebates Out, POS Rebates In

On January 31, 2019, the Department of Health and Human Services’ (HHS) Office of the Inspector General (OIG) issued a proposed rule that would, if finalized, remove the existing legal “safe harbor” that protects rebates currently negotiated between pharmaceutical manufacturers and Medicare Part D prescription drug plans and Medicaid plans. In its place, the agency [...] Read More

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