Healthcare Policy Development Archives - Page 5 of 14

CMS Looks to Expand Use of Value-Based Purchasing, Allowing for Multiple Best Prices; Clarifies Treatment of Patient Assistance and Copay Accumulators

In late December 2020, the Trump Administration released a final rule designed to promote the use of value-based purchasing (VBP) arrangements between drug manufacturers and payers, including Medicaid. The final rule, released by the Centers for Medicare & Medicaid Services (CMS), also contains policies related to line extensions and copay accumulators. The incoming Biden Administration [...] Read More

HHS Proposes Modifications to the HIPAA Privacy Rule to Support Coordinated Care

On December 10, 2020, the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) issued a press release, fact sheet, and an unpublished proposed rule announcing intended changes to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.[1] The proposed changes follow a request for information from December [...] Read More

CMS Releases Final CY 2021 Physician Fee Schedule, Expands Telehealth Coverage and Care Coordination Management

On the evening of December 1, 2020, the Centers for Medicare and Medicaid Services (CMS) released the final Physician Fee Schedule (PFS) for calendar year (CY) 2021. The rule includes finalized policies related to telehealth, the Quality Payment Program (QPP), care management and others. Provisions of this final rule become effective on January 1, 2021. [...] Read More

CMS Releases Final CY 2021 Physician Fee Schedule

On the evening of December 1, 2020, the Centers for Medicare and Medicaid Services (CMS) released the final Physician Fee Schedule (PFS) for calendar year (CY) 2021. The rule includes finalized policies related to telehealth, the Quality Payment Program (QPP), care management and others. The rule has not yet been published in the Federal Register [...] Read More

Trump Administration Finalizes Rule to Prevent PBM Rebates Almost Two Years After Initial Proposal

On November 20, 2020, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a final rule that removes the existing legal safe harbor that protects rebates currently negotiated between pharmaceutical manufacturers and Medicare Part D prescription drug plans, either directly or through Pharmacy Benefit Managers (PBMs). To replace this rescinded [...] Read More

CMS Announces Most Favored Nation Payment Model to Tie Certain Part B Drug Payments to International Prices

On the afternoon of November 20, 2020, the Trump Administration released an interim final rule with comment period (IFC) from the Centers for Medicare and Medicaid Services (CMS) to implement a mandatory, seven-year payment model called the Most Favored Nation (MFN) Model. This model will initially include a group of 50 single source drugs and [...] Read More

HHS-OIG Updates Safe Harbors Under Anti- Kickback Statute, Including Adoption of New Value-Based Framework

On November 20, 2020, the Health and Human Services’ Office of Inspector General (OIG) issued a fact sheet and final rule that removes potential regulatory barriers to care coordination and value-based care created by certain key healthcare laws and associated regulations, including the anti-kickback statute (AKS) and Beneficiary Inducements Civil Monetary Penalty (CMP).1 The changes [...] Read More

CMS Updates Physician Self-Referral Regulations to Reflect Medicare’s Transition Toward Value-Based Payment Systems

On November 20, 2020, the Centers for Medicare & Medicaid Services’ (CMS) issued a fact sheet and final rule to modernize and clarify regulations that interpret and implement the physician self-referral law. The intent of the final rule is to balance the reduction of unnecessary physician burden with the goal of removing a physician’s financial [...] Read More

CMS Updates Minimum Standards of Care for Organ Procurement Organizations, Including Revisions to Outcome Measurements (CMS-3380-F)

On November 20, 2020, the Centers for Medicare & Medicaid Services (CMS) released a fact sheet and final rule that updates the conditions that Organ Procurement Organizations (OPOs) must meet in order to have their services covered by Medicare and Medicaid. Fifty-eight OPOs operate in the U.S. as not-for-profit organizations responsible for recovering organs from [...] Read More

CMS Finalizes Long-Awaited Rule that Provides Additional Flexibility for States with Medicaid & CHIP Managed Care (CMS-2408-F)

On the morning of November 9, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a press release, fact sheet, and a final rule that updates the regulations for Medicaid and Children’s Health Insurance Program (CHIP) managed care programs to address the following policy areas: Setting Actuarially Sound Capitation Rates (Medicaid); Pass-Through Payments (Medicaid); [...] Read More

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Archive Category: Healthcare Policy Development