On June 15, 2021, the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) released one of their two annual Reports to Congress.[1],[2] The June report addresses high-cost specialty drugs in the Medicaid program; access to mental health services for Medicaid and Children’s Health Insurance Program (CHIP) enrollees; the use of EHR [...] Read More
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
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
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
On the evening of October 28, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a press release, fact sheet, and an unpublished interim final rule with comment period (IFC) on its website related to the COVID-19 public health emergency (PHE). The IFC interprets and implements CARES Act requirements regarding COVID-19 immunizations and treatments, [...] Read More
The Food and Drug Administration (FDA) has issued a final rule to allow for the importation of certain prescription drugs from Canada. In conjunction with the final rule, the FDA also released guidance for manufacturers that lays out a pathway for manufacturers to import their own drugs. The rule has not yet been published in [...] Read More
On February 14, 2020, the Centers for Medicare and Medicaid Services (CMS) released its proposed rule and fact sheet for Medicaid’s required Preadmission Screening and Resident Review (PASRR). In this proposed rule, CMS intends to update the PASRR regulations for the first time since 1992 and incorporate statutory changes, update diagnostic criteria for mental illness [...] Read More
Recent announcements from two giants in the healthcare field offer important insights into the growing focus on the social determinants of health, or SDOH, as they are widely known. According to the CDC, these social determinants are “economic and social conditions that influence the health of people and communities” and are shaped by the amount [...] Read More
On May 28, 2019, the Centers for Medicare & Medicaid Services (CMS) released the Medicare and Medicaid Programs’ Programs of All-Inclusive Care for the Elderly (PACE) Final Rule which finalizes the policies proposed in the August 2016 PACE proposed rule. Specifically, the final rule addresses application and waiver procedures, sanctions, enforcement actions and termination, administrative [...] Read More
On April 29th, Dr. Jennifer Lee, Virginia’s state Medicaid Director, will be the Northern Virginia Health Policy Forum's featured speaker. She will discuss how our home state is managing Medicaid expansion, addressing social determinants of health, and dealing with the opioid crisis as well as other topics. As the Director of the Department of Medical [...] Read More