Effective January 1, 2019, The Affordable Care Act has required each hospital to publish, update, and make public a list of its standard charges for items and services provided by each hospital; this includes diagnosis related groups (DRGs). In CMS’ 2019 Proposed Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) Rule and 2019 […]
Read MoreOverview This evening, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule entitled “Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses.” CMS believes that the changes proposed in this rule will give plans more tools to negotiate lower drug prices. The proposed rule discusses the definition [...] Read More
On Monday, the Trump Administration released a high-profile proposed rule that, if implemented, would require drug manufacturers to disclose the list prices of prescription drugs in their respective direct-to-consumer (DTC) advertisements (see AP’s summary of the proposal here). Trying to stay ahead of the curve, PhRMA also released voluntary guidelines for member companies in which [...] Read More
On July 25, 2018, CMS released its CY 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment system proposed rule. The rule contains payment updates for hospital outpatient departments and ASCs as well as proposals related to pass-through payments and the 340B program. Three requests for information (RFIs), including two […]
Read MoreThis evening, the Centers for Medicare and Medicaid Services (CMS) released proposed payment rules for four settings of care: hospices, inpatient rehabilitation facilities (IRF), skilled nursing facilities (SNF), and inpatient psychiatric facilities. Each rule contains payment updates for the prospective payment system for each type of facility as well as update to additional policies. All […]
Read MoreOn the evening of April 24th, the Centers for Medicare and Medicaid Services (CMS) released the proposed rule for the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Proposed Policy Changes. The rule outlines payment policy for hospitals beginning October 1, 2018 (FY 2019) and […]
Read MoreOn February 20, 2018, the U.S. Department of Health and Human Services (HHS) in conjunction with the Department of Labor and the Treasury Department, released the proposed rule “Short-Term, Limited-Duration Insurance” in response to an executive order signed by President Trump that aimed to promote choice and competition in health insurance markets. This rule proposes […]
Read MoreOn Thursday, January 4, the Department of Labor released a proposed rule that would change rules regulating what are known as association health plans (AHPs). This is the result of an executive order issued by President Trump in October 2017, directing the agency to reexamine rules in an attempt to make AHPs more “attractive” to […]
Read MoreLast Friday evening, the Department of Health and Human Services (HHS) released the proposed requirements for qualified health plans (QHPs) in 2019. QHPs are those health plans offered on the individual and small-group markets, both on and off the Marketplaces (or Exchanges). Many of the proposals were familiar, such as delegating more authority and flexibility […]
Read MoreOn July 13, 2017, the Centers for Medicare and Medicaid Services (CMS) released the Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2018 proposed rule. The proposed rule updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule on […]
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