Tagged with Healthcare Reform
HHS Releases Final Interoperability Rules
CMS and the Department of Health & Human Services (HHS)’ Office of the National Coordinator for Health Information Technology have released two interoperability rules. The new rules aim to make it easier for patients to access and share their information and aim to end information blocking by requiring public and private entities to securely share health information with patients and penalize those who fail to do so.
CMS Announces Plans to Change Prior Authorization Rules
CMS Administrator, Seema Verma, on February 11, announced the agency’s intent to reform prior authorization regulations later this year. According to Verma, the changes “will reduce administrative waste, increase patient safety and free physicians to spend time caring for their patients.”
CMS Announces New Medicaid Initiative to Limit Drug Coverage, Keep Rebate Obligations
On January 30, CMS announced the new Healthy Adult Opportunity (HAO) initiative that it will allow states to limit drug coverage under Medicaid without reducing manufacturer rebate obligations.
FDA Issues Gene Therapy Guidances
On January 28, the FDA issued six final guidances on gene therapy manufacturing and clinical development of products, as well as a draft guidance, describing the agency’s proposed approach to determining sameness of gene therapy products for orphan drug designation and exclusivity purposes.
CMS, HHS Proposes Changes to Stark Law and Anti-Kickback Statute Reforms
On October 9, the Department of Health and Human Services (HHS) announced proposed changes that seek to modernize and clarify the regulations that interpret the Physician Self-Referral Law (the Stark Law) and the Federal Anti-Kickback Statute. The proposed rule has been designed to provide greater certainty for healthcare providers participating in value-based arrangements and providing coordinated care for patients. The proposed changes are intended to ease the compliance burden for healthcare providers across the industry while maintaining strong safeguards to protect patients and programs from fraud and abuse.
ACR Seeks Urgent Action Opposing Cuts to Radiology
The American College of Radiology (ACR) is seeking help in its efforts to urge Congress to stop CMS from implementing proposed changes to the Evaluation and Management (E/M) Codes that could result in severe cuts to radiology.
Proposed Legislation Aims to Improve Provider Directories Accuracy
Two physician lawmakers have proposed new legislation that aims to improve the accuracy of information in health plan provider directories and protect patients from surprise out-of-network bills. The Improving Provider Directories Act (HR 4575) would require health plans to provide an avenue for people to report errors in provider directories, in a “highly visible way”.
Executive Order Issued to Protect Traditional Medicare and MA Plans
The president, on October 3, signed an executive order directing the Department of Health and Human Services to increase efforts to provide more insurance plan options under Medicare Advantage and to remove regulations that are considered burdensome to health care providers. The order is intended to protect traditional Medicare and private Medicare Advantage while ramping up alternative payment models, time spent with patients, access to innovative technology and reducing the regulatory burdens on providers.
Illinois Legislation Targets Medicaid Managed Care Claim Denials
The Illinois Legislature unanimously passed a health care reform package, which requires Medicaid managed care plans to pay claims within 30 days or face a penalty.
Texas Lawmakers Pass Three Patient Protection Bills Aimed at Surprise Billing
The Texas legislature has passed three patient protection bills aimed at Medicaid managed care and safeguarding against surprise medical bills.
CMS Announces New Medicare Primary Care Payment Model
CMS, along with the HHS, has announced plans to launch five new Medicare primary pare payment models.
New Legislation Aims to Strengthen Stark Law
The Promoting Integrity in Medicare Act (PIMA) seeks to update Medicare policies by preventing self-referrals related to advanced imaging services, radiation therapy, anatomic pathology and physical therapy.
New Hampshire State Senator Proposes Bill Targeting Surprise Emergency Room Bills
A New Hampshire senator has announced plans to file legislation that is designed to address surprise medical bills that some patients say keep coming after a visit to the emergency room for an illness or injury.
Fourth Quarter ASC Payment Rate Updates Released
CMS has released its October addenda, providing fourth quarter updates to the ASC payment system.
New Jersey – State Passes Legislatures to Stabilize Market, Prevent Surprise Bills
The New Jersey Legislature recently approved two bills targeting state healthcare stabilization, as well as measures to protect patients from surprise out-of-network costs.
Maryland – State Approves Bills Intended to Stabilize Insurance Market
The Governor of Maryland has passed legislation which seeks to stabilize Maryland’s health care insurance market and prevent rates from increasing.
New York Finalizes Draft Waiver Transition Plan for Individuals with Intellectual and Developmental Disabilities
The New York Office for People with Developmental Disabilities (OPWDD) has finalized its Draft Waiver Transition Plan which lays out their vision for reform of the system serving people with intellectual and developmental disabilities (IDD), “People First Care Coordination.” The Transition Plan describes the development of Care Coordination Organizations, which will provide Health Home Care Management services.
Department of Health and Human Services Announces Future Changes to Provider Reimbursements
The Department of Health and Human Services (HHS) has announced its plans to overhaul the way the federal government reimburses providers. The Department states, in an effort to improve technology and transparency, it will make changes to interoperability, price transparency, and care delivery through Medicare and Medicaid, and remove regulations that hinder private innovation.
Insurers Praise Medicare Advantage Alternative Payment Models Demonstration Project
Providers and insurance groups are in favor of CMS’ plans to develop a demonstration project that will test the effects of allowing clinicians to receive credit for financial risk-based arrangements with Medicare Advantage (MA) plans.
NJ – DHS Expands Behavioral Health Benefits Covered Under NJ FamilyCare
The New Jersey Department of Human Services (DHS) last month announced that it has expanded the list of covered health benefits available to align behavioral health coverage for Medicaid Long Term Services and Supports (MLTSS), Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs), and Division of Developmentally Disabled (DDD) MCO members participating in the New Jersey FamilyCare (NJFC) Medicaid managed care program.