A breakdown of 14 recent CMS actions

CMS issued several rules, actions and plans since Jan. 1. The actions include updates on payer rules, physician payment and technology coverage.

Here's a breakdown of the 14 actions, beginning with the most recent:

1. On Jan. 15, CMS issued 2022 Medicare Advantage and Part D rates three months early in a move it says will give plans more time to calculate bids for the next coverage year. The agency expects the rates will increase per-capita plan payments by 4.08 percent on average. Read more here.

2. CMS finalized a rule Jan. 15 to simplify prior authorizations and create a better exchange of healthcare data between payers, providers and patients. The rule requires payers in Medicaid, Children's Health Insurance Program and Qualified Health Plans to build application programming interfaces to ease data exchange and prior authorizations. Read more here.

3. CMS released a final rule Jan. 15 that aims to lower cost-sharing for pricey prescription drugs for Medicare Advantage and Part D enrollees. CMS estimates the changes, most of which are effective for the 2022 plan year, will save the federal government $75.4 million over 10 years. Read more here.

4. CMS released a final rule for states, health insurance exchanges and insurers in the individual and small group markets Jan. 14. CMS hopes the rule will lower premiums, improve member experience and reduce regulatory burden. Read more here.

5. CMS has officially withdrawn its proposed Medicaid fiscal accountability rule. CMS proposed the rule in November 2018. It aimed to promote transparency and fiscal integrity by establishing new reporting requirements for state supplemental payments to Medicaid providers. Read more here.

6. CMS has started auditing a sample of hospitals for compliance with the price transparency rule, an agency spokesperson confirmed to Becker's Hospital Review. Under the rule, which took effect Jan. 1, hospitals in the U.S. are required to post their standard charges online. Hospitals must post a machine-readable file with all items and services and display prices of 300 services in a consumer-friendly format. Read more here.

7. CMS issued a final rule Jan. 12 that updates the agency's definition of "reasonable and necessary" coverage for services that fall under Medicare Parts A and B. The agency said codifying the definition will "bring clarity and consistency to the existing coverage determination processes" for the services and items under Medicare Parts A and B. Read more here.

8. In the same rule mentioned in point six, CMS said it will speed up the FDA approval process for Medicare coverage of new and innovative medical devices and technologies. The Medicare Coverage of Innovative Technology final rule will reduce the lag time between the FDA's approval of innovative medical tech products and Medicare establishing coverage for the devices. Read more here.

9. CMS released an official pandemic plan Jan. 12 that details the agency's actions in response to the COVID-19 pandemic. The plan will ensure CMS operations will continue to provide healthcare access for more than 140 million Americans during the public health emergency, according to CMS. Read more here.

10. CMS extended its deadline for filing cost reports by two months for all cost-reporting periods that ended March 1 to Dec. 31, 2020. The agency revised the deadline Jan. 5. It delayed the filing deadline for fiscal year-end cost reports from Oct. 31, 2019, and Nov. 30, 2019, until June 30, 2020, and all fiscal year-end cost reports from Dec. 31, 2019, until Aug. 31, 2020. Read more here.

11. CMS approved Tennessee's request to use a modified block grant to finance its Medicaid program, the agency said Jan. 8. Tennessee's approved Section 1115 waiver calls for the use of an "aggregate cap" to fund its Medicaid program. The state's Medicaid program provides coverage to about 1.5 million low-income and disabled residents, according to The Wall Street Journal. Read more here.

12. CMS issued a new guidance for state officials looking to roll out social determinants of health strategies for Medicaid and Children's Health Insurance Program members. The guidance, released Jan. 7, focuses on how state Medicaid directors can use flexibilities under federal law to design programs that decrease healthcare spending and improve outcomes through addressing social, environmental and economic factors. Read more here.

13. CMS has recalculated Medicare physician fee schedule payment rates for this year to reflect changes finalized Dec. 27 under the Consolidated Appropriations Act. The new physician fee schedule conversion factor for 2021 is $34.89. That's higher than the conversion factor finalized in the rule released in December, but 3.3 percent less than the 2020 conversion factor, according to the American Hospital Association. Read more here.

14. A change in how Medicare pays laboratories for COVID-19 diagnostic tests took effect Jan. 1, with a 25 percent pay cut enacted for facilities that take more than two days to complete the tests. Medicare lowered the base payment for COVID-19 tests that use high-throughput technology to $75. Labs can get an additional $25 if they provide results in two days or less. Read more here.

Ayla Ellison, Alia Paavola, Jackie Drees, Katie Adams and Gabrielle Masson contributed to this article.

More articles on healthcare finance: 
Biden plans stimulus relief worth trillions: 5 things to know
Chicago, Los Angeles hospitals slated to close
Adeptus Health declares bankruptcy

© Copyright ASC COMMUNICATIONS 2021. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

Featured Whitepapers

Featured Webinars