Ken Choe on Centers for Medicare & Medicaid Services (CMS)

Medicare further expands payment for and coverage of telehealth and similar services

Through several recently published rules, the Centers for Medicare & Medicaid Services (CMS) is making it possible for Medicare beneficiaries to have greater access to health care services provided remotely through telehealth...more

11/8/2018 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Health Information Technologies , Medical Reimbursement , Medicare , Medicare Advantage , Physician Fee Schedule , Telehealth , Telemedicine

CMS considers linking Medicare drug payment rates to international prices

On October 25, 2018, the Centers for Medicare & Medicaid Services (CMS) issued an advance notice of proposed rulemaking (ANPRM) describing a potential mandatory model to test Medicare reimbursement based on an "International...more

10/30/2018 / Advanced Notice of Proposed Rulemaking (ANPRM) , Biologics , Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Health Care Providers , Medicare , Medicare Part B , Pharmaceutical Industry , Physician Medicare Reimbursements , Prescription Drugs , Regulatory Oversight , Regulatory Requirements

Trump touts “historic” plan to overhaul Medicare payments, create International Pricing Index

President Trump yesterday touted “bold” plans to lower drug prices in unspecific terms. Simultaneously, CMS issued an Advance Notice of Proposed Rulemaking (ANRPM), describing options to test Medicare reimbursement based on...more

10/26/2018 / Advanced Notice of Proposed Rulemaking (ANPRM) , Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Healthcare Reform , Medicare , Medicare Part B , Pharmaceutical Industry , Physician Medicare Reimbursements , Prescription Drugs

CMS releases annual health insurance exchanges final rule

On April 9, 2018, the Centers for Medicare & Medicaid Services (CMS) released the Benefit and Payment Parameters final rule for 2019 (2019 Payment Notice) applicable to qualified health plans (QHPs) offered on health...more

4/17/2018 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Essential Health Benefits , Extreme Hardship , Final Rules , Health Insurance , Health Insurance Exchanges , Qualified Health Plans

2019 White House and HHS Budgets Released: Key Changes to Drug Pricing and Reimbursement Proposed

On February 12, 2018, the White House Office of Management and Budget released an overview of the president's Fiscal Year (FY) 2019 Budget (the Budget), which makes, among many others, several proposals regarding drug pricing...more

2/16/2018 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Drug Pricing , Federal Budget , MDRP , Medicaid Reimbursements , Medical Reimbursement , Medicare Part B , Medicare Part D , Section 340B , Trump Administration

Bundle Up: CMS Releases Request for Applications for New Version of Bundled Payments for Care Improvement Model

This week, the Centers for Medicare & Medicaid Services (CMS) released details on the much-anticipated new version of the Bundled Payments for Care Improvement (BPCI) payment model, which will be known as BPCI Advanced. Like...more

1/12/2018 / BPCI , Bundled Payments , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Provider Payments

CMS Proposes Key Changes to the Medicare Advantage Program

On November 16, 2017, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that would revise regulations and clarify requirements for the Medicare Advantage (MA) and Medicare Prescription Drug Benefit...more

11/28/2017 / Centers for Medicare & Medicaid Services (CMS) , Cost-Sharing , Medicare , Medicare Advantage , Medicare Part D , Pharmaceutical Industry , Prescription Drug Coverage , Prescription Drugs , Star Ratings

CMS Releases Major MA/Part D Proposed Rule

CMS released the first major MA/Part D rulemaking in several years, proposing a number of significant changes to the Part D program, including required pass-through of pharmaceutical company rebates to lower patient...more

11/27/2017 / Biologics , Centers for Medicare & Medicaid Services (CMS) , Generic Drugs , Health Insurance , Medicare , Medicare Part D , Pharmacies , Prescription Drug Coverage , Prescription Drugs

Slow but Steady: CMS Proposes to Simplify and Slow Down the Quality Payment Program Rollout

On Tuesday, June 20, the Centers for Medicare & Medicaid Services (CMS) released a Proposed Rule to continue the rollout of the Quality Payment Program (QPP), an initiative to adjust Medicare payments to eligible clinicians...more

6/26/2017 / Alternative Payment Models (APM) , CEHRT , Centers for Medicare & Medicaid Services (CMS) , Electronic Health Record Incentives , Medicare Access and CHIP Reauthorization (MACRA) , MIPS , Quality Payment Program (QPP)

CMS request for information presents rare opportunity for medicare stakeholder engagement

On 14 April 2017, the Centers for Medicare & Medicaid Services (CMS) published the fiscal year (FY) 2018 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective...more

4/24/2017 / Centers for Medicare & Medicaid Services (CMS) , Comment Period , Health Care Providers , Inpatient Prospective Payment System (IPPS) , Long Term Care Facilities , Medicaid , Medicare , Request For Information , Stakeholder Engagement

Calling for Ideas—CMS Releases Final 2018 Medicare Advantage and Part D Rate Announcement and Call Letter

On 3 April 2017, the Centers for Medicare & Medicaid Services (CMS) released its final Medicare Advantage (MA) and Part D Rate Announcement and Call Letter (Call Letter) for calendar year 2018. The Call Letter is part of...more

4/7/2017 / Call Letter , Centers for Medicare & Medicaid Services (CMS) , Cost-Sharing , Health Care Providers , Medicare , Medicare Advantage , Medicare Part D , Opioid , Physician Medicare Reimbursements , Substance Abuse

Trump administration issues proposed health insurance market stabilization rule: Will it be enough to stabilize exchange...

On 15 February 2017, the Centers for Medicare & Medicaid Services (CMS) took a step toward addressing concerns about the stability of the individual and small group health insurance markets by proposing a modicum of...more

2/21/2017 / Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Certification Requirements , Comment Period , Employer Group Health Plans , Federal Register , Health Insurance , Health Insurance Exchanges , Insurance Industry , Open Enrollment , Trump Administration , Verification Requirements

Trump Administration Issues Proposed Health Insurance Market Stabilization Rule: Will It Be Enough to Stabilize Exchange...