Rachel Stauffer on Medicare

Back for seconds: digital health policies in the CY 2026 PFS proposed rule

It’s been more than two weeks since the release of the CY 2026 Medicare Physician Fee Schedule (PFS) proposed rule. We’ve had a chance to digest our initial helping and now we’re ready for seconds. We thought we would see...more

7/31/2025 / Centers for Medicare & Medicaid Services (CMS) , Digital Health , Health Care Providers , Health Insurance , Healthcare , Healthcare Reform , Insurance Industry , Medical Devices , Medicare , Medicare Fraud , Mental Health , Technology , Telehealth

CMS releases CY 2026 Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System proposed rule

On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule [CMS-1834-P],...more

7/18/2025 / Ambulatory Surgery Centers , Centers for Medicare & Medicaid Services (CMS) , Financial Services Industry , Healthcare , Healthcare Reform , Medicare , Outpatient Prospective Payment System (OPPS) , Payment Systems , Proposed Rules , Regulatory Requirements , Reporting Requirements

CMS releases CY 2026 Physician Fee Schedule Proposed Rule

On July 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B [CMS-13271]...more

7/17/2025 / Ambulatory Surgery Centers , Centers for Medicare & Medicaid Services (CMS) , Healthcare , Healthcare Reform , Insurance Industry , Medicare , Medicare Part B , Medicare Shared Savings Program , New Regulations , Physician Fee Schedule , Proposed Rules , Regulatory Agenda , Technology , Telehealth

Healthcare Extenders Tracker (July 2025 Update)

Many healthcare programs are extended for specific time periods, as short as one or two years or as long as 10, and are usually attached to a larger piece of must-pass legislation. Additionally, while traditional...more

7/11/2025 / Federal Funding , Government Agencies , Health Care Providers , Healthcare , Healthcare Reform , Legislative Agendas , Medicaid , Medicare , New Legislation

2026 Medicare Advantage and Part D Final Rate Notice: What to Expect

Key Takeaways - - CMS is expected to issue the 2026 final rate notice for Medicare Advantage (MA) and Part D plans by April 7, 2025. - The January 2025 advance notice proposed policies that would increase payments to MA...more

3/26/2025 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Medicare , Medicare Advantage , Medicare Part D , Prescription Drugs , Proposed Rules , Regulatory Agenda , Risk Management , Trump Administration

Healthcare Policy Options to Reduce the Deficit

The Trump Administration and 119th Congress will likely be targeting trillions of dollars in savings in the year ahead. Healthcare makes up a significant portion of mandatory spending and therefore likely will be a large part...more

1/24/2025 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Federal Budget , Healthcare , Healthcare Reform , Medicaid , Medicare , Medicare Advantage , Medicare Payment Reform , MedPAC , Section 340B , Trump Administration

Congress Extends Certain Telehealth Flexibilities Through March 31, 2025

At the close of 2024, US Congress passed a short-term extension of Medicare telehealth flexibilities as part of the American Relief Act, 2025 (ARA). The Medicare telehealth waivers, originally enacted as part of the COVID-19...more

1/17/2025 / Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Insurance , Legislative Agendas , Medicare , Medicare Advantage , New Legislation , Regulatory Requirements , Reimbursements , Telehealth

Virtual Care Policy Update: What to Expect in Lame Duck

The Consolidated Appropriations Act (CAA), 2023 (Public Law 117-328), signed into law on December 29, 2022, extended certain key virtual care flexibilities instituted during the COVID-19 public health emergency (PHE) through...more

11/12/2024 / Consolidated Appropriations Act (CAA) , Controlled Substances , DEA , HDHP , Health Insurance , Health Savings Accounts , Healthcare , Healthcare Reform , Lame Duck Session , Legislative Agendas , Medicare , Pharmaceutical Industry , Public Health Emergency , Regulatory Agenda , Telehealth , Telemedicine

CMS Releases CY 2025 Physician Fee Schedule Final Rule

On November 1, 2024, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2025 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B...more

11/6/2024 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Health Care Providers , Hospitals , Medicare , MIPS , Outpatient Prospective Payment System (OPPS) , Physician Fee Schedule , Physicians

CMS Releases Final Procedural Notice on Transitional Coverage for Emerging Technology (TCET)

The Centers for Medicare & Medicaid Services (CMS) issued the final procedural notice on Transitional Coverage for Emerging Technologies (TCET), effective as of August 12, 2024. TCET is a new pathway that uses existing...more

8/20/2024 / Centers for Medicare & Medicaid Services (CMS) , Food and Drug Administration (FDA) , Insurance Industry , MACs , Manufacturers , Material Adverse Change Clauses (MACs) , Medicare , Public Comment , Technology Sector

CMS Releases Final TCET Notice – Implications and Next Steps

Last week, the Centers for Medicare & Medicaid Services (CMS) issued a final procedural notice for the new Transitional Coverage for Emerging Technologies (TCET) pathway for certain US Food & Drug Administration (FDA)...more

8/15/2024 / Centers for Medicare & Medicaid Services (CMS) , Emerging Technologies , Food and Drug Administration (FDA) , Health Insurance , Healthcare , Legislative Agendas , Medical Devices , Medicare , New Legislation , Regulatory Agenda

CMS Releases CY 2025 Physician Fee Schedule Proposed Rule

On July 10, 2024, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2025 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B...more

7/17/2024 / Centers for Medicare & Medicaid Services (CMS) , Medicare , MIPS , Physician Fee Schedule , Physicians , Telehealth

Telehealth: Regulatory Questions Amid Legislative Uncertainty

Where has the time gone? We have hit the one-year mark since the end of the COVID-19 public health emergency (PHE). Yes, you read that correctly. One year! One of the long-term consequences of the PHE was the shift in when...more

5/16/2024 / Centers for Medicare & Medicaid Services (CMS) , Consolidated Appropriations Act (CAA) , Healthcare , Medicare , Proposed Legislation , Regulatory Standards , Telehealth , Waivers

2024: The Year of the Telehealth Cliff

What does December 31, 2024, mean to you? New Year’s Eve? Post-2024 election? Too far away to know? Our answer: December 31, 2024, is when we will go over a “telehealth cliff” if Congress fails to act before that date,...more

1/15/2024 / Coronavirus/COVID-19 , Healthcare , Healthcare Reform , Medicare , Medicare Advantage , Public Health Emergency , Telehealth , Telemedicine

Looking Forward: Top Policy Areas for 2024

Happy New Year! As we enter 2024, we want to lay out some of the main regulatory issues (both new and old) that McDermott+Consulting will be tracking over the next year. While these may evolve, we think they are still...more

HHS Issues Provider Information Blocking Disincentives Proposed Rule

On October 30, 2023, the US Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) released a...more

11/14/2023 / 21st Century Cures Act , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Electronic Health Record Incentives , Health Care Providers , Hospitals , Information Blocking Rules , Medicare , ONC , Proposed Rules

Policy Update - CMS Releases CY 2024 Physician Fee Schedule Final Rule

On November 2, 2023, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2024 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B...more

11/7/2023 / Centers for Medicare & Medicaid Services (CMS) , Final Rules , Health Care Providers , Medicare , Medicare Part B , Physician Fee Schedule , Physicians , Quality Payment Program (QPP) , Reimbursements , Telehealth

Pharmacy Benefit Manager Reform: What’s on the Horizon?

The price of prescription drugs has brought scrutiny to the entire drug supply chain. Congress and other policymakers continue to seek opportunities to lower costs for patients and the federal government. Pharmacy benefit...more

9/6/2023 / Drug Pricing , MCOs , Medicare , Medicare Advantage , Medicare Part D , Pharmaceutical Industry , Pharmacies , Pharmacy Benefit Manager (PBM) , Prescription Drug Coverage , Prescription Drugs , Supply Chain

Drug Payment Reform and Transparency: It’s What’s on the Menu for Policymakers

August 31, 2023 – When it comes to prescription drug costs, policymakers have set their focus on the consumer: “Let’s lower drug prices for the consumer.” “Let’s give consumers more options in paying their out-of-pocket...more

8/31/2023 / Centers for Medicare & Medicaid Services (CMS) , Drug Pricing , Healthcare Reform , Inflation Reduction Act (IRA) , Medicare , Medicare Part B , Medicare Part D , Negotiations , Pharmaceutical Industry , Pharmacy Benefit Manager (PBM) , Prescription Drugs , Rebates , Transparency

Policy Update - CMS Releases CY 2024 Physician Fee Schedule Proposed Rule

On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B...more

7/18/2023 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Medicare Part B , Physician Fee Schedule , Physicians , Proposed Rules , Quality Payment Program (QPP)

Omnibus Bill Extends Medicare Telehealth Flexibilities and HDHP Telehealth Safe Harbor

On December 23, 2022, US Congress approved a year-end omnibus legislative package, Consolidated Appropriations Act, 2023 (CAA 2023), which consists of all 12 fiscal year 2023 appropriations bills and numerous other...more

12/26/2022 / Consolidated Appropriations Act (CAA) , Coronavirus/COVID-19 , HDHP , Medicare , New Legislation , Omnibus Guidance , Safe Harbors , Telehealth

Rachel Stauffer

McDermott Will & Schulte

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