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News by Topic: Health insurance

May 24, 2024 - The Centers for Medicare & Medicaid Services (CMS) will hold a virtual public meeting of the Advisory Panel for Outreach and Education (APOE) on June 27, 2024, from 12:00 – 5:00 p.m. Eastern. Agenda items include remarks from CMS leadership; a recap of the April 2024 meeting; presentations on CMS programs, initiatives, and priorities; and more. Presentations and written comments must be submitted to the designated federal official by June 13, 2024. Registration is required.
Source: Federal Register
May 24, 2024 - Notice of direct final rule from the Department of Defense Assistant Secretary of Defense for Health Affairs (ASD(HA)) removing certain temporary regulation changes put in place in response to the COVID-19 pandemic that were automatically terminated by the end of the President's national emergency and the associated Health and Human Services (HHS) Public Health Emergency (PHE). Temporary provisions being removed by this rule include a waiver of the requirement for a three-day prior hospital stay before admission to a skilled nursing facility; waiver of certain acute care hospital requirements for temporary hospitals and freestanding ambulatory surgery centers; a waiver of certain interstate and international licensing requirements for individual professional providers; and more. If adverse comments are received, DOD will withdraw this rule and issue a proposed rule. Otherwise, this rule is effective on August 2, 2024.
Source: Federal Register
May 23, 2024 - Notice from the Centers for Medicare & Medicaid Services (CMS) seeking comments on the reestablishment of a matching program between CMS and the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) titled "Identification and Recovery of Duplicate Payments for Medical Claims." This matching program will assist CMS and VHA in identifying those VHA-enrolled beneficiaries who are also enrolled as Medicare beneficiaries; the specific claims where VHA and CMS made duplicate payments for the same healthcare services; and potential fraud, waste, and abuse. Comments are due by June 24, 2024.
Source: Federal Register
May 21, 2024 - Notice from the Centers for Medicare & Medicaid Services (CMS) seeking comments on the extension of an information collection titled "Quality Payment Program/Merit-Based Incentive Payment System (MIPS) Surveys and Feedback Collections." This generic clearance will cover surveys and feedback collections designed to obtain data and feedback from MIPS eligible clinicians, third-party intermediaries, Medicare beneficiaries, and any other audiences that would support CMS in improving MIPS or the Quality Payment Program. Comments are due by July 22, 2024.
Source: Federal Register
May 17, 2024 - Notice of proposed rule from the Centers for Medicare & Medicaid Services (CMS) describing a new mandatory Medicare payment model, the Increasing Organ Transplant Access Model (IOTA Model). The IOTA Model would test whether performance-based incentive payments paid to or owed by participating kidney transplant hospitals increase access to kidney transplants for patients with end-stage renal disease (ESRD) while preserving or enhancing the quality of care and reducing Medicare expenditures. This proposed rule also describes standard provisions for CMS Innovation Center (CMMI) models relating to beneficiary protections, cooperation in model evaluation and monitoring, audits and records retention, rights in data and intellectual property, monitoring and compliance, and more. These standard provisions would apply to any CMMI model whose first performance period begins on or after January 1, 2025, and in whole or in part to any CMMI model whose first performance period began before January 1, 2025. Comments are due by July 16, 2024.
Source: Federal Register
May 17, 2024 - An analysis by the Georgetown University Center for Children and Families showed that Alaska, Arkansas, Colorado, Idaho, Montana, New Hampshire, South Dakota, and Utah had fewer children enrolled in Medicaid at the end 2023 than before the pandemic. States with the largest drops in coverage have large rural areas, where clinician shortages, long drives to care, and poorer health outcomes are common.
Source: Stateline
May 16, 2024 - Notice from the Centers for Medicare & Medicaid Services (CMS) seeking comments on the extension of an information collection titled "Prior Authorization Process and Requirements for Certain Hospital Outpatient Department (OPD) Services." CMS requires prior authorization for certain covered OPD services as a condition of Medicare payment to help to reduce unnecessary utilization and payments for these services. Comments are due by June 17, 2024.
Source: Federal Register
May 14, 2024 - Notice from the Centers for Medicare & Medicaid Services (CMS) seeking comments on revisions to an information collection titled "Fast Track Appeals Notices: NOMNC/DENC." Skilled nursing facilities (SNFs), home health agencies (HHAs), comprehensive outpatient rehabilitation facilities (CORFs), and hospices must provide notice to all beneficiaries/enrollees whose Medicare-covered services are ending no later than two days in advance of the proposed termination of service via the Notice of Medicare Non-Coverage (NOMNC). Comments are due by July 15, 2024.
May 10, 2024 - Notice of final rule from the Centers for Medicare & Medicaid Services (CMS) implementing improvements to increase transparency and accountability, standardize data and monitoring, and create opportunities for States to promote active beneficiary engagement in their Medicaid programs, with the goal of improving access to care. These regulations are effective July 9, 2024.
Source: Federal Register
May 10, 2024 - Notice of final rule from the Centers for Medicare & Medicaid Services (CMS) advancing CMS' efforts to improve access to care, quality and health outcomes, and better address health equity issues for Medicaid and Children's Health Insurance Program (CHIP) managed care enrollees. This rule specifically addresses standards for timely access to care and States' monitoring and enforcement efforts, reduces burden for some State directed payments and certain quality reporting requirements, adds new standards that will apply when States use in lieu of services and settings (ILOSs) to promote effective utilization and specify the scope and nature of ILOS, specifies medical loss ratio (MLR) requirements, and establishes a quality rating system for Medicaid and CHIP managed care plans. These regulations are effective July 9, 2024.
Source: Federal Register