Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

CMS

CMS Proposes Drug Price Transparency in Television Ads

October 16, 2018 - CMS has proposed a new rule that would enhance drug price transparency by requiring drug manufacturers to publish wholesale prices of Medicaid and Medicare prescription drugs during television ads. The proposed rule would require pharmaceutical companies to display the price of a short-term or thirty-day supply prescription before accounting for possible insurer or pharmacy benefit...


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Medicare Deductibles, Premiums to Increase Slightly in 2019

by Thomas Beaton

CMS has announced that Medicare Part A and Part B premiums and deductibles are expected to increase slightly for the 2019 plan year. Part B members will see small increases in both their premiums and their deductibles, while Part A...

CMS: ACA Premiums to Decline in 2019 for Silver Plan Consumers

by Thomas Beaton

CMS has announced it expects the average ACA health plan premium to drop by 1.5 percent for healthy consumers that purchase low-cost silver tier plans. The agency stated that it is the first time since 2014 that premiums in any part of...

CMS Releases 2019 Medicare Advantage Health Plan Star Ratings

by Thomas Beaton

CMS has released its 2019 star ratings for Medicare Advantage (MA) health plans, noting that the Medicare Advantage market continues to grow in affordability and access for consumers. CMS estimates that 74 percent of MA beneficiaries will...

OIG Finds Profits to Blame for Denied Medicare Advantage Claims

by Thomas Beaton

Fifty-six percent of Medicare Advantage (MA) payers inappropriately denied claims from beneficiaries and providers to potentially profit from the capitated payment system, according to a report from the Office of Inspector General...

Medicare Advantage Premiums to Decrease by 6% in 2019

by Thomas Beaton

CMS officially announced a six-percent decrease in Medicare Advantage premiums in 2019 as the result of MA enrollment, health plan options, and benefits increase. All signs point to the MA marketplace continuing to be a lucrative...

CPC+ Model Offers Payers Insight into Population Health Management

by Thomas Beaton

CMS’s Comprehensive Primary Care Plus (CPC+) model may offer lessons and strategies for payers that want to increase primary care efficiency with population health management strategies. The CPC+ model is the nation’s largest...

AMA Expresses Concern with Medicare Part D Formulary Changes

by Thomas Beaton

New Medicare Part D formulary policies introduced by CMS in August may increase patient safety risks and complicate the prior authorization process, said AMA President Barbara L. McAneny, MD, to HealthPayerIntelligence.com. In an emailed...

CMS Adds Flexibility to Medicare Part D Formulary Strategies

by Thomas Beaton

CMS is encouraging Medicare Part D health plans to adopt new formulary design strategies that are geared towards lowering drug prices and improving consumer choice. A memo from the agency highlights a major upcoming change to the...

1115 Medicaid Demonstrations Should be Budget-Neutral, CMS Says

by Thomas Beaton

CMS has issued new guidelines for state officials around creating budget-neutral 1115 Medicaid demonstrations. CMS informed state governments that the agency will use a formalized methodology to determine if 1115 demonstrations are a...

CMS Tells States to Curb Silver-Loading with Off-Exchange Plans

by Thomas Beaton

CMS is asking state insurance departments to offer more off-exchange health plans in order to reduce silver-loading of qualified health plans (QHP). Silver-loading is the practice of raising premiums so that payers can earn larger federal...

CMS Provides $8.4M to Stabilize State Insurance Markets

by Thomas Beaton

CMS has awarded $8.4 million to 31 states in an effort to stabilize state insurance markets and increase the number of affordable health plan options for beneficiaries. Recipients are allowed to use the ACA-funded State Flexibility Grant...

New Jersey Gains CMS Approval for Reinsurance Program

by Thomas Beaton

New Jersey has received approval from CMS to implement a five-year reinsurance program that aims to lower individual health plan premiums by 15 percent. The program will operate from 2019 to 2023 and provide $218 million in reinsurance...

CMS Processes State Medicaid Requests, Approvals 23% Faster

by Thomas Beaton

CMS has announced that an agency initiative to streamline state Medicaid approvals and state plan amendments (SPAs) has increased approval processing speed by 23 percent. In 2017, CMS sent a bulletin to state Medicaid programs informing...

CMS Proposed Rule Aims to Secure 2018 Risk Adjustment Payments

by Thomas Beaton

CMS has proposed a new rule that aims to resolve legal issues over the risk adjustment program’s payment methodology.  The rule would ensure that payers will receive appropriate risk adjustment payments for plan year 2018. The...

Medicare Advantage Part B Plans Can Use Drug Step Therapy

by Thomas Beaton

CMS is allowing Medicare Advantage (MA) health plans to implement step therapy protocols in order to decrease prescription drug spending. On January 1, 2019, MA health plans can apply step therapy guidelines for physician-administered...

Medicare Part D Premiums Expected to Decline in 2019

by Thomas Beaton

CMS has announced that monthly Medicare Part D premiums are expected to fall from $33.59 in 2018 to $32.50 in 2019 as new policies to reduce Medicare’s drug costs take effect. Earlier in 2018, CMS issued a final rule that made...

CMS Final Rule Extends Short-Term Health Insurance to 3 Year Max

by Thomas Beaton

CMS has issued a final rule that triples the length of time a beneficiary can keep short-term health insurance. The rule allows individuals to purchase a new short-term, limited benefit health plan that lasts for 12 months, or extend...

CMS: We Will Make $10.4B in 2017 Risk-Adjustment Payments

by Thomas Beaton

CMS has issued a final rule that will allow the agency to disburse $10 billion in 2017 risk adjustment payments that had been in doubt due to a court ruling.   To comply with the initial outcome of a New Mexico lawsuit contending the...

Generic Drugs Could Have Saved $3B for Medicare Part D Program

by Thomas Beaton

Using generic drugs instead of their brand-name equivalents could have saved the Medicare Part D program approximately $3 billion in 2016 alone, according to new data from HHS. A relatively small number of brand-name therapies is...

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