CHA News

DHCS Reminds Providers That New Fee-for-Service Pharmacy Reimbursement Begins Feb. 23

Beginning Feb. 23, the Department of Health Care Services (DHCS) will implement a new fee-for-service reimbursement methodology for covered outpatient drugs. The methodology will reimburse the lower of the actual acquisition cost (as determined by the Centers for Medicare & Medicaid Services), the federal upper limit, the maximum allowable ingredient cost, and the pharmacy’s usual and customary charge. For more details about the changes, visit the DHCS website.

CMS Proposes Rate Updates for 2020 Medicare Advantage Plans

The Centers for Medicare & Medicaid Services (CMS) has issued Part II of its 2020 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part D Payment Policies and Draft Call letter. CMS proposes a 1.59 percent increase to baseline Medicare Advantage payment rates for 2020.

CMS Announces New Part D Payment Modernization Model

The Centers for Medicare & Medicaid Services (CMS) has announced a new Part D Payment Modernization model, available through the Center for Medicare and Medicaid Innovation, for Part D and Medicare Advantage (MA) drug plans beginning in January 2020.

Authors
  • Ryan Witz
    Vice President, Health Care Finance Initiatives