Regulations

Proposed Rule Would Require Mental Health Parity for Health Plans

The departments of the Treasury, Labor, and Health and Human Services have released a proposed rule to improve access to mental health services by requiring health plans to make changes when inadequate access is provided.   The proposed rule reinforces the Mental Health Parity and Addiction Equity Act of 2008, which requires health plans to ensure […]

CMS Issues a Request for Information Related to Episodic Payment Models

On July 14, the Centers for Medicare & Medicaid Services (CMS) issued a request for information (RFI) related to episodic payment models. In the RFI, CMS notes its interest in developing payment models that will create additional opportunities for specialists to participate in models that facilitate “accountable care relationships” with Medicare beneficiaries. The agency believes this step is necessary to achieve its goal of having 100% of Medicare beneficiaries in an accountable care relationship by 2030.  

CMS Issues CY 2024 Physician Fee Schedule Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) has issued its calendar year (CY) 2024 proposed rule for the physician fee schedule (PFS).  In addition to updating physician payments, the rule creates new billable services that support caregivers and the provision of whole person care. The rule also makes additional changes to the Medicare Shared Savings Program (MSSP).  

CMS Issues CY 2024 OPPS Proposed Rule

On July 13, the Centers for Medicare and Medicaid Services (CMS) issued its calendar year (CY) 2024 outpatient prospective payment system (OPPS) proposed rule. CMS estimates that Medicare expenditures under OPPS will increase by $6 billion relative to estimated current year payments based on changes in the proposed rule.  

CHA Issues Summary of Proposed Remedy for Prior 340B Payment Cuts

CHA has issued a members-only summary, prepared by Health Policy Alternatives, Inc., of the proposed remedy issued by the Centers for Medicare & Medicaid Services (CMS) for its 340B-acquired drug payment policy that was in effect from 2018-2022 for hospitals paid under the outpatient prospective payment system. The proposal is in response to a remand from the U.S. District Court for the District of Columbia and the U.S. Supreme Court’s decision in American Hospital Association v. Becerra

CMS Proposes 340B Repayment Policy for 2018-2022

As a result of the Supreme Court ruling in American Hospital Association v. Becerra, the Centers for Medicare & Medicaid Services (CMS) issued its proposed remedy for its 340B-acquired drug payment policy that was in effect from 2018-2022. The rule proposes to make a hospital-specific lump sum settlement of an estimated $9 billion to approximately 1,600 340B-eligible hospitals paid under the outpatient prospective payment system (OPPS).