The Washington Report
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Apirl 27, 2022
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Health
CMS Announces Proposed Rule on Medicare Access, Enrollment, and SEPs
On April 22, 2022, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would create Special Enrollment Periods (SEPs), reduce gaps in Medicare coverage and improve administration of the Medicare Savings Program. CMS issued the proposed rule to implement sections of the Consolidated Appropriations Act, 2021 (CAA) that would simplify Medicare enrollment rules and extend coverage of immunosuppressive drugs for certain beneficiaries. Section 120 of the CAA makes changes to traditional Medicare by revising the effective dates of coverage and giving the Secretary of the Department of Health and Human Services (HHS) the authority to establish new SEPs for individuals who meet exceptional conditions. Section 402 of the CAA extends immunosuppressive drug coverage under Part B for certain individuals whose Medicare entitlement based on end-stage renal disease would otherwise end 36-months after the month in which they received a successful kidney transplant provided they do not have certain other health coverage. The rule also proposes other non-CAA related changes to improve state payment of Medicare premiums, and a technical change related to how enrollment forms are referenced in regulations.
The news release is available here.
A Fact Sheet is available here.
The proposed rule is available here.
(Federal Register Note: “This HHS-approved document has been submitted to the Office of the Federal Register (OFR) for publication and has not yet been placed on public display or published in the Federal Register. The document may vary slightly from the published document if minor editorial changes have been made during the OFR review process. The document published in the Federal Register is the official HHS-approved document.”)
Departments Issue FAQs About ACA Implementation Part 53: Transparency in Coverage Machine-Readable Files
On April 19, 2022, the Departments of Labor, Health and Human Services, and the Treasury (Departments) released two frequently asked questions (FAQs) about Affordable Care Act (ACA) implementation regarding transparency in coverage machine-readable files. "The Departments are providing an enforcement safe harbor for satisfying the reporting requirements for plans and issuers that use alternative reimbursement arrangements that do not permit the plans and issuers to derive with accuracy specific dollar amounts contracted for covered items and services in advance of the provision of that item or service, or that otherwise cannot disclose specific dollar amounts according to the schema as provided in the Departments' technical implementation guidance through GitHub." The FAQs are provided below.
- Q1: In the In-network Rate File, how can plans and issuers report applicable rates for specific items or services provided under “percentage-of-billed-charges” contracts if an exact dollar amount cannot be determined for those items or services prospectively?
- Q2: In the In-network Rate File, how can plans and issuers report applicable in-network rates for items and services provided under alternative reimbursement arrangements that are not supported by the schema or require additional context to be understood?
The FAQs About ACA Implementation Part 53: Transparency in Coverage Machine-Readable Files are available here.