CMS
- CMS released a proposed program integrity rule that affects ACA Marketplaces. The rule increases verification standards and requirements for enrollees getting premium tax credits, tightens special enrollment rules, and made changes to plan design requirements (e.g., increases actuarial value de minimis, increased allowable maximum out of pocket,) among other things. The rule has a 30-day comment period and is expected to be finalized in late Spring.
- CMS announced that it would end certain CMMI demonstrations early. Models that will be changing include Maryland Total Cost of Care, Primary Care First, ESRD Treatment Choices, and Making Care Primary. In addition, CMS will not implement the Medicare $2 Drug List and Accelerating Clinical Evidence models. Potential changes are still being considered for the Integrated Care for Kids model.
- CMS also announced that it was rescinding Medicaid and CHIP on health-related social needs.
Congress
- Budget Bill – House Republicans passed a budget that would keep the government open until the end of the fiscal year (end of September). The bill included some Medicare telehealth provisions but did not include a fix for payment cuts to Medicare providers. The Senate is expected to vote on the package shortly with its passage unclear. Politico reported that there were discussions about potentially including the elimination of the provider payment cut in a future reconciliation bill.
- Nominations – The Senate is expected to hold a hearing for Dr. Oz’s nomination for head of CMS. There have been no indications that Dr. Oz’s nomination is in jeopardy for not being approved.
