CMS Finalizes 2027 MA And Part D Rule
The Centers for Medicare and Medicaid Services (CMS) finalized the 2027 Medicare Advantage (MA) and Part D rule. Next week, I will publish a detailed blog on the changes between the draft and final rules. The major Star ratings changes were adopted, including the cancellation of the Excellent Health Outcomes for All (EHO4all) reward while maintaining the Reward Factor as well as the sunset of numerous measures. All of the proposed measure terminations were adopted except the Diabetic Eye Exam measure was maintained. Depression Screening will also be added. Most changes occur in Star Year 2029.
In other news, CMS announced Maximus will no longer be the Part C Independent Review Entity (IRE). C2C will take over, which also is the Part D IRE.
Additional articles: https://www.beckershospitalreview.com/legal-regulatory-issues/cms-finalizes-2027-medicare-advantage-and-part-d-rule-10-notes/ and https://www.beckerspayer.com/payer/medicare-advantage/cms-awards-ma-independent-review-contract-to-new-vendor/ and https://www.cms.gov/newsroom/fact-sheets/contract-year-2027-medicare-advantage-part-d-final-rule
(Some articles may require a subscription.)
#medicareadvantage #stars #quality #cms
https://www.modernhealthcare.com/politics-regulation/mh-cms-medicare-advantage-star-ratings-2027
Trump Imposes Brand Drug Tariffs
President Donald Trump signed an executive order Thursday imposing a 100% brand name drug import tariff. A number of exceptions are made, including lower tariffs for nations that have negotiated trade deals and those that are investing in manufacturing in America. As well, brand companies that negotiated with the president on most-favored-nation pricing will not face levies.
#drugpricing #trump #branddrugmakers #tariffs
https://thehill.com/policy/healthcare/5813970-trump-signs-drug-tariffs
Rural Hospital Bill Introduced
Lawmakers in the Senate and House of Representatives have introduced bipartisan legislation that would ensure struggling rural hospitals are fairly reimbursed for Medicare. Many are in danger of closure.
The proposal would codify the low-wage index hospital policy for hospitals with wage indexes in the bottom 25th percentile. That policy increased reimbursements for rural hospitals, which resulted in higher Medicare payouts. The rule provided higher reimbursement from federal fiscal years 2020 to 2024 but was struck by a court.
On other hospital news, the Centers for Medicare and Medicaid Services announced it would exempt from Accountable Care Organization (ACO) cost calculations certain highly suspect codes that likely have fraud and suspect billing. In some cases, the ACOs are not responsible for such services.
Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-cms-acos-medicare-billing-practices/
(Some articles may require a subscription.)
#ruralhealthcare #hospitals #medicare
GAO Audit OF CMMI Spurs Congressional Interest
A Government Accountability Office (GAO) audit of the Center for Medicare and Medicaid Innovation Center’s (CMMI) historical spending and success rate may lead to lawmakers increasing scrutiny.
The audit outlined 70 delivery and payment models that CMMI developed and tested between 2011 and 2024. As of January 2025, 24 of those remained in active testing and just four had been scaled for nationwide implementation. The report raises issues of earlier reports, which criticized costs and savings of the reform models launched. Recently, Trump 47 has expanded reform models, some of them focused on technology.
Additional article: https://www.gao.gov/products/gao-26-107953
#gao #cmmi #cms #innovation #medicare
— Marc S. Ryan
