The Centers for Medicare & Medicaid Services (CMS) has extended the grace period previously granted to Indian Health Service (IHS) facilities, and facilities operated by Tribes and Tribal organizations, to claim Medicaid reimbursement for services provided outside of the “four walls” of the facility to October 31, 2021.  This bulletin also explains the steps Tribal facilities and states will need to take before the extended grace period expires in order to continue to be reimbursed for services provided outside the four walls of the facility after October 31st.

This final rule updates the requirements for benefits and payments for issuers offering individual market Qualified Health Plans on the Federal Health Insurance Exchange in 2022.  It clarifies that the network adequacy standards regulation does not apply to Qualified Health Plans that do not use provider networks and adds a new direct enrollment option for federally-facilitated Exchanges and State Exchanges.

CMS has finalized the Medicare Advantage and Prescription Drug Plans payment methodologies for CY 2022, including updates to the risk adjustment methodology and star rating system. Read more here.

In this rule, CMS is finalizing remaining proposals from the Medicare Advantage (MA) and Prescription Drug Plans final rule published June 2020, including those related to Special Needs Plans, Part D Coverage Gap Discount Program, opioid misuse and abuse, and the PACE program. Some provisions are effective in March and others will take effect in 2022.

This final rule from the Centers for Medicare & Medicaid Services (CMS) requires Medicaid and CHIP programs, including managed care plans, and issuers of individual market Qualified Health Plans on the Federal Health Insurance Exchange to include in their patient access applications information about a patient’s pending and active prior authorization decisions in addition to claims and encounter data and laboratory results.

The Centers for Medicare & Medicaid Services (CMS) Innovation Center released the Request for Applications (RFA) for the new Geographic Direct Contracting Model, which will test if using a geographic-based approach to care improves quality and reduces costs.  The RFA specifies the regions targeted for the model and that Direct Contracting Entities may contract with Critical Access Hospitals, Federally Qualified Health Centers, and Rural Health Clinics as Preferred Providers.