The House passed 10 of their 12 fiscal year (FY) 2021 appropriations bills this past summer, and until this week, the Senate had not posted any of their bills. However, on Tuesday, November 10, the Senate Appropriations Committee released the text of each of their 12 FY 2021 appropriations bills to spur negotiations ahead of the December 11, 2020, federal funding cliff. In recent weeks, both House Speaker Nancy Pelosi (D-CA) and Senate Majority Leader Mitch McConnell (R-KY) have expressed willingness and intent to pass a full appropriations package ahead of the expiration of the current continuing resolution (CR).

CMS released the 2020 Medicaid and Children’s Health Insurance Program (CHIP) Managed Care final rule. This is the finalization of a 2018 proposed rule implementing policy changes with the attempt to streamline managed care regulations. The rule will give state Medicaid agencies greater flexibility to tailor their managed care programs to fit their specific populations.

The Centers for Medicare & Medicaid Services (CMS) proposed policy changes for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule effective April 1, 2021, or the date immediately following the duration of the COVID-19 public health emergency.  Under the rule, CMS is proposing continuation of higher payment rates for items and services furnished in rural and non-contiguous areas, classifying all continuous glucose monitors as DME, and revisions to the application process for common procedure codes.

The Centers for Medicare & Medicaid Services (CMS) finalized Medicare payment policy updates for renal dialysis services provided to Medicare beneficiaries beginning January 1, 2021. The final rule includes an overall payment increase of 2.0 percent or $250 million for all ESRD facilities, while rural ESRD facilities are estimated to experience a 1.0 percent increase as a result of the proposed changes. Other policy changes include adoption of the 2018 OMB delineations, expansion of the list of new equipment and supplies, TPNIES, to include home dialysis machines, and updates to the low-volume payment adjustment due to the COVID-19 public health emergency.

Under the Medicare Quality Payment Program (QPP), clinicians can participate in two tracks for payment purposes based on their practice size, specialty, location, or patient population: the Merit-based Incentive Payment System (MIPS) or an Alternative Payment Model (APM).  The criteria for clinicians to qualify as a participant in an APM are changing as of January 1, 2021, so the Centers for Medicare & Medicaid Services (CMS) developed a Quick Start Guide and an Eligibility Decision Tree to help clinicians determine if they qualify for an APM or if they will need to participate in MIPS in 2021. Find more information here.

The Centers for Medicare & Medicaid Services (CMS) finalized revisions to the Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations that were proposed in 2018.   The 2018 proposed rule and this final rule modifies several provisions from the 2016 managed care rule based on stakeholder feedback, including pass-through payments, network adequacy standards, and the Quality Rating System.  It also adds a provision allowing states to determine the most appropriate method to coordinate Medicare and Medicaid benefits for those that qualify for both.