Congress and federal agencies often engage in a game, each trying to see what the other is willing to do to achieve a particular policy or outcome. While Congress and federal agencies have unique authorities (legislative...more
10/5/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Clinical Laboratories ,
Congressional Committees ,
Diagnostic Tests ,
Food and Drug Administration (FDA) ,
Laboratory Developed Tests ,
Legislative Agendas ,
Life Sciences ,
Medical Devices ,
Medicare Advantage ,
Proposed Rules
Passing the 12 annual appropriations bills that fund the federal government for the next fiscal year (which starts on October 1), or enacting a stopgap continuing resolution in the interim, seems to come down to the wire...more
9/28/2023
/ Appropriations Bill ,
Centers for Medicare & Medicaid Services (CMS) ,
CMMI ,
Department of Health and Human Services (HHS) ,
Federal Budget ,
Government Shutdown ,
Healthcare ,
Healthcare Reform ,
MIPS ,
OMB ,
Payment Systems ,
Regulatory Agenda
Given the number of healthcare-related congressional hearings this past week, you would think there was a legislative requirement to hold them all at once! There were at least five major healthcare hearings on Tuesday alone...more
9/21/2023
/ American Medical Association ,
Biden Administration ,
Congressional Investigations & Hearings ,
Department of Veterans Affairs ,
Dispute Resolution ,
Healthcare ,
Home Health Care ,
Inflation Reduction Act (IRA) ,
Licensing Rules ,
No Surprises Act (NSA) ,
Nurses ,
Pharmacy Benefit Manager (PBM)
Time’s up and pencils down! Comments on the calendar year (CY) 2024 physician fee schedule (PFS) proposed reg were due earlier this week. Now, the Centers for Medicare & Medicaid Services (CMS) will have to review them and...more
9/15/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Health Care Providers ,
Medicaid ,
Medical Monitoring ,
Medicare ,
Physician Fee Schedule ,
Physicians ,
Proposed Regulation ,
Quality Payment Program (QPP) ,
Telehealth
If you recognize the first part of the title of the blog post, then we share the same taste in movies! The well-known phrase (which I modified slightly), “If you build it, he will come,” comes from my favorite movie, Field of...more
The Texas Medical Association and additional plaintiffs have brought four Administrative Procedure Act (APA) challenges to the rules and guidance implementing the No Surprises Act (NSA) (termed TMA I, II, III and IV). The...more
9/1/2023
/ Administrative Procedure Act ,
Department of Health and Human Services (HHS) ,
Department of Justice (DOJ) ,
Department of Labor (DOL) ,
Disclosure Requirements ,
Dispute Resolution ,
Employer Group Health Plans ,
No Surprises Act (NSA) ,
Out of Network Provider ,
Regulatory Requirements ,
Risk Management ,
U.S. Treasury
August 31, 2023 – When it comes to prescription drug costs, policymakers have set their focus on the consumer:
“Let’s lower drug prices for the consumer.”
“Let’s give consumers more options in paying their out-of-pocket...more
8/31/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Drug Pricing ,
Healthcare Reform ,
Inflation Reduction Act (IRA) ,
Medicare ,
Medicare Part B ,
Medicare Part D ,
Negotiations ,
Pharmaceutical Industry ,
Pharmacy Benefit Manager (PBM) ,
Prescription Drugs ,
Rebates ,
Transparency
As physician groups and other stakeholders work to finalize comment letters on the calendar year (CY) 2024 Physician Fee Schedule (PFS) proposed regulation by September 11, 2023, the Centers for Medicare & Medicaid Services...more
It’s likely no surprise to anyone who has been following the implementation of the No Surprises Act over the last couple of years that we again find ourselves on an uncertain path. While Regs & Eggs has focused on some of the...more
8/22/2023
/ Administrative Procedure Act ,
Billing ,
Department of Health and Human Services (HHS) ,
Dispute Resolution ,
Health Care Providers ,
Healthcare ,
Healthcare Reform ,
New Legislation ,
No Surprises Act (NSA) ,
Payment Systems ,
Regulatory Agenda ,
Rulemaking Process ,
Texas ,
U.S. Treasury
The No Surprises Act (NSA) has been in effect since January 2022, and has faced litigation ever since from healthcare providers. States and federal agencies are also examining surprise billing and consumer protection laws...more
Congress may be on summer break, but reg season is in full swing. Last week, the Centers for Medicare & Medicaid Services (CMS) released a final reg that will impact Medicare hospital payments in fiscal year (FY) 2024, which...more
Another week, a lot more regs! Last week, the US Departments of Health and Human Services, Treasury and Labor (the Departments) released a proposed reg related to mental health parity requirements for health plans. This week,...more
8/3/2023
/ Biden Administration ,
Coronavirus/COVID-19 ,
Department of Health and Human Services (HHS) ,
Department of Labor (DOL) ,
Employee Benefits ,
Employer Group Health Plans ,
Employer Liability Issues ,
Enforcement ,
Mental Health ,
Mental Health Parity Rule ,
MHPAEA ,
Proposed Regulation ,
U.S. Treasury
As most of you already know, the Centers for Medicare & Medicaid Services (CMS) recently released two Medicare payment regulations: the Calendar Year (CY) 2024 Physician Fee Schedule (PFS) proposed reg and the CY 2024...more
7/27/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Health Care Providers ,
Inpatient Billing ,
Medicare ,
Outpatient Prospective Payment System (OPPS) ,
Outpatient Services ,
Payment Systems ,
Pharmaceutical Industry ,
Physician Fee Schedule ,
Price Transparency ,
Section 340B
Last week, the Centers for Medicare & Medicaid Services (CMS) released the two major regulations we all were waiting for: the Calendar Year (CY) 2024 Physician Fee Schedule (PFS) proposed reg and the CY 2024 Outpatient...more
7/20/2023
/ Centers for Medicare & Medicaid Services (CMS) ,
Health Care Providers ,
Healthcare Facilities ,
Medicare ,
Outpatient Prospective Payment System (OPPS) ,
Outpatient Services ,
Physician Fee Schedule ,
Physicians ,
Proposed Regulation ,
Provider Payments ,
Telehealth
On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2024 Revisions to Payment Policies Under the Physician Fee Schedule (PFS) and Other Revisions to Medicare Part B...more
On July 13, 2023, the Centers for Medicare & Medicaid Services (CMS) released the calendar year (CY) 2024 Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems Proposed Rule [CMS-1786-P],...more
On June 22, 2023, the US House of Representatives Committee on Energy and Commerce Subcommittee on Oversight and Investigations held a hearing titled “MACRA Checkup: Assessing Implementation and Challenges that Remain for...more