A breakdown of 5 recent CMS rules

CMS released or proposed five rules since Oct. 28 concerning new payment reforms, price transparency regulations and coverage of a COVID-19 vaccine.

Here’s a breakdown of the five rules and proposals, beginning with the most recent:

1. CMS released a final rule Nov. 2 that updates payment rates for dialysis services. It takes effect Jan. 1. The agency is expanding add-on payments for new and innovative equipment and supplies to certain home dialysis machines. In 2021, CMS expects to pay $10.3 billion to about 7,400 dialysis facilities in the prospective payment system.

2. On Nov. 2, CMS issued part two of its proposed 2022 Medicare Advantage Advance Notice. The rule updates payment methodologies to Medicare Advantage and Part D plans. Among its provisions, the rule increases payment rates to Medicare Advantage plans by 2.82 percent compared to last year. CMS also wants to change how it uses risk scores to calculate payment to Medicare Advantage plans in 2022. 

3. CMS unveiled a final rule Oct. 29 that requires health plans to disclose the rates they negotiate with hospitals and other healthcare providers. The final rule requires health insurers to offer an online tool that provides members with personalized out-of-pocket cost information and the negotiated rates for all covered services and items, including prescription drugs. Health plans must also provide this information in paper form if it is requested. 

4. CMS finalized 2021 payment updates for home health agencies Oct. 29. CMS will increase payments to home health agencies by about 1.9 percent, or $390 million, for 2021. Under the rule, home health agencies can provide telehealth visits to Medicare beneficiaries as long as remote patient monitoring and other telecommunication services are included in the plan of care. 

5. CMS said Oct. 28 that under an interim final rule, Medicare, Medicaid and private insurers will all be required to cover a COVID-19 vaccine without any out-of-pocket costs for beneficiaries and members. CMS said the Medicare rate for a single-dose vaccine will be $28.39, and a vaccine with two or more doses will be reimbursed at $16.94 for initial doses and $28.39 for the final.