Billy Wynne

Certain Surprise Billing IDR Proceedings Can Resume The Centers for Medicare and Medicaid Services (CMS) announced that certified independent dispute resolution (IDR) entities can resume processing payment determinations on February 27, 2023 for payment disputes involving items or services furnished before October 25, 2022 (February 24 notice).   As a result of the decision in…

Portal for Plans and Issuers to Submit Gag Clause Prohibition Compliance Attestation, Due Dec. 31, 2023 The Centers for Medicare and Medicaid Services (CMS) opened the portal for group health plans and health insurance issuers offering group or individual health insurance coverage to submit a Gag Clause Prohibition Compliance Attestation (GCPCA). Plans and issuers are…

Agency Announces Draft Research Plan on Interventions to Prevent Perinatal Depression The U.S. Preventive Services Task Force (USPSTF) released a draft research plan on interventions to prevent perinatal depression. USPSTF aims to use data on population characteristics to explore the degree to which study findings are representative of different populations of persons at risk for…

Innovation Center Accepting Applications for BPCI Advanced Two Year-Extension Period The Center for Medicare and Medicaid Innovation (CMMI) announced it is now accepting applications for Medicare providers, suppliers, and accountable care organizations (ACOs) to participate in the forthcoming two-year extension of the Bundled Payments for Care Initiative (BPCI) Advanced Model. The model extension period will…

Office for Civil Rights Delivers Annual Reports to Congress on HIPAA Compliance and Breaches of Unsecured Protected Health Information The Department of Health and Human Services (HHS) Office of Civil Rights (OCR) shared two reports to congress for 2021 on HIPAA compliance and breaches of unsecured protected health information (PHI) to help regulated entities better…

TEP Nominations Sought to Advise on Exchange Health Plan Quality Initiatives; Due Mar. 1 The Centers for Medicare & Medicaid Services (CMS) is seeking nominations for a Technical Expert Panel (TEP) to contribute direction and thoughtful input to measure development and maintenance for the exchange health plan Quality Rating System (QRS) and Quality Improvement Strategy…

Senators Discuss Farm Bill Nutrition Programs, Focus on Cost The Senate Committee on Agriculture, Nutrition, and Forestry held a hearing on the nutrition programs in the Farm Bill, which must be reauthorized by September 30, 2023. Over 80 percent of Farm Bill Funding goes to nutrition programs which include the Supplemental Nutrition Assistance Program (SNAP),…

CST Committee Examines PBM Legislation, Witnesses Express Support for Increased Transparency The Senate Committee on Commerce, Science, and Transportation convened a hearing to examine pharmacy benefit manager (PBM) practices and their role in the pharmaceutical supply chain. The following witnesses testified that PBM anticompetitive practices negatively impact beneficiaries and community pharmacies and emphasized the need…

In Anticipated Report, Innovation Center Announces Three New Drug Pricing Model Concepts the Secretary of the Department of Health and Human Services (HHS) released a report in response to President Biden’s Executive Order on Lower Prescription Drug Costs for America, which describes three models the Secretary has selected for testing by the Center for Medicare…

Legislative Hearing: Fentanyl Crisis, Cybersecurity Protections for 9-8-8, QALYs The House Energy and Commerce Subcommittee on Health convened a hearing to examine legislation related to addressing the fentanyl crisis, improving cybersecurity protections for the 9-8-8 Suicide and Crisis Lifeline, and prohibiting the use of Quality-Adjusted Life Years (QALYs) in cost-effectiveness analysis (hearing memo). The discussion…