Today, the Center for Medicare and Medicaid Innovation (CMMI) released a request for information (RFI) and a sample list of prescription drugs that the agency intends to include in its $2 Drug List Model (press release). What is it. Under the $2 Drug List Model, beneficiaries enrolled in participating Part D plans would have access to the drugs on the… (Slifer, October 9, 2024) #Cost-Sharing, #Medicare Part D, #Prescription Drugs

Below please find information on recent funding awards and new technical assistance centers from the Biden Administration. SAMHSA Announces $68.5 for Behavioral Health Education, Training and Community Programs The U.S. Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA), has recently awarded $68.5 million in grants to support behavioral health education, training,… (Marceno, October 8, 2024) #Grants, #Health Equity, #Mental and Behavioral Health, #Opioids

The Centers for Medicare and Medicaid Services (CMS) is inviting public comments on electronic clinical quality measures (eCQMs) related to timely follow-up for: Abnormal Screening Mammograms for Breast Cancer Detection: This measure evaluates the percentage of women aged 40 to 75 who, following at least one abnormal screening mammogram, receive either follow-up imaging with negative or benign results or undergo… (Eisen, October 7, 2024) #Care Coordination, #Prevention, #Quality

The Centers for Medicare & Medicaid Services (CMS) is seeking nominations for a Technical Expert Panel (TEP) to assist in the development and maintenance of electronic clinical quality measures (eCQMs). This initiative aims to enhance the quality of healthcare delivery by ensuring that eCQMs are effectively aligned with CMS’s quality improvement goals. Details about the TEP follow. Title: Electronic Clinical Quality… (Eisen, October 7, 2024) #Care Coordination, #Chronic Diseases, #Health Information Technology, #Quality

The Centers for Medicare and Medicaid Services (CMS) released the HHS Notice of Benefit and Payment Parameters for 2026 proposed rule (fact sheet) – a wide-ranging rule affecting Marketplaces and qualified health plans in the individual and small group markets, as well as requirements for agents, brokers, web-brokers, direct enrollment entities, and assisters. The proposed rule also includes proposals that… (Llamas, October 4, 2024) #Insurance Coverage, #Insurance Reform

The White House’s Office of Management and Budget (OMB) recently released a new memorandum, M-24-18, offering guidance on the responsible acquisition of artificial intelligence (AI) solutions by U.S. federal agencies. This memo, part of the Biden administration’s ongoing efforts to ensure the responsible use of AI in government, introduces new requirements for federal agencies to manage risks, promote market competition,… (Colocho, October 4, 2024) #Health Information Technology, #Privacy, #Public Option, #Transparency

The Department of Health and Human Services (HHS), through the Office of Infectious Disease and HIV/AIDS Policy (OIDP), is seeking input through a Request for Information (RFI) to help shape the 2026–2030 National HIV/AIDS Strategy (NHAS), along with strategic plans for Sexually Transmitted Infections (STIs), Vaccines, and Viral Hepatitis. The Strategic Plans serve as national roadmaps to help address the… (Colocho, October 4, 2024) #Chronic Diseases, #Health Equity, #Prevention

The Department of Health and Human Services (HHS) Office of the Inspector General (OIG) conducted a study on maternal health care access in Medicaid managed care, highlighting critical gaps in a landscape marked by disparities and poor outcomes. Despite federal mandates for managed care organizations (MCOs) to cover OB/GYN services, many states do not ensure coverage for essential providers like… (Eisen, October 2, 2024) #Social Determinants of Health, #Women’s Health

Today, the Centers for Medicare and Medicaid Services (CMS) issued final guidance for the initial price applicability year (IPAY) 2027 and for the effectuation of the maximum fair price (MFP) in 2026 and 2027 (press release and fact sheet). What is it. In May, CMS released the draft guidance for IPAY 2027 and effectuation of the maximum fair price (MFP)… (Slifer, October 2, 2024) #Medicare Part D, #Prescription Drugs

The Government Accountability Office (GAO) has released a report evaluating the completeness of hospital pricing data, following a mandate from the Centers for Medicare & Medicaid Services (CMS) in 2021 that required hospitals to publicly post their pricing to enhance transparency and promote competition, potentially lowering healthcare costs. However, stakeholders, including health plans and researchers, have raised concerns about the… (Eisen, October 2, 2024) #Costs, #Hospitals