Friday, April 30, 2021
The Biden Administration used the annual rulemaking that governs health plans sold on the Affordable Care Act’s exchanges to lower health care costs for consumers and improve access to health care. Part 2 of the Notice of Benefit and Payment Parameters for 2022 Final Rule (the Payment Notice), issued April 30, 2021, is the second in a series of rulemakings addressing exchange plans.
[1] The Department of Health and Human Services (HHS) anticipates additional rulemakings on the 2022 Payment Notice later this year.
[2] The rulemaking announced changes to out-of-pocket costs, special enrollment periods, risk adjustment, and HHS’s audit and oversight of exchanges, among other things.
[author: Christopher Jew]
On April 19, 2021, HHS OIG Principal Deputy Inspector General Christi A. Grimm gave the keynote address at the Health Care Compliance Association’s 25th Annual Compliance Institute wherein she highlighted 10 key compliance priorities that will drive much of OIG’s work in the coming year and beyond. While these priorities do not represent OIG’s full work plan and there are other core areas OIG is focused on, the compliance priorities include: (1) Overseeing COVID-19 Relief and Response; (2) Realizing the Potential of Telehealth (3) Ensuring Quality of Care and Patient Safety in Nursing Homes; (4) Advancing Health Equities; (5) Modernizing Program Integrity and Compliance Information; (6) Combating the Substance Use Disorder Epidemic; (7) Prioritizing Cybersecurity; (8) Information Blocking Enforcement; (9) Implementing Value-Based Care; and (10) Strengthening Managed Care Program Integrity
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In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss the new wave of CMS Center for Program Integrity (CPI) audits that have been issued during the past couple weeks. These CPI audits remain focused on long length of stay patients and typically involve hundreds of claims valued at over $1 million. As Meg and Bryan explain, these audits may signal a new approach to auditing by CMS, and it is important for hospices to refine their response and appeal strategy accordingly.
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