The institutionalization of research and development at CMS through the Center for Medicare and Medicaid Innovation has been another positive outcome of the ACA. Originally enacted to protect health insurance coverage . With the new presidential administration, staying abreast of and responding to new and changing healthcare policy changes, legislation, and regulatory activities is more important than ever. Regulatory Overload Report | AHA Assistant Secretary for Planning and Evaluation, Room 415F In making these reimbursement decisions, payers make formal and informal evaluations of the value that drugs and devices confer. From the outset of the Trump Administration, establishing price transparency has been a cornerstone of the Department of HHSs set of strategic initiatives to improve the functioning of the healthcare marketplace. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. One of the critical building blocks for this transformative journey is the requirement for providers and third-party managed care payers to move from traditional transactional and purely contractual relationships to partnerships that are strategic, durable, and long-term; that are based on a strategic vision of integration with common guiding Federal Legal Framework for Third-Party Payment Programs. It is important to note that the rate reduction designated for 2021 is only about half of the total mitigation called for in the act, and an additional reduction in the conversion factor may be looming in 2022. How to Notice and Avoid Errors on Your EOB, Mental Health Parity Rules for Health Insurance, Patient-reported outcomes in health economic decision-making: A changing landscape in oncology. In the third implementation year of the FPS, the government reported a return on investment of $2.84 for every dollar spent, and more than $453 million in unadjusted savings that the FPS identified. HHS Regulations With Enduring Impact On Pricing And Reimbursement Of Rather than only allowing one best price for each drug covered by Medicaid, CMS is permitting arrangements in which there can be more than one price for a drug. CMS uses quality measures to support a patient-centered health care system anchored by quality, accessibility, affordability, innovation, and accountability. HFMA empowers healthcare financial professionals with the tools and resources they need to overcome today's toughest challenges. As one participant asked: Can we really expect the current structure of the federal government to make major policy changes that might affect the cost of care? Another participant added: While it may not happen this year or next, its possible that youll see the political parties run specifically on a cost of care platform for 2022. National Impact Assessment of the Centers for Medicare & Medicaid - CMS In 1990, Congress established the Medicaid Drug Rebate Program.