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NEW – Healthsperien Publishes Comprehensive Summary of CY 2024 MPFS and QPP Proposed Rule

This week, Healthsperien released its comprehensive summary of the Centers for Medicare and Medicaid Services’ (CMS) calendar year (CY) 2024 Medicare Physician Fee Schedule (MPFS) and Quality Payment Program (QPP) Proposed Rule. Notably, overall payment rates under the MPFS are proposed to be reduced by 1.25% in CY 2024 compared to CY 2023. The proposed CY 2024 MPFS conversion factor is $32.75, a decrease of $1.14, or 3.34%, from the current CY 2023 conversion factor of $33.89. This year’s proposed rule also includes key provisions related to caregiver training services, services related to addressing health related social needs, telehealth, behavioral health, and more. Comments are due by September 11th.

To view Healthsperien’s full summary, please click here.

Healthsperien Releases Summaries of Medicaid Managed Care and Access Proposed Rules

On May 3rd, the Centers for Medicare and Medicaid (CMS) released two rules proposing changes to Medicaid managed care and access. The Managed Care Access, Finance, and Quality proposed rule institutes new access requirements, reforms stated directed payments processes and reporting, institutes new medical loss ratio reporting requirements, codifies in-lieu-of-services guidance, makes changes to the external quality review process, and proposes a new Medicaid managed care quality rating system. The Ensuring Access to Medicaid Services proposed rule includes a number of changes focusing on improving access to and quality of home and community-based services (HCBS).

Healthsperien developed detailed section-by-section summaries of each proposed rule, describing all provisions and identifying opportunities for comment. Here are the links to the summaries for the Managed Care Rule and Access Rule. 

Healthsperien Releases Summary of 2024 Medicare Advantage and Part D Final Rule

On April 5th, CMS released their annual Medicare Advantage (MA) and Part D Final Rule for 2024 (fact sheet) which governs requirements for MA and Part D plans. Among its provisions, the rule finalizes stricter prior authorization requirements, increases beneficiary marketing protections, better incorporates health equity into Star Ratings, provider directories, and quality improvement programs, and improves access to behavioral health.

Healthsperien developed a detailed section-by-section summary of the Final Rule, describing finalized provisions and stakeholder comments. The summary can be found here.On May 3rd, the Centers for Medicare and Medicaid (CMS) released two rules proposing changes to Medicaid managed care and access. The Managed Care Access, Finance, and Quality proposed rule institutes new access requirements, reforms stated directed payments processes and reporting, institutes new medical loss ratio reporting requirements, codifies in-lieu-of-services guidance, makes changes to the external quality review process, and proposes a new Medicaid managed care quality rating system. The Ensuring Access to Medicaid Services proposed rule includes a number of changes focusing on improving access to and quality of home and community-based services (HCBS).Healthsperien developed detailed section-by-section summaries of each proposed rule, describing all provisions and identifying opportunities for comment. The summaries for the Managed Care Rule and Access Rule are linked on our website. Comments on both rules are due July 3rd, 2023.