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CMS Issues Final Rule for Exchange and Insurance Market Standards for 2015 and Beyond   May 22, 2014
On 5/16/2014, CMS released a final rule on Exchange and Insurance Market Standards for 2015 and beyond. This lengthy rule finalizes numerous policies related to navigators and other consumer assisters, changes in premium stabilization programs, the Small Business Health Options Program (SHOP), formulary exceptions, and improving quality standards, among various other standards. The most notable standards relate to how enrollees may request access to non-formulary drugs under exigent circumstances. In 2015 all ACA-compliant health plans in the individual and small group markets are required to have an accelerated exceptions process where enrollees can gain access to non-formulary drugs under situations where an enrollee’s life, health, or ability to regain maximum function are threatened or the enrollee is undergoing a current course of treatment for a non-formulary drug.READ MORE »

DKP e-Alert®: CMS ICD-10 Committee Implements Partial Freeze of ICD-9 & ICD-10 Codes   May 22, 2014
The ICD-10 Coordination and Maintenance Committee (CMC) has implemented a partial freeze of the ICD-9-CM and ICD-10 (ICD-10-CM and ICD-10-PCS) codes prior to the implementation of ICD-10 which would end one year after the implementation of ICD-10. The ICD-10 CMC will continue to meet twice a year during the partial freeze. At these meetings, the public will be asked to comment on whether or not requests for new diagnosis or procedure codes should be generated based on the criteria of the need to capture a new technology or disease. Any code requests that do not meet the criteria will be evaluated for implementation within ICD-10 on and after October 1, 2016 once the partial freeze has ended. On May 2, 2014, CMS released a News Update stating HHS will release an interim final rule in the near future which will address the delay of ICD-10 implementation until October 1, 2015. The rule will include information regarding the continued use of ICD-9 codes through September 30, 2015. We continue to monitor this topic and will pass along more information as it becomes available.READ MORE »

CMS Issues 2015 Final Call Letter – Reverses Planned Payment Cuts for Medicare Advantage   Apr 09, 2014
The Centers for Medicare & Medicaid Services (CMS) issued the 2015 rate announcement and final call letter for Medicare Advantage and prescription drug benefit (Part D) programs. The announcement sets a stable path for Medicare Advantage and implements a number of policies that ensure beneficiaries will continue to have access to a wide array of high quality, high value, and low cost options while making certain that plans are providing value to Medicare and taxpayers. READ MORE »