Medicare & Medicaid
The old federal regulations burdened providers with added administrative costs and fear of financial consequences, CMS says.
Opponents say the rule will not lower drug prices, and some question whether it is legal, having bypassed the public comment process.
The letter warns that the new thresholds are too high and will force many clinicians to exit from APMs and revert back to fee-for-service.
Medicare negotiation could result in 94,000 fewer deaths annually, and reduce spending by $475.9 billion by 2030.
The allegations were brought by a whistleblower former employee who will receive about $1.5 million as her share of the recovery.
Better Medicare Alliance said the rule threatens to raise seniors' health costs amid a global pandemic.
The agreement leverages existing private sector infrastructure, since the majority of the public lives within five miles of a pharmacy.
Although Medicare won't pay for monoclonal antibody treatments that providers receive for free, it will reimburse for the infusion.
The rule seeks to reduce federal regulatory barriers, support adaptability and promote transparency and innovation.
The severability issue of the individual mandate is where "the rubber hits the road," says AHIP Attorney Pratik Shah.