Policy and Legislation
CMS believes that eligibility systems in a number of states are programmed incorrectly, possibly leading to disenrollments.
The group urged CMS to consider other coverage gaps that subject patients to unaffordable cost sharing and address them in its rulemaking.
Negotiations with participating drug companies will occur in 2023 and 2024, and prices will become effective beginning in 2026.
With the expiration of the public health emergency ending waivers and flexibilities, providers are looking for answers, says Dr. Robert Murry, chief medical officer of NextGen Healthcare.
The company has now removed prior authorization on more than 1,100 medical services since 2020.
The lawsuit alleges that the Medicaid redeterminations began a month before they were allowed under federal legislation.
The ruling, which includes banning telemedicine prescriptions, will not take effect until and if the Supreme Court reviews it.
These improvements are likely driven by the continued opioid crisis and the concurrent growth in demand for affordable SUD treatment.
CMS estimates the rule would result in a net increase of 4%, or about $1.4 billion, in Medicare Part A payments.
The groups say the regulatory proposals are "conflicting" and could contribute to the burden and cost that the rule seeks to alleviate.