Adam Fein’s Post

BREAKING INFLATION REDUCTION ACT NEWS: Centers for Medicare & Medicaid Services released the final part one guidance for the new Medicare Prescription Payment Plan for Part D plan sponsors. https://lnkd.in/emsS78Hb The final part one guidance outlines the necessary operational requirements Part D plan sponsors and addresses topics such as: - Identifying Part D enrollees likely to benefit from the program - The opt-in process for Part D enrollees, and - Program participant protections, and the data collection needed to evaluate the program. The final part one guidance requires Part D sponsors to notify a pharmacy to provide information on the program for anyone who meets a $600 out-of-pocket threshold based on a single prescription at the point-of-sale. The guidance also finalizes the requirement that Part D sponsors must process election requests within 24 hours during the plan year. #pharma #inflationreductionact #managedcare #marketaccess Learn more below 👇 👇 👇

Each year, employers whose #healthplans include #prescriptiondrug coverage must disclose to the Centers for Medicare & Medicaid Services (CMS) whether that coverage is creditable. Employers must complete an online disclosure with CMS within 60 days after the beginning of the plan year, or Feb. 29, 2024, for calendar year plans. This Compliance Bulletin summarizes the #medicarepartd disclosure requirement with CMS.

Supporting informed decision-making and easier enrollment in coverage for people dually-eligible is one of MMIA’s policy priorities. We are pleased that the Centers for Medicare & Medicaid Services is advancing those priorities by making improvements to the information resources on the consumer-facing website, Medicare Plan Finder. Starting in 2025, Medicare Plan Finder will display both Medicare and Medicaid benefits for select plans serving people who are dually eligible. Having more complete information about plan benefits can improve care and service. Read more about MMIA’s policy priorities at https://lnkd.in/eTahppnr #Medicare #Medicaid #DuallyEligible #MedicareAdvantage

The Centers for Medicare & Medicaid Services took two major steps toward implementing culturally competent care in 2023, with a focus on #Medicare Advantage provisions. What #physicians need to know about the updated rules going into 2024. https://bit.ly/3vvMtZk

In my review of hundreds of companies over the past few years, I have created a "best-of-the-best" short list to help Plan President's, CMO's, CFO's & CEO's jump to those with proven value for patients/members AND which create value for RBEs, CINs, ACOs, Health Systems and/or Health Plans. ECHO is one of these rare breeds - worth evaluating - if you're trying to solve the Medicare M3P challenge ahead of your plan.

🛑 New Medicaid Prescription Payment Plan: What You Need to Know Starting January 1, Medicare Part D will introduce an optional program allowing patients to pay $0 out-of-pocket at the pharmacy counter and be billed monthly for any cost-sharing. Pharmacies must follow specific guidelines to inform patients and adjust point-of-sale processes based on enrollment. PSW has created a helpful guide to walk pharmacies through these processes. Check it out here: https://lnkd.in/gah3TY6t. Additional resources are also available from CMS. #MedicarePartD #PharmacyUpdate #PSWeducation #PatientCare

There's still time to register for today's #webinar at 2:00 pm ET. Key takeaways include examining the differences between #Medicare and #Medicaid and how each can impact settlements, reviewing how #lien processes differ between Medicare and Medicaid, and discussing #FutureMedicalAllocations. Register now at https://lnkd.in/gZ2NF-7c. #MSPcompliance #LienResolution

Let´s talk about money today (for screening and in the US) - DOI: 10.7326/m24-0375 Look at Table 2 of the paper for costs. Colonoscopy costs were 4fold with private insurances, and 7-35 times higher than for the other screening measures. Medicare and Medicaid rates were 3-4 times lower, with similar differences to other screening costs.

#ICYMI: On March 7-8, the MACPAC - Medicaid and CHIP Payment and Access Commission held a meeting regarding the proposed recommendations for improving the transparency of #Medicaid financing, optimizing state Medicaid agency contracts, and more. Read our #ADVIAnalysis* as our #ADVIExperts summarize the meeting with key takeaways: https://lnkd.in/eYgepvB4 *This is a delayed release. ADVI Analysis content is distributed in real-time for retainer clients.