Spotlights
Physician Fee Schedule: CY 2025 Proposed Rule – Submit Comments by September 9
CMS issued the CY 2025 Physician Fee Schedule (PFS) proposed rule to propose updates for Medicare PFS:
- Payment policies and rates
- Medicare Prescription Drug Inflation Rebate Program
- Behavioral Health Services
- Dental and Oral Health Services
- Opioid Treatment Programs
- Telehealth Services
- Rural Health Clinics and Federally Qualified Health Centers
See a summary of proposed provisions. Comments are due by September 9, 2024; see the proposed rule for details on how to submit them.
PrEP for HIV
CMS is encouraging pharmacies and other interested parties to prepare now for the expected transition of coverage from Medicare Part D to Medicare Part B for Preexposure Prophylaxis (PrEP) using antiretroviral drugs to prevent HIV. We expect to release the final National Coverage Determination (NDC) in late September 2024. Coverage under Part B will begin at that time. For more information on:
Average Sales Price Files
CMS posted the July 2024 Average Sales Price (ASP) and Not Otherwise Classified (NOC) pricing files and crosswalks on the 2024 ASP Drug Pricing Files webpage.
Appropriate use of place-of-service codes
Review the revised Skilled Nursing Facility 3-Day Rule Billing (PDF) fact sheet and the SNF PPS section of Medicare Payment Systems to learn more about place-of-service codes.
Physician Fee Schedule: Learn What's New for CY 2024
CMS issued the CY 2024 Physician Fee Schedule (PFS) final rule that announces policy changes for Medicare payments under the PFS and other Medicare Part B payment policy issues. See a summary of key provisions effective January 1, 2024.
States Are Restarting Medicaid & CHIP Eligibility Reviews: Tell Your Patients to Prepare Now
Share the Renew Your Medicaid or CHIP Coverage flyer (PDF) with your Medicaid and Children’s Health Insurance Program (CHIP) patients.
Starting February 1, 2023, some states resumed Medicaid and CHIP eligibility reviews that they temporarily stopped during the pandemic. This means millions of people could lose their current Medicaid or CHIP coverage in the coming months. To find out if they can continue their coverage, people with Medicaid and CHIP must get ready to renew now.
Read about it in the MLN Connects® newsletter.
