We have important information regarding Massachusetts payor surcharges and the MA Managed Care Organization Payor Assessment Notice. The Commonwealth of Massachusetts, in accordance with statutory changes that were included in its fiscal year 2025 budget, terminated the Health Safety Net surcharge program for payments to acute hospitals and ambulatory surgical centers on January 1, 2025. [...]
Before December 31, 2024, self-insured plan sponsors are required to file a gag clause attestation with CMS using the HIOS system. For self-insured clients, uploading the attestation is a plan sponsor responsibility under the Consolidated Appropriations Act. However, Diversified Group will submit the attestations to CMS on behalf of our clients in time to meet the [...]
The Consolidated Appropriations Act requires self-insured plan sponsors to file a gag clause attestation with CMS using the HIOS system no later than December 31st, 2023. A gag clause is any contractual term that prohibit health plan sponsors and plan issuers from having any agreements with a healthcare provider, a network, an association of providers, [...]
Before December 31, 2023, self-insured plan sponsors are required to file a gag clause attestation with CMS using the HIOS system. For self-insured clients, uploading the attestation is a plan sponsor responsibility under the Consolidated Appropriations Act. However, Diversified Group will submit the attestations to CMS on behalf of our clients in time to meet the [...]
On Thursday, May 7, 2020, the United States Centers for Medicare and Medicaid Services (CMS) released the 2021 Notice of Benefit and Payment Parameters final rule. This rule finalizes the CMS’ proposed modification of existing policy relating to how pharmaceutical manufacturer direct assistance (i.e., coupons) accrues with respect to health plan enrollees’ annual limit on [...]
The Medicare Prescription Drug Improvement and Modernization Act of 2003 implemented prescription drug coverage under Medicare (Medicare D), requiring all employers that offer prescription drug benefits to provide an annual notice of Medicare open enrollment. The notice must go to all Medicare eligible plan participants and qualified beneficiaries before October 15th each year. The notice [...]
While hospitals in 34 geographic areas will still be required to participate in the Comprehensive Care for Joint Replacement Model, hundreds of acute care hospitals in other areas have received a reprieve. In addition to modifying CJR model compliance, CMS recently finalized plans to cancel the Episode Payment and Cardiac Rehabilitation Incentive Payment Models, both [...]
The Centers for Medicare and Medicaid Services (CMS) began their initiative to tie payments to quality or value earlier this year by implementing their Comprehensive Care Joint Replacement Model (CJR). The mandatory program holds hospitals accountable for all costs, processes and outcomes associated with hip and knee replacements performed on Medicare patients. Since hip and [...]
As you may recall, with the introduction of Medicare Part D prescription drug benefits, the Centers for Medicare and Medicaid Services (CMS) imposed specific notice requirements on employers. Each year, employers whose healthcare plans include prescription drug benefits are required to notify all Medicare beneficiaries and the CMS of the “creditable” or “non-creditable” coverage status [...]
