A newly released proposed rule by the US Centers for Medicare and Medicaid Services (CMS) targets transparency, quality, care access, and payment rates for Medicaid and Children’s Health Insurance Program (CHIP) managed care. States would need to provide an annual payment analysis of all managed cares payment rates for a variety of services. In addition, states will need to develop a quality rating system for Medicaid and CHIP plans.
Despite a recently implemented rule requiring insurers to disclose what they pay for different kinds of care, patients have yet to benefit. The Centers for Medicare and Medicaid Service (CMS) also requires healthcare systems to do similarly. Unfortunately, a patient advocacy org has found these rules have not driven down health care prices for patients.
Despite a litany of complaints and concerns from the industry, the new US drug pricing reform passed by the Democrats would have a marginal impact on pharma, according to analysts from the Bank of America and UBS. The legislation will allow Medicare to set Part D prices for some medications, 10 by 2026 and 60 by 2029. In addition, the Centers for Medicare and Medicaid Services (CMS) will be able to negotiate part B prices.