CMS makes opting out of meaningful use easier

Modern Healthcare

  • The CMS has made it easier for providers to opt out of meaningful use requirements in the federal electronic health record program. In December, a new federal law authorized the CMS to batch process hardship applications by categories instead of the case-by-case method previously used. To comply with the law, the CMS has posted a new streamlined hardship application, reducing the amount of information that providers must submit to apply for an exception. The CMS has also made it easier for whole groups of providers to waive out by allowing them to apply for a hardship exception on a single application.

  • Cigna was banned from offering new Medicare Advantage plans after the CMS took issue with the way the insurer handled appeals and grievances and its drug formulary. Cigna held 3% of the Medicare Advantage market last year, according to the Kaiser Family Foundation. That represented about 502,000 enrollees. The Bloomfield, Conn.-based insurer said in a U.S. Securities and Exchange Commission filing that it is working to resolve the issues and is fully cooperating with the CMS. Financial analysts said that they didn't expect the news to affect Cigna's pending $48 billion sale to Anthem. The deal, which would create the nation's largest insurer, is being scrutinized by state and federal regulators for possible antitrust violations.

  • By April 1, state Medicaid agencies must start reimbursing pharmacies for prescription drugs based on actual acquisition costs. It previously based payment on the ingredient costs for a drug and a dispensing fee for filling the prescription. The CMS says the change will more accurately reflect pharmacies’ purchase prices. The rule also requires states to provide the CMS with data that show their reimbursement methodology represents actual acquisition costs. The new regulations come nearly six years after an initial proposed rule was withdrawn in 2010 because it conflicted with sections of the Affordable Care Act. The CMS then released a second version of the draft regulations in February 2012.
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