ICYMI policy wonks - CMS released a marketplace integrity rule (yes the one that is still technically pending at OMB). It didn’t clear OMB or hit the FR yet but was released on the CMS website & via list serv late this afternoon.
CMS proposed a rule to protect ppl from being enrolled in Marketplace coverage without knowledge or consent, promote stable & affordable insurance markets, & ensure taxpayer dollars only fund financial assistance for the ppl the ACA is set to support. https://t.co/hbxL3kC6y7
@makotoyukimura
I loved this unicorn panel so much I had someone make a custom mug. I think they did a great job and I hope you love it! Thank you for all the amazing art ❤️
LVPA —proposing to create a two-tiered LVPA. ESRD facilities that furnished fewer than 3k treatments per cost reporting year would receive a 28.4% ⬆️ adjustment to the ESRD PPS base rate, and ESRD facilities that furnished 3k to 3.9k treatments would receive an 18.1% ⬆️ .
TPNIES—The proposed CY 2025 average per treatment offset amount for the TPNIES for capital-related assets that are home dialysis machines is $10.18.
No new TPNIES applications this year.
Oral drugs—CMS moving forward with drug shift. CMS is considering whether it may be appropriate to make additional payments to account for operational costs in excess of 100 percent of ASP (ex. Shipping and handling). Asks for feedback.
🧵:CY25 ESRD PPS proposed rule highlights! Not exhaustive but I’m exhausted 🤣
The proposed base rate is $273.20, an increase from the CY 2024 ESRD PPS base rate of $271.02. (1.8% net update).
Same rate for AKI.