The United States Centers for Medicare and Medicaid Services (CMS) recently released proposals that will directly impact the health care industry. Two potential impacts to watch include changes made in response to the current coronavirus pandemic and a potential move to support an increased shift towards the use of value-based drugs.
Here are the basics.
COVID-19 related changes
If approved, the agency’s proposed rule for the Home Health Prospective Payment System would go into effect in 2021. According to the agency, the proposal is designed to update the payment rates and wage index. Another change, as noted above, includes language to make certain changes regarding the use of technology to provide services permanent.
In order to qualify, the agency notes the plan of care must generally include a provision of remote patient monitoring using such technology for patient-specific needs to help achieve the overall goals of the plan of care.
Proposal could result in increase of value-based drugs
Another proposal supports flexibility to enter “innovative value-based purchasing arrangements (VBPs) with manufacturers,” likely paving the way for further adoption of value-based purchasing. If approved, the change would update rules relating to Medicaid drug pricing that are over three decades old. The changes would broaden the definition of VBPs and adjust reporting requirements.
As noted in a recent discussion published in The National Law Review, the later proposal could signal an upcoming increase in VBP proposals. President Donald Trump has made it clear that he intends to lower drug prices, and the administration may see it fit to move such proposals forward before November elections.