“The new DHHS program will improve the quality of care and access to health care by providing a streamlined legal and administrative process and streamlined billing and data collection,” reads an explanation included in the new regulations. The new DHHS program would be “aimed toward achieving greater transparency, providing more predictable and predictable health care costs for patients and providers, and reducing unintended consequences resulting from increased government regulation including the need to hire more lawyers,” according to an earlier version of the new regulations, published by the Office of Management and Budget, in January 2013.
How are these changes related to Obamacare?
According to a statement from CMS, two sets of legislation and a proposed rule regarding Medicare changes are connected to the new regulations’ implementation.
The first bill relates to the changes to Medicare Advantage payments that went into effect as part of the Affordable Care Act. The first amendment requires CMS to include Medicare data including payment data for physician networks in the Medicare Statistical Data System, which is a centralized federal database of health care data and costs. In addition, CMS has been authorized to exempt certain payments that are not tied to Medicare.
The second bill relates to the Medicare Part D program changes that are tied to the federal regulations governing drug coverage.
What are the changes to the Medicare Advantage program?
The new rules include several changes to the Part D program that were outlined in the initial legislation.
Payment amounts for the Part D drug benefit, which covers certain drugs prescribed for treating certain conditions, are being limited to the amount of medication that a patient could potentially take in a year.
The new regulation also prevents the agency from paying physicians, through Part D, to provide drugs for patients that the person would not be permitted to receive for that condition by a traditional drug plan on a plan year at the physician’s discretion.
These changes were included in an amendment introduced by Democratic Rep. Fred Upton of Tennessee.
Can the new regulations be used against Obamacare?
A group of 30 states, led by the Center for Consumer Freedom, filed a lawsuit against the Centers for Medicare & Medicaid Services (CMS) in October 2013 after the agency failed to include in new regulations the changes to the Part D drug benefit.
At the time of the suit, CMS was also reportedly “stalling” any effort to include the new Medicare prescription drug benefit in regulations.
The lawsuit alleged that the agency has failed to make the changes to existing Part D regulations that would affect coverage of drug benefits
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