The Reed Smith Health Industry Washington Watch blog has been updated to report on recent health policy developments, including the following:

  • Circuit Split on Availability of ACA Tax Credits in Federal Exchanges. Two circuit court panels have handed down conflicting decisions on whether Affordable Care Act (ACA) insurance premium tax credits are available for insurance purchased on federal, rather than state, insurance Marketplaces/Exchanges.
  • HHS Regulatory Developments. CMS has issued major proposed rules to update Medicare payment and other policies under the physician fee schedule (including proposed changes to Physician Payment Sunshine Act regulations), hospital outpatient prospective payment system, the ambulatory surgical center prospective payment system (PPS), the home health PPS, and the end-stage renal disease PPS (including provisions impacting DMEPOS reimbursement and coverage). The HHS OIG is seeking comments on potential revisions to its permissive exclusion criteria. HHS has proposed ACA eligibility redetermination and renewal process rules for 2015.
  • Other HHS Developments. CMS has released information on the next phase of Medicare DMEPOS competitive bidding, revised its policy on Medicare Part D drugs for hospice enrollees, and modified ACA requirements for health plans in the territories, and the CMS Sunshine Act Open Payments System review/dispute process is underway. HHS has announced a “Settlement Conference Facilitation” pilot as an ALJ hearing alternative and a Medicaid Innovation Accelerator Program. HRSA has published an interpretative ruling on the 340B orphan drug exclusion. FDA has released draft guidance on Medical Device Data Systems.
  • OIG Reports. Recent OIG reports have focused on questionable billing for Medicare clinical lab claims and manufacturer reporting of average sales price (ASP) data.
  • Legislative Developments. A Senate committee report calls for Medicare audit and local coverage policy reforms. Congress is considering a number of bipartisan public health bills, and committee hearings have addressed various health policy issues.
  • Odds & Ends. MedPAC has released its 2014 data book.
  • Health Industry Events. Upcoming CMS events will focus on Medicare hospital outpatient payments and policies. FDA events will address 3-D printing of medical devices and biomarker development.
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