January 2025 Newsletter Highlights
A Note From Natalie
Happy New Year!
We’d like to take a moment to say thank you to our clients for all the collaboration throughout 2024 and send our most sincere wishes for a healthy, joyful, prosperous, and compliant 2025.
Remember: QualCode can help.
Natalie Williams ~ President & CEO
New CMS proposed rule would expand access to anti-obesity medications, make MA prior authorization rules public
The specifics: If finalized, CMS proposed rule (CMS-4208-P) would permit coverage of anti-obesity medications for the treatment of obesity. If finalized, the rule would also make Medicare Advantage (MA) plans’ prior authorization and coverage criteria publicly available.
What’s next: Comment on the proposed rule no later than 5pm EST on January 27, 2025. Stay tuned for additional developments and a final rule.
New CMS framework seeks to optimize care delivery, access, and equity
The specifics: A new CMS framework includes seven priorities to improve the healthcare experience and reduce administrative burden by improving care approval processes; reducing redundant or outdated data collection, documentation, and reporting requirements; leveraging technology to adopt best practices; and more.
What’s next: Read through the framework to stay abreast of CMS rulings and other important efforts to reduce administrative burden and improve health equity.
HHS releases information blocking rule related to care access
The specifics: HHS recently published a final rule amending two exceptions from previous information blocking rules and clarifying additional activities that don’t constitute information blocking through the Protecting Care Access Act. The rule took effect December 17.
What’s next: Here’s a quick overview of the rule and what you need to know. Familiarize yourself with what’s new and ensure efficient workflows to prevent costly fines and penalties.