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December 31, 2021

Federal Regulations on Opioid Treatment Programs, Guidance on Co-Locating for Hospitals, and More Transparency Rules

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CMS Releases Final Guidance on Hospital Co-Locating

Centers for Medicare and Medicaid Services ("CMS") released final guidance clarifying hospital co-locating, which is when two Medicare certified hospitals or a Medicare certified hospital and another healthcare entity are located on the same campus or in the same building and share space, staff, or services. The guidance does not apply to critical access hospitals or private physician offices in leased or shared space agreements with hospitals. Per the guidance, common examples of co‑location include: (1) one hospital entirely located on another hospital's campus or in the same building as another hospital; (2) part of one hospital's inpatient services (e.g., at a remote location or satellite) is in another hospital's building or on another hospital's campus; and (3) the outpatient department of one hospital is located on the same campus of, or in the same building as, another hospital or a separately Medicare‑certified provider, such as an ambulatory surgery center. Co‑located hospitals must demonstrate independent compliance with Medicare Conditions of Participation.

Final Rule Freezes Payment Rate for Methadone

CMS has released an interim final rule with comment period ("IFC"), 86 FR 66031, that freezes the payment rate to Opioid Treatment Programs for methadone in CY 2022 at the CY 2021 rate, finding that decreasing the rate would not be appropriate given that substance use and overdoses have increased and been exacerbated by the COVID-19 pandemic. The IFC is effective January 1, 2022. Comments are due January 3, 2022.

New Federal Rule Requires Health Plans to Report Costs

The Biden administration has released IFCs, 86 FR 66662, implementing the No Surprises Act and transparency requirements of the Consolidated Appropriations Act. The regulations aim to further increase transparency by requiring group health plans and health insurance issuers offering group and individual health insurance coverage to report annually certain information about prescription drugs and healthcare spending to the Department of Health and Human Service, the Department of Labor, and the Department of Treasury (collectively, the "Departments"). For example, health plans and insurance issuers must submit the 50 most frequently dispensed brand prescription drugs, the 50 costliest drugs by total annual spending, and the 50 prescription drugs that have contributed to the greatest increase in plan expenditures from the previous year. The new reporting requirements will apply starting with data from 2020. However, the Departments will provide temporary and limited deferral of enforcement during the first year of applicability to give health plans and insurance issuers time to come into compliance. Therefore, the required information for 2020 and 2021 will be due December 27, 2022. Comments are due on January 24, 2022. 

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