We propose to revise § 438.604(a) and (b) to specify data, information and documentation that must be submitted by each MCO, PIHP, PAHP, PCCM, or PCCM entity to the

In the Premium Stabilization Rule, we defined a ‘‘risk adjustment covered plan’’ in § 153.20 as health insurance coverage offered in the individual or small group

proposed rule to set a minimum materiality threshold for an issuer to request reconsideration under § 156.1220(a)(1) for (1) advance payments of the premium tax credit,

Subject to providing the beneficiary with the opportunity to decline data sharing as described in this § 425.708, and subject to having a valid DUA in place, CMS, upon the

Consistent with the existing requirements at § 425.704, in order to request beneficiary identifiable claims data, and regardless of track, an ACO must: (1) Certify that it is

Disconnect governor spring, check for binding or uneven resistance in governor arm travel from stop to stop. Replace governor spring or controls,

This provision would require that Part D sponsors include all Part D drugs on their formularies in categories or classes of clinical concern that CMS specifies for a

We proposed to designate IPPS hospitals as the episode initiators to ensure that all Medicare FFS LEJR services furnished by participant hospitals in selected geographic areas to

These options include adding an exclusion to the ‘‘farm’’ definition in the produce safety rule; adding provisions to the human preventive controls rule to enable

Although heart rate variability parameters indicated sympathetic dominance during sitting (supporting work of others), blood pressure was higher in the prone posture.. These

Therefore, in § 156.430(c)(4)(v) of this final rule, we establish that if a QHP issuer’s standard plan meets certain criteria, and the QHP issuer has selected the

This final rule: (1) Provides that health insurance issuers may vary the premium rate for health insurance coverage in the individual and small group markets only based on family

Business associates are directly liable under the HIPAA Rules for impermissible uses and disclosures, 4 for a failure to provide breach notification to the covered entity, 5 for

Fourth, under §§ 155.210(c)(1)(iii)(D), we proposed that a non-Federal requirement that required a Navigator (but not a certified application counselor or non-Navigator

§ 422.311(c)(2)(i), we proposed that as a general rule, MA organizations may appeal RADV medical record review determinations and RADV payment error calculation, though in order

SUMMARY : This final rule revises the Medicaid home health service definition consistent with section 6407 of the Patient Protection and Affordable Care Act of 2010 (the

Medicaid Eligibility Part II Final Rule In the January 22, 2013 Federal Register (78 FR 4594), we published the proposed rule entitled ‘‘Essential Health Benefits in

In paragraph (c), we propose to codify the two basic sets of requirements that an Exchange must ensure that a health plan meets to be certified as a QHP issuer by an