Medicare and Medicaid Programs; Policy and Technical Changes to the Medicare Advantage, Medicare Prescription Drug Benefit, Program of All-Inclusive Care for the Elderly (PACE), Medicaid Fee-For-Service, and Medicaid Managed Care Programs for Years 2020 and 2021; Extension of Timeline To Finalize a Rulemaking
| Published date | 21 October 2021 |
| Citation | 86 FR 58245 |
| Record Number | 2021-22908 |
| Section | Proposed rules |
| Court | Centers For Medicare & Medicaid Services |
Federal Register, Volume 86 Issue 201 (Thursday, October 21, 2021)
[Federal Register Volume 86, Number 201 (Thursday, October 21, 2021)]
[Proposed Rules]
[Pages 58245-58246]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-22908]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Parts 422, 423, 438, and 498
[CMS-4185-RCN]
RIN 0938-AK02
Medicare and Medicaid Programs; Policy and Technical Changes to
the Medicare Advantage, Medicare Prescription Drug Benefit, Program of
All-Inclusive Care for the Elderly (PACE), Medicaid Fee-For-Service,
and Medicaid Managed Care Programs for Years 2020 and 2021; Extension
of Timeline To Finalize a Rulemaking
AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of
Health and Human Services (HHS).
ACTION: Extension of timeline.
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SUMMARY: The Social Security Act (the Act) requires us to publish a
Medicare final rule no later than 3 years after the publication date of
the proposed rule. This document announces an extension of the timeline
for publication of a Medicare final rule in accordance with the Act,
which allows us to extend the timeline for publication of the
``Medicare and Medicaid Programs; Policy and Technical Changes to the
Medicare Advantage, Medicare Prescription Drug Benefit, Program of All-
inclusive Care for the Elderly (PACE), Medicaid Fee-For-Service, and
Medicaid Managed Care Programs for Years 2020 and 2021'' final rule
under exceptional circumstances.
DATES: As of October 21, 2021, the timeline for publication of a rule
to finalize the November 1, 2018 proposed rule (83 FR 54982) is
extended until November 1, 2022.
FOR FURTHER INFORMATION CONTACT: Joseph Strazzire, (410) 786-2775.
SUPPLEMENTARY INFORMATION: On November 1, 2018 (83 FR 54982), we
published a proposed rule, ``Medicare and Medicaid Programs; Policy and
Technical Changes to the Medicare Advantage, Medicare Prescription Drug
Benefit, Program of All-inclusive Care for the Elderly (PACE), Medicaid
Fee-
[[Page 58246]]
For-Service, and Medicaid Managed Care Programs for Years 2020 and
2021,'' that would revise the Medicare Advantage (MA) Risk Adjustment
Data Validation (RADV) regulations to improve program efficiency and
payment accuracy. The proposed rule discussed the Secretary's authority
to: (1) Extrapolate in the recovery of RADV overpayments, starting with
payment year 2011 contract-level audits; and (2) not apply a fee-for-
service (FFS) adjuster to the RADV overpayment determinations.
Section 1871(a)(3)(A) of the Act requires the Secretary to
establish and publish a regular timeline for the publication of final
regulations based on the previous publication of a proposed regulation.
In accordance with section 1871(a)(3)(B) of the Act, the timeline may
vary among different regulations based on differences in the complexity
of the regulation, the number and scope of comments received, and other
relevant factors, but may not be longer than 3 years except under
exceptional circumstances. In addition, in accordance with section
1871(a)(3)(B) of the Act, the Secretary may extend the initial targeted
publication date of the final regulation if the Secretary, no later
than the regulation's previously established proposed publication date,
publishes a notice with the new target date for publication, and such
notice includes a brief explanation of the justification for the
variation.
The final rule for the November 1, 2018 proposed rule should be
published by November 1, 2021. However, we are unable to meet the 3-
year timeline for publication of the previously referenced RADV-audit
related provisions because of exceptional circumstances. Specifically,
on October 26, 2018, just prior to the publication of the proposed
rule, we published the FFS Adjuster Study. On December 27, 2018, we
announced an extension of the comment period for the proposed RADV
provisions of the rule until April 30, 2019 and a plan to release data
underlying the FFS Adjuster study. On March 6, 2019 we announced the
release of data underlying the FFS Adjuster study. On April 30, 2019,
we announced an additional extension of the comment period for the RADV
provision until August 28, 2019. We also announced that we would be
releasing additional data underlying the FFS Adjuster Study, including
additional data containing Protected Health Information, to all parties
who entered an applicable data use agreement and paid the required fee.
Finally, on June 28, 2019, we released additional material related to
the FFS Adjuster Study, and made a further request for public comment.
Based on extensive public comments received on the proposed rule and
subsequent FFS Adjuster study and related data along with delays
resulting from the agency's focus on the COVID-19 public health
emergency, we determined that additional time is needed to address the
complex policy and operational issues that were raised.
This document extends the timeline for publication of the final
rule for 1 year, until November 1, 2022.
Karuna Seshasai,
Executive Secretary to the Department, Department of Health and Human
Services.
[FR Doc. 2021-22908 Filed 10-20-21; 8:45 am]
BILLING CODE 4120-01-P
