1. Contract Year 2015 Policy and Technical Changes to Medicare Program

    The Centers for Medicare & Medicaid Services (CMS) has issued its Final Rule to revise the Medicare Advantage (MA) program (Part C) regulations and prescription drug benefit program (Part D) regulations to implement statutory requirements; improve program efficiences; and clarify program requirements. The final rule also includes several provisions designed to improve payment accuracy.

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  2. ICD-10 Update

    The following was provided to Work Group for Electronic Data Interchange (WEDI) from the Centers for Medicare & Medicaid Services (CMS): "On April 1, 2014, the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which said that the Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services (HHS) expects to release an interim final rule in the near future that will include a new compliance data that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015."

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  3. FDA Stops Issuance of NHRIC and NDC for Medical Devices

    In order to conform to changes made under the Unique Device Identification (UDI) final rule, the FDA has stopped issuing National Health Related Items Code (NHRIC) and National Drug Code (NDC) labeler codes to manufacturers for use with medical devices. See more information.

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  4. Telecom Quantity Prescribed Update

    In August 2013, NCPDP requested reconsideration and clarification from the Department of Health and Human Services (HHS). The reconsideration was based on HHS determination that the industry request for the updating of Telecommunication Standard Version D.0 for the use of Quantity Prescribed (460-ET) would have to go through full rulemaking (Notice of Proposed Rule Making (NPRM) and Final Rule) process. In March 2014, NCPDP received a response from HHS that the NPRM and Final Rule process would be used. We have asked, but not yet received any information on the regulatory process starting. See HIPAA Information under the banner Implementation Guide Corrections.

    All entities are to continue to put on hold the implementation of Quantity Prescribed changes until the regulatory process has been invoked.

    We will continue to update the industry as information is known.

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  5. ACA Implementation - Exchange and Insurance Market Standards

    The Department of Health & Human Services (HHS) has issued a proposed rule to establish Exchange and Insurance Market Standards beginning in 2015. The proposed rule would establish standards related to product discontinuation and renewal, quality reporting, non-discrimination standards, minimum certification standards and responsibilities of qualified health plan (QHP) issuers, the Small Business Health Options Program, and enforcement remedies in Federally-facilitated Exchanges.

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