How CMS Makes Changes
Each year, the Center for Medicare and Medicaid Services (CMS) can make adjustments to guidelines and rules for the upcoming year. These regulations can make adjustments or modifications to many things, affecting both providers and beneficiaries. CMS’ proposed regulations can affect which services must be provided under law, how beneficiaries can access those services, and even which companies qualify to be contracted insurers under the law. Learn how CMS makes changes.
Because these rulings affect so much of the Medicare system, they must be published so that people can be informed of them. The Federal Register is the publication that CMS uses to disseminate the new rulings and information. While a rule is in the proposal stage, CMS allows public comment. The next step is for the CMS to send a set of proposed amendments to the Code of Federal Regulations (CFR). This does not, however, amend the CFR immediately.
Public Comment Period
Once the public comment period has ended for the proposed regulations and amendments, the CMS can develop and publish the final regulation. However, it is not immediately effective. If the new or amended regulation affects a large portion of the population or a large profit margin (typically defined as $100 million dollars or more), then the amended regulations are only effective 60 days after the publication date. If the regulation does not affect the margin of people or profit, then it is effective much sooner, at thirty days after publication.
When the CMS sends the regulation to have it published, it also forwards the information to the Government Accountability Office (GAO) as well as both houses of Congress for review. There are certain instances in which the amended regulations can be effective immediately. When the CMS thinks that the delay might cause further damage, that it is contrary to the best interest of the public, or if the delay is unnecessary, impractical, or otherwise not the best way forward, they can find cause to waive the normal delay period.
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