Additionally, reconciliation of payment amounts is consistent with the approach to the calculation of payment amounts in other CMS programs (such as the Coverage Gap Discount Program) that provide for a reconciliation period
Further, these specific services (shown in Table 19) are duplicative with APCM services because there is significant overlap in the patient populations included in the code descriptors for these services and APCM services, such as patients who have chronic conditions, high-risk conditions, or both complex and chronic conditions
(2) Units With a Rebate Under Section 1927 of the Social Security Act To receive payment under Medicaid for covered outpatient drugs, manufacturers must participate in the Medicaid Drug Rebate Program (that is, have a drug rebate agreement in effect with the Secretary of HHS) and are required to report certain pricing and drug product information and pay Medicaid drug rebates for covered outpatient drugs furnished and paid for under the Medicaid State plan
and to propose to establish a process by which an ACO could request a reopening of an initial determination of shared savings or shared losses
21-27, focuses on offering those Oklahomans who use smokeless tobacco the opportunity to quit, with FREE help from the Oklahoma Tobacco Helpline, a program of TSET
For the CY 2025 PFS proposed rule, refer to item CMS-1807-P