The major CMS rules (inpatient, outpatient, physician/ambulatory) come out 60 days before they are effective. Since the Inpatient rule is active with the fiscale year October 1, it comes out around August 1.
CMS publishes the "inspection version" or "typescript" on August 2 for the FY2025 iinpatient rule. The typeset Federal Register version will be August 28.
The inspection copy weighs in at 2987 pages. See responses of AHA and other stakeholders at Healthcare Dive and at MedCity.
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NTAP
One area that is always of interest is how CMS interpreted and decided the varous applications for New Tech Add On Payment (NTAP). There were 16 applications for FY2025 (see inspection copy, p. 367 ff., to p. 668) A total of 6 were withdrawn for technical reasons such as not having FDA approval by May 1. One drug had an application for two separately considered indications (Casgevy, p. 368). CMS summarizes that 6 technologies are not approved and 5 are approved (p. 368).
There is a comment that technologies can be approved for NTAP because they are "substantially similar" to a technology currently approved in an NTAP cycle and this applied to ELREXFIO and TALVEY (similar to TECVAYLI). .
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CMS Remarks on Doctors, Decisions, and Costs
Occassionally someone asserts that CMS payment decisions are cost-blind. See a remark here, p. 665,
"In deciding which treatment is most appropriate for any particular patient, physicians are expected to balance the clinical needs of patients with the efficacy and costliness of particular treatments. We continue to believe that [a type of policy change] would remove consideration of the costs of new technology from treatment decisions, and that it is important to maintain some incentive to weigh the costs of new technology in making clinical decisions."
