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Payment Innovation: Quality Payment Program
CMS uploaded new and updated materials to the QPP Resource Library.
Payment Innovation: Innovation Center
On May 13, CMS hosted a webinar covering changes made to the CJR model. This model tests whether bundled payments and quality measures can improve quality and reduce costs for an episode of care associated with hip and knee replacements.
Payment Innovation: Innovation Center
CMS released a summary document of key takeaways from a meeting on the AHC model.
Payment Innovation: COVID-19
As part of the ongoing White House Coronavirus Task Force efforts, CMS and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting organizations, and taken other related actions.
Payment Innovation: COVID-19
The US House of Representatives on May 15, 2020, approved the HEROES Act a massive new relief and stimulus measure assembled by House Democrats and advanced on party lines, with only one Republican voting in favor.
Payment Innovation: Quality Payment Program
On April 30, CMS released a second Interim Final Rule and additional waivers that provide increased regulatory relief and flexibility for healthcare providers during the public health emergency. Through this rulemaking, CMS delayed the implementation of the QCDR measure testing and data collection approval criteria by 1 year.
Payment Innovation: COVID-19
On April 30, MACPAC sent a letter to the Secretary of HHS urging the Administrator to speed relief to Medicaid providers across the nation.
Payment Innovation: Quality Payment Program
CMS uploaded new and updated materials to the Quality Payment Program QPP Resource Library.
Payment Innovation: Quality Payment Program
CMS encouraged clinicians who participate in the QPP to contribute to scientific research and evidence through clinical trials to help fight the COVID-19 pandemic.
Payment Innovation: Innovation Center
CMS has extended the comment period deadline to June 23, 2020, for stakeholders to submit comments on the CJR Model Three-Year Extension and Changes to Episode Definition and Pricing proposed rule.
Payment Innovation: Innovation Center
CMS has implemented changes to the CPC+ payment model to ensure participating providers have the supports and the flexibility necessary to provide care during the current Public Health Emergency.
Payment Innovation: COVID-19
As part of the ongoing White House Coronavirus Task Force efforts, CMS and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting organizations, and taken other related actions.
Payment Innovation: COVID-19
On April 26, CMS announced that it is suspending its Advance Payment Program to Part B suppliers effective immediately.
Payment Innovation: COVID-19
CMS released a toolkit to help states evaluate their Medicaid program’s capacity to expand telehealth capabilities and coverage policies.
Payment Innovation: Innovation Center
On Wednesday, April 15, 2020, CMS released the final 2021 Hospice Capitation Ratebook and Actuarial Methodology.
Payment Innovation: COVID-19
On April 19, 2020, CMS released guidelines and recommendations for providers and facilities as they emerge from public health emergency restrictions.
Payment Innovation: COVID-19
On April 21, 2020, the Department of Health and Human Services announced delays to the implementation of certain provisions of the interoperability final rules released on March 9, 2020, in response to COVID-19.
Payment Innovation: COVID-19
As part of the ongoing White House Coronavirus Task Force efforts, CMS and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting organizations, and taken other related actions.
Payment Innovation: COVID-19
On April 15, 2020, CMS announced plans for reprocessing IPPS hospitals and LTCHs claims to account for payment increases for COVID-19 discharges authorized under the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
Payment Innovation: Other
On April 10, 2020, CMS issued three different proposed rules updating payment and policy changes for FY 2021 for the IPF, Skilled Nursing Facility, and Hospice Prospective Payment Systems.
Payment Innovation: Other
CMS has extended the deadline for the submission of measure specifications and supporting documentation until June 30, 2020. The agency took this action to extend the deadline in light of the current global pandemic.
Payment Innovation: Innovation Center
CMMI has posted additional resources for two of the current payment models.
Payment Innovation: Innovation Center
CMS announced that it is delaying the start of the Emergency Triage, Treat, and Transport (ET3) Model from May 1, 2020, until an unspecified date this fall.
Payment Innovation: COVID-19
On April 14, 2020, the Administration announced a national ventilator exchange program led by Adam Boehler, former Director of the Center for Medicare and Medicaid Innovation.
Payment Innovation: COVID-19
Last week, CMS announced they had distributed more than $51 billion in advanced payments to healthcare providers.
Payment Innovation: COVID-19
On April 15, 2020, CMS announced that they will pay $100, nearly doubling payment, for certain lab tests that use high-throughput technologies to rapidly diagnose COVID-19 cases.
Insurance Coverage: Waivers
On February 27, 2020, New Jersey submitted to the CMS a request to amend the state’s existing Section 1115 demonstration program.
Payment Innovation: COVID-19
As part of the ongoing White House Coronavirus Task Force efforts, CMS and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting organizations, and taken other related actions.
Payment Innovation: COVID-19
On April 2, 2020, the CMS issued recommendations to state and local governments, as well as nursing homes, to help mitigate the spread of the 2019 Novel Coronavirus (COVID-19) in nursing homes.
Insurance Coverage: Waivers
On March 25, 2020, New Hampshire released a draft Section 1332 waiver application that the state plans to submit to the CMS for the purpose of creating a state-based reinsurance program.
Payment Innovation: Other
MACPAC posted the agenda for their April 2 public meeting which will be hosted online. Registration for the online meeting can be accessed here.
Payment Innovation: Innovation Center
On March 23, CMS announced the three participating pharmaceutical manufacturers for the new Part D Senior Savings Model. The pharmaceutical manufacturers participating in the model include Eli Lilly and Company, Novo Nordisk, and Sanofi-Aventis.
Payment Innovation: COVID-19
As part of the ongoing White House Coronavirus Task Force efforts, CMS and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting organizations, and taken other related actions.
Insurance Coverage: Waivers
On March 16, 2020, Oklahoma Governor Kevin Stitt issued a draft Section 1115 waiver application to expand the state’s Medicaid program (SoonerCare) and make other modifications
Payment Innovation: Quality Payment Program
CMS uploaded new and updated materials to the QPP Resource Library.
Payment Innovation: COVID-19
This announcement from the Centers for Medicare and Medicaid Services (CMS) brings the total number of approved Section 1135 waivers for states to 13.
Payment Innovation: COVID-19
As part of the ongoing White House Coronavirus Task Force efforts, CMS and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting organizations, and taken other related actions.
Payment Innovation: Other
MACPAC released its March 2020 Report to Congress on Friday, March 13, 2020.
Payment Innovation: Quality Payment Program
CMS uploaded new and updated materials to the QPP Resource Library.
Payment Innovation: Innovation Center
On Thursday, March 19, the Centers for Medicare and Medicaid Services will host office hours on the MA VBID Model.
Payment Innovation: COVID-19
On March 17, 2020, CMS and other agencies released further guidance on the use of telehealth during the declared national emergency related to the coronavirus (COVID-19) pandemic.
Payment Innovation: COVID-19
As part of ongoing White House Coronavirus Task Force efforts, CMS and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting organizations, and taken other related actions.
Payment Innovation: COVID-19
On March 13, 2020, President Trump declared the COVID-19 situation a national emergency which enables the CMS to waive certain requirements in Medicare, Medicaid, and CHIP under Section 1135 authority.
Payment Innovation: Other
As part of ongoing White House Coronavirus Task Force efforts, the CMS has issued a number of resource documents, refocused activities related to state survey agencies and accrediting organizations; and taken other related actions.
Payment Innovation: Other
MACPAC held a public meeting on February 27-28, 2020.
Payment Innovation: Innovation Center
CMS posted the evaluation report and a summary of the findings for Year Five of the IAH Demonstration.
Payment Innovation: Innovation Center
CMS released the final evaluation report and a summary of the findings for the MDAPM.
Payment Innovation: Innovation Center
CMS released the second annual report and a summary of the findings at a glance for the MCCM.
Payment Innovation: Other
MACPAC posted the agenda for their next public meeting scheduled for February 27, 2020.
Payment Innovation: Other
The initiative, called the HAO initiative, would allow states to submit a Section 1115 waiver to implement a block grant or per capita cap alternative for certain Medicaid populations while being granted increased flexibility to administer their Medicaid program.
Payment Innovation: Innovation Center
A bipartisan group of Representatives introduced the Strengthening Innovation in Medicare and Medicaid Act (H.R. 5741), a bill aimed at increasing transparency and accountability of the CMMI.
Payment Innovation: Innovation Center
Medicare Advantage Value-Based Insurance Design (VBID) Model team will host a webinar on Thursday, January 30, 2020, on the hospice benefit component recently added to the VBID Model.
Payment Innovation: Innovation Center
Center for Medicare and Medicaid Innovation (Innovation Center) will host office hours on the Direct Contracting model’s payment methodology.
Insurance Coverage: Waivers
Governor Brian Kemp of Georgia signed and enacted Senate Bill 106, otherwise known as the Patients First Act. This legislation authorizes the Georgia Department of Community Health to submit a Section 1115 Demonstration waiver to the Centers for Medicare and Medicaid Services (CMS).
Insurance Coverage: Waivers
Idaho submitted a new section 1115 waiver application to the Centers for Medicare and Medicaid Services (CMS).
Payment Innovation: Quality Payment Program
CMS uploaded new materials to the QPP Resource Library.
Payment Innovation: Quality Payment Program
CMS published the final summary report of the September 19, 2019 public listening session on the Hospital Quality Star Rating program.
Payment Innovation: Innovation Center
CMMI posted the final evaluation report for the Maryland All-Payer Model.
Payment Innovation: Other
In the latest response to the President’s Executive Order on Improving Price and Quality Transparency in American Healthcare, the Department of Health and Human Services released two rules related to requiring increased price transparency for hospitals and health plans.
Payment Innovation: Quality Payment Program
CMS is currently accepting nominations for a TEP on the validation criteria for the Improvement Activities for the 2020 performance year of the MIPS.
Payment Innovation: PTAC
CMMI will host office hours on the recently announced Primary Care First Model.
Payment Innovation: Innovation Center
CMS Center for Medicare & Medicaid Innovation posted the final report to Congress providing the results of the MEPD.
Payment Innovation: Other
The Health Care Payment Learning and Action Network (LAN) hosted its annual Summit.
Payment Innovation: Other
The Health Care Payment LAN is hosting its annual Summit on October 24th.
Payment Innovation: Innovation Center
CMS posted a case study describing how St. Joseph’s Hospital Health System (St. Joseph), a participant in an Accountable Health Communities (AHC) Model, leveraged data to implement quality improvements in their screening strategies.
Payment Innovation: Innovation Center
CMS has posted a fact sheet summarizing the results of the second year of the Part D Enhanced MTM Model.
Payment Innovation: Quality Payment Program
CMS uploaded new materials to the Quality Payment Program Resource Library.
Payment Innovation: Other
On Thursday, September 19, 2019, the GAO released a report on quality measurement activities of the Centers for Medicare and Medicaid Services titled, “CMS Could More Effectively Ensure Its Quality Measurement Activities Promote Its Objectives.”
Insurance Coverage: Waivers
On September 17th, 2019, Tennessee released its proposal to implement a black grant for Tennessee’s Medicaid program, otherwise known as TennCare. This 1115 waiver, referred to as “Amendment 42,” would convert the federal share of the state’s Medicaid funding for most services into a block grant.
Payment Innovation: Other
The GAO has released a report on identifying, predicting, and managing high-cost beneficiaries in Medicaid.
Insurance Coverage: Waivers
Montana submitted a new 1115 waiver application to CMS on August 30, 2019. The waiver is pending approval.
Insurance Coverage: Regulation
We have highlighted recent state grassroots, legislative and executive action to expand Medicaid.
Insurance Coverage: Waivers
CMS has approved Utah’s 1115 waiver, implementing a “bridge plan” while the state submits additional waivers.
Insurance Coverage: Waivers
On August 9, 2019, New York announced it will submit a Section 1115 Medicaid Demonstration waiver application to CMS to provide Medicaid services to certain incarcerated individuals about to be released from county jails and New York State prisons.
Prescription Drug: Legislation
Senate Finance Committee posts description of the Chairman’s mark of its legislation addressing prescription drug pricing.
Payment Innovation: Other
Recommendations for the 2020 Medicaid and CHIP Core Set are open through August 5.
Payment Innovation: Other
On July 18, 2019, CMS updated the data within the Medicaid and CHIP Scorecard.
Prescription Drug: Pricing
The Administration has announced it is no longer pursuing its drug pricing proposal that would have required pharmacy benefit managers to pass rebates directly on to the patient.
Payment Innovation: Other
CMS released a Notice of Funding Opportunity for planning grants to address the opioid crisis.
Payment Innovation: Other
President Trump signed an executive order on June 24 containing guidance regarding price, quality and data transparency.
Insurance Coverage: Waivers
On May 8, 2019, South Carolina submitted a new 1115 waiver application to the Centers for Medicare and Medicaid Services (CMS). The waiver includes work requirements, expands coverage for children, pregnant women and parents, and expands coverage for certain individuals with substance use disorders, who are chronically homeless or who are involved in the justice…
Payment Innovation: Other
On June 6, CMS issued an RFI on Patients over Paperwork.
Insurance Coverage: Waivers
On May 31, 2019, Utah released its 1115 waiver proposal, “Per Capita Cap.” This waiver requests authority to implement the provisions of Senate Bill 96 “Medicaid Expansion Adjustments”, which passed during the 2019 Utah legislative session. Provisions of the waiver include implementing a per capita cap, seeking enhanced Federal Medical Assistance Percentages (FMAP) for the…
Payment Innovation: Innovation Center
The Innovation Center recently posted several documents to their website.
Payment Innovation: Other
On May 17, the GAO released a report recommending an improved transparency policy for Section 1115 waivers.
Payment Innovation: Quality Payment Program
CMS is holding a webinar on May 21 on the All-Payer Combination Option.
Payment Innovation: Quality Payment Program
CMS posted the eCQM specifications for 2020 reporting.
Payment Innovation: Innovation Center
The Innovation Center released updated FAQs for the InCK Notice of Funding Opportunity.
Payment Innovation: Innovation Center
The Innovation Center will host a webinar on the InCK model on May 15.
Insurance Coverage: Legislation
Senators Jeff Merkley (D-OR), Chris Murphy (D-CT), and Dianne Feinstein (D-CA) introduced the Choose Medicare Act, which would allow for any individual who is not already enrolled in Medicare or Medicaid to enroll in Medicare as an individual. This would be known as Medicare Part E and would be offered on all state and federal…
Insurance Coverage: Legislation
Representatives Rosa DeLauro (D-CT) and Jan Schakowsky (D-IL) introduced the Medicare for America Act. The bill would expand coverage in Medicare and Medicaid to include prescription drugs, dental, vision, hearing, and long-term support services. Those who are uninsured or do not have employer-sponsored health insurance, including those in the individual marketplace, would be auto-enrolled into…
Payment Innovation
On April 24, 2019, CMS sent a letter to State Medicaid Directors inviting states to partner with CMS to test innovative approaches to better serve those who are dually eligible for Medicare and Medicaid.
Payment Innovation: Innovation Center
The Innovation Center is holding its second webinar on the InCK Model Notice of Funding Opportunity.
Insurance Coverage: Waivers
On June 22, 2018, Utah submitted an 1115 waiver amendment to CMS seeking to implement a partial and capped Medicaid expansion, as well as Medicaid work requirements for certain populations. Following that waiver amendment, on February 6, 2019, Utah submitted an additional 1115 waiver amendment lifting the Medicaid Institution for Mental Disease (IMD) exclusion for…
Payment Innovation: Innovation Center
The Innovation Center will hold a webinar on the MOM Model application process on April 4, 2019.
Insurance Coverage: Waivers
On March 15, 2019, CMS approved Ohio’s Medicaid 1115 waiver, allowing the state to implement work requirements for certain Medicaid recipients.
Payment Innovation: Other
CMS published guidance for states on 1115 waiver evaluations.
Payment Innovation: Other
CMS updated its drug spending dashboards with 2017 data.
Prescription Drug: Original Analysis
The White House FY 2020 budget proposal
Insurance Coverage: Stakeholder Engagement
An American Academy of Actuaries report out today breaks down criteria and implications for “Medicare for All” and less sweeping approaches, including Medicare and Medicaid buy-ins.
Payment Innovation: Other
Colorado has become the latest state to receive approval from CMS for negotiating drug prices for Medicaid recipients using value-based contracting arrangements.
Payment Innovation: Innovation Center
CMMI is holding a webinar on February 21 from 2:00 to 3:15 pm ET to review the Maternal Opioid Misuse (MOM) model Notice of Funding Opportunity and Grants.gov application process.
Insurance Coverage: Legislation
On February 14, 2019, Senator Brian Schatz (D-HI) introduced the State Public Option Act (S. 489) which allows states to provide a public option through Medicaid for individuals not otherwise covered under Medicaid or enrolled in other insurance.
Payment Innovation: Innovation Center
The CMS Innovation Center has announced a funding opportunity for the Integrated Care for Kids model and a webinar on Feb. 19.
Payment Innovation: Innovation Center
The CMS Innovation Center will execute up to 12 cooperative agreements with states whose Medicaid agencies will implement the Maternal Opioid Misuse model with one or more “care-delivery partners” in their communities. The Notice of Funding Opportunity is now available.
Payment Innovation: Other
HHS and OIG release proposed rule targeting pharmacy benefits managers.
Payment Innovation: Innovation Center
This handy CMMI payment model tracker will allow you to easily follow changes and help you better understand the evolution of value-based payment in the Medicare and Medicaid program.
Insurance Coverage: Legislation
On January 24, 2019, the Medicaid Extenders Act of 2019 (H.R. 259) was signed into law. This law extends the Money Follows the Person program, among other things.
Payment Innovation: Other
CMS releases various payment innovation-related announcements.
Payment Innovation: Other , Quality Payment Program
CMS announces Medicaid demonstration to expand mental health treatment services.
Payment Innovation: Other
Survey results released by the Institute for Medicaid Innovation find that around half of Medicaid managed care organizations launched population-specific value-based purchasing models last year, and around 10 percent of plans had extensive value-based purchasing arrangements in place.
Payment Innovation: Innovation Center
CMS announces the Material Opioid Misuse (MOM) model as part of the agency’s strategy for combating the opioid crisis.
Payment Innovation: Other
Health Care Payment Learning and Action Network released a new report on alternative payment model adoption.
Payment Innovation: Innovation Center
On August 23, 2018, CMS announced a new model that is intended to address the opioid crisis for children.
Insurance Coverage: Budget Information
The Republican House Budget Committee released a FY 2019 budget roadmap, The Budget for A Brighter American Future, on June 19.
Payment Innovation: Innovation Center
Insurance Coverage: Litigation
Insurance Coverage: Regulation
Insurance Coverage: Stakeholder Engagement
On March 16, 2017, four Republican governors (John Kasich of Ohio, Rick Snyder of Michigan, Brian Sandoval of Nevada and Asa Hutchison of Arkansas) sent congressional leaders a letter criticizing the American Health Care Act and proposing an alternative framework for reforming the Medicaid program. The four governors endorse per capita caps and block grants,…
Insurance Coverage: Stakeholder Engagement
January 12, 2017 report examining how repeal legislation could affect Medicaid.
Insurance Coverage: Congress
In a letter to the Republican Governors Association dated December 13, 2016, the Senate Finance Committee announced that it will convene a Governor Roundtable in January 2017 to discuss the sustainability and future of the Medicaid program.
Insurance Coverage: Regulation
Insurance Coverage: Stakeholder Engagement
November 18, 2016 report from the Commonwealth Fund examining the President-elect Trump and some congressional leaders’ calls for absolute limits on the federal government’s spending on Medicaid. This report explores the two most common proposals for reengineering federal funding of Medicaid: block grants that set limits on total annual spending, regardless of enrollment; and caps…