Archive for: Medicare

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Payment Innovation: Other

GAO Releases Report on Medicare Spending on Codes for Comprehensive Care Planning Services

The GAO recently released a report on Medicare physician spending on longitudinal comprehensive care planning services.

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Payment Innovation: Innovation Center

New ET3 Model Overview Infographic Available

The Innovation Center released an infographic describing the new ET3 Model.

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Payment Innovation: Quality Payment Program

CMS Releases CY 2020 PFS Proposed Rule

On July 29, 2019, CMS released the CY 2020 Revisions to Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies (CMS-1715-P).

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Prescription Drug: Legislation

Summary of Senate Finance Prescription Drug Package

Senate Finance Committee posts description of the Chairman’s mark of its legislation addressing prescription drug pricing.

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Payment Innovation: Other

Proposal to Cover Acupuncture in Medicare

CMS is proposing coverage of acupuncture for Medicare patients with chronic low back pain in approved studies.

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Payment Innovation: Other

MedPAC Releases 2019 Health Care Spending Data Book

On July 19, 019, MedPAC released their 2019 Health Care Spending and the Medicare Program data book.

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Payment Innovation: Other

CMS Issues Updates to the Home Health Quality Reporting Program

CMS proposes changes to the Home Health Quality Reporting Program for CY 2020. The program currently has 19 reporting requirements.

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Payment Innovation: Other

OIG Reports Find Hospice Deficiencies Posing Risks to Medicare Beneficiaries

OIG publishes two reports identifying significant vulnerabilities in the Medicare hospice benefit that are harming beneficiaries.

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Prescription Drug: Pricing

Administration Withdraws Rebate Overhaul Proposal

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.

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Payment Innovation: Innovation Center

Second Annual CJR Evaluation Report Finds Continuing Declines in Average Episode Payments

The Innovation Center released the Second Annual Evaluation Report for the CJR model.

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Payment Innovation: Other

GAO Appoints MedPAC Members

The GAO appointed new MedPAC members.

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Payment Innovation: Innovation Center

Innovation Center Hosts Webinar on MDPP on May 29

The Innovation Center will hold a webinar on the MDPP Expanded Model on May 29.

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Payment Innovation: Quality Payment Program

Senate Finance Holds MACRA Hearing on May 8

On May 8 the Senate Finance Committee held a hearing examining MACRA.

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Insurance Coverage: Legislation

SEnate Dems Introduce Choose Medicare Act, Public Option

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…

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Insurance Coverage: Legislation

House Dems Introduce Medicare for America Act, Expanding Coverage in Medicare and Medicaid

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…

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Payment Innovation: Innovation Center

CMS Releases Medicare Advantage Quality Data

CMS released a report regarding disparities in quality of care received by Medicare Advantage (MA) beneficiaries.

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Payment Innovation: Other

Medicare Spending Projected to Grow to 5.9 Percent of GDP by 2038

The Medicare Board of Trustees projected that Medicare spending will grow to 5.9 percent of GDP by 2038.

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Insurance Coverage: Legislation

Democratic Senators Introduce the Medicare Choice Act

This legislation would allow anyone to buy Medicare plans, an option they say is more realistic than Medicare for All.

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Diagnostics: Regulation

CMS Extends Comment Period on Proposed Changes to Proficiency Testing

The Centers for Medicare and Medicaid Services has extended the comment period on proposed changes to proficiency testing to June 4.

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Payment Innovation: Innovation Center

BPCI Update: Second Cohort Application Period to Start in April, CMS Announces Participants Leaving First Cohort

The second cohort application period for BPCI to start in April 2019 while CMS announces 252 participants from the first cohort leave program.

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Payment Innovation: Other

CMS is Now Accepting Proposals for New Measures for the Medicare Promoting Interoperability Program

The CMS Annual Call for Measures for the Medicare Promoting Interoperability Program is now open.

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Payment Innovation: Other

CMS Accepting Proposals for New Measures for the Medicare Promoting Interoperability Program

The CMS Annual Call for Measures for the Medicare Promoting Interoperability Program is open.

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Prescription Drug: Other

Members Send Letter to HHS Opposing Changes to Protected Classes

On March 13, 2019, more than 70 members joined Representatives Barbara Lee (D-CA) and Will Hurd (R-TX) in sending a letter to Secretary and of Health and Human Services Alex Azar expressing opposition to the CMS proposed rule changing the six protected classes of drugs in Medicare Part D.

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Prescription Drug: Other

CMS Updates Drug Spending Dashboards

CMS updated its drug spending dashboards with data for 2017.

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Payment Innovation: Other

Five Takeaways from March 2019 MedPAC Meeting

At their public meeting on March 7 and 8, MedPAC considered a range of Medicare payment issues. Our five takeaways from the meeting.

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Insurance Coverage: CMS

Section 1115 State Waivers List

The Centers for Medicare and Medicaid Services Section 1115 demonstration waiver portal.

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Insurance Coverage: Stakeholder Engagement

Actuaries Weigh in on Expanding Public Insurance

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.

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Diagnostics: PAMA

CMS Releases Laboratory Data Collection FAQ

CMS has released a new set of frequently asked questions addressing lab data collection.

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Payment Innovation: Quality Payment Program

Preliminary 2019 MIPS Eligibility Available on the QPP Website

Clinicians can now check the Quality Payment Program (QPP) Participation Status Tool to view their MIPS eligibility status for the 2019 performance period.

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Insurance Coverage: Legislation

Medicare Buy-in Bill Introduced

On February 13, 2019, Senator Debbie Stabenow (D-MI) introduced the Medicare at 50 Act (S. 470) which lowers the eligibility age for Medicare coverage to age 50.

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Diagnostics: Regulation

CMS Proposes Rule on Proficiency Testing

On February 4, 2019 CMS released the “Clinical Laboratory Improvement Amendments of 1988 (CLIA) Proficiency Testing Regulations Related to Analytes and Acceptable Performance” proposed rule on.

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Payment Innovation: Other

CMS Launches App on What Original Medicare Covers

CMS launches new app called “What’s Covered” that tells users whether Medicare covers a specific medical item or service.

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Payment Innovation: Innovation Center

McDermottPlus Launches 2019 CMS/CMMI Payment Model Tracker

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.

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Payment Innovation: Other

MSSP Final Rule Seeks to Accelerate Move to Performance-based Risk in Traditional Medicare

CMS published a final rule on December 31, 2018, that overhauls the Medicare Shared Savings Program and takes a new approach to transitioning providers to performance-based risk arrangements in traditional Medicare.

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Payment Innovation: Regulation

CMS Releases Final Rule Overhauling Medicare ACO Program

CMS has released its final rule redesigning the Medicare Accountable Care Organization Program.

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Payment Innovation: Other

MedPAC Considers Draft Recommendation to Revamp Hospital Value Based Purchasing Program

MedPAC considers draft recommendation to revamp the Hospital Value Based Purchasing Program.

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Payment Innovation: Other

CMS Releases Procedure Price Look-Up Tool for Services Performed in the OPPS and the ASC

CMS launches new online tool that allows consumers to compare Medicare payments and copayments for certain procedures that are performed in both hospital outpatient departments and ambulatory surgical centers.

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Payment Innovation: Other

FY 2019 HVBP Results Released: Most Hospitals Will See Modest Adjustments to their IPPS Payments

CMS released FY 2019 results from the Hospital Value Based Purchasing Program.

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Payment Innovation: Quality Payment Program

MIPS Participation Lookup Tool Updated: Final 2018 MIPS Eligibility Status Now Available

Eligible clinicians can check the Quality Payment Program (QPP) Participation Status Tool to view their final 2018 MIPS eligibility status.

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Payment Innovation: Other

CMS Proposes Changes for MA and Part D Plans: Coverage Changes for Protected Class Drugs, Step Therapy Requirements and Greater Price Transparency for Medicare Beneficiaries

On November 26, 2018, CMS released a proposed rule that would allow for changes in 2020 to coverage of protected class drugs, establish new requirements for when MA plans may apply step therapy as a utilization management tool for Part B drugs and implement electronic tools to increase drug price transparency for Medicare beneficiaries.

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Payment Innovation: Quality Payment Program

MedPAC Scheduled to Discuss Modifying the Advanced APM Incentive on Nov 1

MedPAC is scheduled to discuss a policy option for revising the Advanced APM incentive payment during their public meeting on Thursday, November 1.

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Payment Innovation: Other

LAN Releases Updated Report on APM Adoption

Health Care Payment Learning and Action Network released a new report on alternative payment model adoption.

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Payment Innovation: Other

ASPE’s Social Risk Request for Information

RFI released seeking provider and plan approaches to improve care for Medicare beneficiaries with social risk factors.

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Payment Innovation: Other

CMS Announces Changes to the Oversight of Medicare Accrediting Organizations

CMS announces a number of changes to the oversight of Medicare Accrediting Organizations. CMS believes these changes will improve quality and safety in healthcare facilities and empower patients with information to make decisions about where to receive care.

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Payment Innovation: Other

CMS Releases 2019 Medicare Advantage and Part D Prescription Drug Quality Program Star Ratings

CMS has released Part C and Part D Star Ratings; providing information about the quality of plan choices.

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Payment Innovation: Quality Payment Program

Representative DelBene Circulates Dear Colleague Letter on MIPS Low Volume Threshold

Rep. DelBene (D-WA) requests support in asking CMS to adjust the MIPS low-volume threshold in order to include more providers in MIPS as part of the final 2019 physician fee schedule.

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Diagnostics: OIG

Medicare Payments for Clinical Diagnostic Laboratory Tests in 2017: Year 4 of Baseline Data

OIG releases the fourth in a series of data briefs looking at Medicare spending under the Clinical Laboratory Fee Schedule.

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Payment Innovation: Quality Payment Program

Energy and Commerce Health Subcommittee Hearing to Review Regulatory Burdens that Impede Value-Based Arrangements

On September 13, 2018 at 1:15 pm, the Energy and Commerce Health Subcommittee will hold a hearing entitled “Examining Barriers to Expanding Innovative, Value-Based Care in Medicare.”  The hearing will look at ways to meaningfully evaluate and increase the use of Medicare value-based payment arrangements.

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Payment Innovation: Other

MedPAC to Discuss Mandated Report on Clinician Payment in Medicare at September 6th Meeting

MedPAC is scheduled to discuss a mandated report on clinician payment examining the relationship between Medicare’s payments to clinicians and the supply of and quality of care provided by those clinicians report at their September 6, 2018, meeting.

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Payment Innovation: Quality Payment Program

CMS Releases 2017 MSSP ACO Performance Data

CMS has released a data set showing how Medicare Accountable Care Organizations (ACOs) performed in 2017. 

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Payment Innovation: Quality Payment Program

CMS Releases First Snapshot of 2018 APM Qualifying Participant and MIPS APM Status

CMS updated the Quality Payment Program Participation Status Tool to include 2018 Advanced Alternative Payment Model Qualifying Participant and Merit-based Incentive Payment System APM status.

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Payment Innovation: Other

CMS Hosts Webinar on Public Reporting on Physician Compare

July 24, 2018 11:00 AM ET/8:00 AM PT and July 26, 2018 3PM ET/12:00 PM PT

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Insurance Coverage: Budget Information

House GOP Proposes 2019 Budget Plan

The Republican House Budget Committee released a FY 2019 budget roadmap, The Budget for A Brighter American Future, on June 19.

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Payment Innovation: Quality Payment Program

Medicare Diabetes Prevention Program Supplier Enrollment Call

On Wednesday, June 20, 2018, the Centers for Medicare & Medicaid Services (CMS), will host a call to present information about the Medicare Diabetes Prevention Program (MDPP) supplier enrollment requirements and process.

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Insurance Coverage: Budget Information

2018 Medicare Solvency Report Released

On June 5, 2018, the Board of Trustees released the 2018 annual report on solvency of the Medicare trust funds (the Hospital Insurance Trust Fund and the Supplementary Medical Insurance Trust Fund).

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Diagnostics: Litigation

ACLA Files Lawsuit Challenging CMS Implementation of PAMA Section 216

On Monday December 11, the American Clinical Laboratory Association (ACLA) filed a legal challenge to CMS’s implementation of the revised Clinical Laboratory Fee Schedule (CLFS) required under Section 216 of the Protecting Access to Medicare Act (PAMA) of 2014.

ORIGINAL ANALYSIS

Insurance Coverage: Congress

H.R. 4848 (Congressman Tom Price, M.D.)

Would delay implementation of the Medicare Comprehensive Care for Joint Replacement (CJR) payment model

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Insurance Coverage: Congress

H.R. 1650 (Congressman Tom Price, M.D.)

Expands Medicare beneficiary-physician private contracting rights

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