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diagnostic

Featured Content

Diagnostics: Payment Rates

CMS Releases CY 2019 CLFS Payment Rates

December 17, 2018

CMS has released the final CY 2019 payment rates for clinical diagnostic services along with supporting instructional materials.

Resource Centers

Dedicated resource libraries for clients and partner organizations.

Payment Innovation
Resource Center

A library of content about Medicare payment transformation initiatives. Includes original analysis, major regulations, agency guidance, program announcements and other primary source documents.

Diagnostics
Resource Center

A collection of primary source materials about laboratory diagnostics regulation and payment, including original analysis, Medicare rates, rulemakings, final determinations and other items of interest.

Prescription Drug
Resource Center

A collection of materials about prescription drug pricing initiatives and regulation from the Administration and Congress, original analysis, and other items of interest.

Insurance Coverage
Resource Center

A library of content about efforts to redesign health care insurance and coverage. Includes original analysis, major regulations, agency guidance, program announcements and other primary source documents.

The Latest from our Resource Centers

CMS Releases CY 2020 Medicare OPPS  and ASC Payment System Final Rule

Insight: original analysis

CMS Releases CY 2020 Medicare OPPS and ASC Payment System Final Rule

November 06, 2019

On November 1, 2019, CMS released the CY 2020 Hospital Outpatient Prospective Payment System and the Ambulatory Surgical Center Payment Systems effective for services on January 1, 2020.

ORIGINAL ANALYSIS

CMS Releases Final Rule for CY 2020 Physician Fee Schedule

Insight: original analysis

CMS Releases Final Rule for CY 2020 Physician Fee Schedule

November 06, 2019

On November 1, 2019, CMS released the CY 2020 Revisions to Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies, which includes changes related to Medicare physician payment and the Quality Payment Program effective for services on January 1, 2020.

ORIGINAL ANALYSIS

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

November 05, 2019

CMS uploaded new materials to the QPP Resource Library.

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Star Ratings Posted for Exchange Health Plans

Payment Innovation: Other

Star Ratings Posted for Exchange Health Plans

November 05, 2019

CMS posted quality ratings for all health plans offered on the federal Exchange during the 2020 Open Enrollment period.

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MedPAC to Discuss Quality at November Public Meeting

Payment Innovation: Other

MedPAC to Discuss Quality at November Public Meeting

November 05, 2019

MedPAC is discussing several innovation and quality topics at their next public meeting scheduled for November 7-8, 2019.

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You’re Invited: Stark Law and Anti-Kickback Luncheon and Discussion

Payment Innovation: Other

You’re Invited: Stark Law and Anti-Kickback Luncheon and Discussion

November 05, 2019

McDermott+Consulting (McDermottPlus) and McDermott Will & Emery, LLP invite you to join us for a discussion around the October 8, 2019 release of the U.S. Department of Health and Human Services’ proposed changes to the Stark Law and Anti-Kickback Statute regulations.

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Request for Comment on MIPS Cardiac Outpatient Outcome Measure

Payment Innovation: Quality Payment Program

Request for Comment on MIPS Cardiac Outpatient Outcome Measure

November 05, 2019

CMS is soliciting comments on a measure of acute cardiovascular-related admissions for patients with heart failure.

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CMS Publishes CY 2020 Quality Payment Program Final Rule

Payment Innovation: Quality Payment Program

CMS Publishes CY 2020 Quality Payment Program Final Rule

November 05, 2019

CMS released CY 2020 Revisions to Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies [CMS-1715-F and IFC], which includes changes related to Medicare physician payment and the QPP effective for services on January 1, 2020.

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19 Senators Push for Expansion of MDPP

Payment Innovation: Innovation Center

19 Senators Push for Expansion of MDPP

November 05, 2019

First launched in 2018, the MDPP expanded model is a structured intervention to prevent type 2 diabetes in individuals with an indication of prediabetes.

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CMS Discusses Potential Oncology Payment Model, Solicits Feedback Through Informal RFI

Payment Innovation: Innovation Center

CMS Discusses Potential Oncology Payment Model, Solicits Feedback Through Informal RFI

November 05, 2019

CMS Center for Medicare and Medicaid Innovation (Innovation Center) held a public listening session on Monday, November 4, 2019, to discuss a new oncology payment model that builds on the current OCM.

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Participants Selected for the AI Health Outcomes Challenge

Payment Innovation: Innovation Center

Participants Selected for the AI Health Outcomes Challenge

November 05, 2019

CMS announced the 25 participants advancing to the second stage of the AI Health Outcomes challenge.

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CMS Releases CY 2020 PFS, OPPS and ASC Final Rules

Payment Innovation: Regulation

CMS Releases CY 2020 PFS, OPPS and ASC Final Rules

November 01, 2019

The CY 2020 final rules were released on November 1, 2019.

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LAN Sets Goal of Tying 100% of Traditional Medicare and MA Payments to Shared Accountability Models by 2025

Payment Innovation: Other

LAN Sets Goal of Tying 100% of Traditional Medicare and MA Payments to Shared Accountability Models by 2025

October 30, 2019

The Health Care Payment Learning and Action Network (LAN) hosted its annual Summit.

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

October 30, 2019

The CMS uploaded new materials to the QPP Resource Library.

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Year Five Report: IAH Demonstration Overall Savings Total $33.5 million

Payment Innovation: Innovation Center

Year Five Report: IAH Demonstration Overall Savings Total $33.5 million

October 30, 2019

The CMS released the year five report for the IAH Demonstration.

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CMS Begins Accepting Applications for Primary Care and Kidney Care Payment Models

Payment Innovation: Innovation Center

CMS Begins Accepting Applications for Primary Care and Kidney Care Payment Models

October 30, 2019

The CMMI posted RFAs for the Primary Care First (PCF) and Kidney Care Choices (KCC) Models.

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Prescription Drug

Protected: Prescription Drug Pricing Tracker

October 30, 2019

There are a lot of moving parts when it comes to prescription drug cost reform. Keep up-to-date with our tracker! (Updated 10.31.19)

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LAN Hosts Annual Summit on October 24

Payment Innovation: Other

LAN Hosts Annual Summit on October 24

October 22, 2019

The Health Care Payment LAN is hosting its annual Summit on October 24th.

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CMS Seeks Expertise in Cancer Screening, Genetic Testing, Clinical Epidemiology, Psychopharmacology, Screening/Diagnostic Testing Analysis and Vascular Surgery for MEDCAC Nominations

Payment Innovation: Other

CMS Seeks Expertise in Cancer Screening, Genetic Testing, Clinical Epidemiology, Psychopharmacology, Screening/Diagnostic Testing Analysis and Vascular Surgery for MEDCAC Nominations

October 22, 2019

CMS is currently seeking nominations for members of the MEDCAC.

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CMS Solicits Comments on the Future of Medicare Program Integrity

Payment Innovation: Other

CMS Solicits Comments on the Future of Medicare Program Integrity

October 22, 2019

As a follow-up to the recently released Presidential Executive Order on Medicare, the CMS released two RFIs on the future of Medicare program integrity.

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

October 22, 2019

CMS uploaded new materials to the QPP Resource Library.

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New APM Learning Modules for CME Credit Posted

Payment Innovation: Quality Payment Program

New APM Learning Modules for CME Credit Posted

October 22, 2019

CMS added five additional courses on APMs.

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Data-Driven Quality Improvement Strategies Highlighted in Accountable Health Communities Model Case Study

Payment Innovation: Innovation Center

Data-Driven Quality Improvement Strategies Highlighted in Accountable Health Communities Model Case Study

October 22, 2019

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.

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Annual Star Ratings Update Finds 81% of Beneficiaries with MA-PD Coverage Enrolled in Four or Five Star Plans

Payment Innovation: Other

Annual Star Ratings Update Finds 81% of Beneficiaries with MA-PD Coverage Enrolled in Four or Five Star Plans

October 16, 2019

CMS released their annual update of Medicare Part C and D Star Ratings.

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

October 16, 2019

CMS uploaded new materials to the QPP Resource Library.

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Data Element Definitions for the 2020 Performance Period Now Available

Payment Innovation: Quality Payment Program

Data Element Definitions for the 2020 Performance Period Now Available

October 16, 2019

CMS has updated the eCQM DERep to include information on the reporting and performance metrics for 2019 and 2020.

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GAO Appoints Charles DeShazer, MD to PTAC

Payment Innovation: PTAC

GAO Appoints Charles DeShazer, MD to PTAC

October 16, 2019

GAO announced the appointment of Charles DeShazer, MD to the Physician-Focused PTAC.

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CMS Holds a Public Listening Session on Nov. 4, Seeks Feedback on a Potential Oncology Payment Model

Payment Innovation: Innovation Center

CMS Holds a Public Listening Session on Nov. 4, Seeks Feedback on a Potential Oncology Payment Model

October 16, 2019

The Center for Medicare and Medicaid Innovation (Innovation Center) will hold a public listening session to discuss a potential oncology payment model and get feedback from stakeholders on how to best create a value-based payment program for oncology care.

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Part D Enhanced MTM Model: Year Two Results Fact Sheet

Payment Innovation: Innovation Center

Part D Enhanced MTM Model: Year Two Results Fact Sheet

October 16, 2019

CMS has posted a fact sheet summarizing the results of the second year of the Part D Enhanced MTM Model.

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Recently Approved 1332 Waivers

Insurance Coverage: Waivers

Recently Approved 1332 Waivers

October 16, 2019

Section 1332 of the ACA allows states apply for waivers requesting authority to amend ACA provisions in the individual and small group market place.  A 1332 wavier grants the states flexibility in ensuring the stability of fragile insurance markets and address unique state insurance issues. As of October 2019, 13 states received approval to implement…

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Idaho 1115 Waiver Application

Insurance Coverage: Waivers

Idaho 1115 Waiver Application

October 11, 2019

On September 27, 2019, Idaho submitted a new section 1115 waiver application to CMS. Please find our summary of key points of the waiver.

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LAN Releases Agenda for 2019 Summit

Payment Innovation: Other

LAN Releases Agenda for 2019 Summit

October 10, 2019

The Health Care Payment Learning and Action Network (LAN) is hosting its annual Summit on October 24th and the full agenda is now available. The agenda for the event can be found here.

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MedPAC Continues Work on Part D Redesign, Unified PAC Payment System and Discusses Population-based Outcome Measures

Payment Innovation: Other

MedPAC Continues Work on Part D Redesign, Unified PAC Payment System and Discusses Population-based Outcome Measures

October 10, 2019

MedPAC met in Washington, DC on October 3-4, 2019 and the Commission continued the discussion on a variety of innovation topics.

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HHS Proposes to Update Stark and Safe Harbor Regulations to Promote Value-based Care

Payment Innovation: Other

HHS Proposes to Update Stark and Safe Harbor Regulations to Promote Value-based Care

October 10, 2019

On October 9, 2019, the Department of HHS released regulations to update Stark and Anti-Kickback regulations to promote the implementation of value-based care.

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New CMS Policy in Effect for Quality Measures Impacted by ICD-10 Updates

Payment Innovation: Quality Payment Program

New CMS Policy in Effect for Quality Measures Impacted by ICD-10 Updates

October 10, 2019

Finalized in the CY 2018 QPP, the CMS established a new protocol for quality measures impacted by changes in ICD-10 coding.

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

October 10, 2019

The CMS uploaded new materials to the QPP Resource Library.

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CMS Opens MIPS Virtual Group Election Period

Payment Innovation: Quality Payment Program

CMS Opens MIPS Virtual Group Election Period

October 10, 2019

The CMS is accepting election notices from providers who want to participate in a MIPS virtual group for the 2020 performance year.

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+SPECIAL REPORT: Checking Up on the Value Movement

Insight: original analysis

+SPECIAL REPORT: Checking Up on the Value Movement

October 03, 2019

McDermottPlus is pleased to present this special report examining the state of the value-based payment movement in the lead up to the 2020 election.

ORIGINAL ANALYSIS

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

October 01, 2019

CMS has uploaded new materials to the QPP Resource Library

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QPP Training Courses Available

Payment Innovation: Quality Payment Program

QPP Training Courses Available

October 01, 2019

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CMS Begins Distribution of 2019 Advanced APM Bonuses

Payment Innovation: Quality Payment Program

CMS Begins Distribution of 2019 Advanced APM Bonuses

October 01, 2019

CMS has announced that they have begun distribution of the 2019 APM bonuses. The Advanced APM pathway of the CMS Quality Payment Program lets clinicians earn rewards for taking on financial risk.

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Secretary Responds to PTAC Recommendations from Sept. and Dec. 2018 Public Meetings

Payment Innovation: PTAC

Secretary Responds to PTAC Recommendations from Sept. and Dec. 2018 Public Meetings

October 01, 2019

The HHS Secretary posted comments on five recent PTAC recommendations from the September and December 2018 public meetings.

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MedPAC Discusses Innovation and Quality at October 2019 Public Meeting

Payment Innovation: Other

MedPAC Discusses Innovation and Quality at October 2019 Public Meeting

October 01, 2019

MedPAC is discussing several innovation and quality topics at their next public meeting scheduled for October 3 to 4, 2019.

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CMS Releases Evaluation Reports on Payment Models Including MSSP, CPC+, ESRD CEC Model, and Dual Eligibles

Payment Innovation: Innovation Center

CMS Releases Evaluation Reports on Payment Models Including MSSP, CPC+, ESRD CEC Model, and Dual Eligibles

October 01, 2019

Recently released performance results show that the Medicare Shared Savings Program generated $739.4 million in total net savings across 548 accountable care organizations in 2018.

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CMS Grants CLIA Exemption to All State-Licensed Laboratories in Washington State

Diagnostics: Other

CMS Grants CLIA Exemption to All State-Licensed Laboratories in Washington State

September 27, 2019

CMS grants CLIA exemption to Washington state laboratories.

EXTERNAL LINK

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ONC Posts Interoperability Forum Slides

Payment Innovation: Other

ONC Posts Interoperability Forum Slides

September 24, 2019

The ONC hosted an annual Interoperability Forum to discuss trends and solutions for the implementation and adoption of various health IT practices.

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Opportunities to Participate in a Technical Expert Panels

Payment Innovation: Other

Opportunities to Participate in a Technical Expert Panels

September 24, 2019

CMS has announced opportunities to participate in Technical Expert Panels.

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GAO Announces New PCORI Board Members

Payment Innovation: Other

GAO Announces New PCORI Board Members

September 24, 2019

The GAO named the new Chair and Vice-Chair for the board of the Patient-Centered Outcomes Research Institute.

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

September 24, 2019

CMS uploaded new materials to the Quality Payment Program Resource Library.

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GAO Report Finds Changes Needed in Order for CMS to Assess the Effectiveness of its Quality Measurement Activities

Payment Innovation: Other

GAO Report Finds Changes Needed in Order for CMS to Assess the Effectiveness of its Quality Measurement Activities

September 24, 2019

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.”

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Innovation Center Solicits Proposals from Third Party Payers on Maryland Total Cost of Care Model

Payment Innovation: Innovation Center

Innovation Center Solicits Proposals from Third Party Payers on Maryland Total Cost of Care Model

September 24, 2019

Innovation Center is collaborating with the state of Maryland to implement the Maryland Total Cost of Care Model.

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Tennessee 1115 Waiver Application

Insurance Coverage: Waivers

Tennessee 1115 Waiver Application

September 20, 2019

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.

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The Overlap of Drug Pricing Proposals

Insight: original analysis

The Overlap of Drug Pricing Proposals

September 20, 2019

On September 19, 2019, the Speaker of the US House of Representatives released a proposal to contain federal and individual spending on prescription drugs, joining Administration and Senate efforts to address prescription drug pricing. This article contemplates the likelihood of a drug pricing package and how it could come together.

ORIGINAL ANALYSIS

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GAO Releases Report on Managing High Cost Medicaid Beneficiaries

Payment Innovation: Other

GAO Releases Report on Managing High Cost Medicaid Beneficiaries

September 17, 2019

The GAO has released a report on identifying, predicting, and managing high-cost beneficiaries in Medicaid.

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CMS Reviews New Payment Model on SNF Open Door Forum

Payment Innovation: Other

CMS Reviews New Payment Model on SNF Open Door Forum

September 17, 2019

CMS is hosting the next skilled nursing facilities /long term care Open Door Forum

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CMS Opioids Listening Session

Payment Innovation: Other

CMS Opioids Listening Session

September 17, 2019

CMS is hosting a listening session for all prescribers to determine criteria that would identify an “outlier prescriber.”

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

September 17, 2019

CMS has updated its QPP resource center.

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CMS Accepting Applications for Hardship and Extreme and Uncontrollable Circumstances MIPS Exceptions

Payment Innovation: Quality Payment Program

CMS Accepting Applications for Hardship and Extreme and Uncontrollable Circumstances MIPS Exceptions

September 17, 2019

CMS is accepting hardship exemption applications for the MIPS Promoting Interoperability (PI) Performance Category.

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Payment Innovation: PTAC

PTAC Update: Committee Recommends Rural Telemedicine Payment Model

September 17, 2019

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) held a public meeting on September 16. The Committee voted on a proposed physician-focused payment model: ACCESS Telemedicine: An Alternative Healthcare Delivery Model for Rural Cerebral Emergencies.

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ACO Investment Model Second Annual Report Posted

Payment Innovation: Innovation Center

ACO Investment Model Second Annual Report Posted

September 17, 2019

The Innovation Center has posted the second annual report for the Accountable Care Organization Investment Model,

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ET3 RFA Deadline Extended

Payment Innovation: Innovation Center

ET3 RFA Deadline Extended

September 17, 2019

CMMI has announced the Emergency Triage, Treat, and Transport Model request for applications deadline has been extended until October 5, 2019.

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Insurance Coverage: Waivers

Montana 1115 Waiver Application Summary

September 17, 2019

Montana submitted a new 1115 waiver application to CMS on August 30, 2019. The waiver is pending approval.

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Insurance Coverage: Regulation

Recent State Action Relating to Medicaid Expansion

September 12, 2019

We have highlighted recent state grassroots, legislative and executive action to expand Medicaid.

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LAN Summit Registration Open

Payment Innovation: Other

LAN Summit Registration Open

September 11, 2019

The Health Care Payment Learning and Action Network is holding its 2019 Annual Summit on Thursday, October 24 in Washington DC.

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CMS Meeting: Opioid Action Plan

Payment Innovation: Other

CMS Meeting: Opioid Action Plan

September 11, 2019

CMS will host an in-person, live-streamed meeting, on September 20 to provide an overview of activity related to opioid use disorder prevention and solicit stakeholder input on developing an action plan for Congress to prevent opioid addiction and coverage for medication-assisted treatment.

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MedPAC Discusses a PAC Value Incentive Program

Payment Innovation: Other

MedPAC Discusses a PAC Value Incentive Program

September 11, 2019

MedPAC held its September public meeting on Sept 5-6, 2019. At the meeting, MedPAC staff presented a proposal for a uniform post-acute care value incentive program.

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

September 11, 2019

CMS has updated its QPP resource center.

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CMS Holds All-Payer QP Webinar

Payment Innovation: Quality Payment Program

CMS Holds All-Payer QP Webinar

September 11, 2019

CMS will host a webinar to provide an overview on how to become a qualifying advanced alternative payment model participant through the All-Payer Combination Option.

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PTAC Update: New Proposal on Remote Specialists and Experts Open for Comment

Payment Innovation: PTAC

PTAC Update: New Proposal on Remote Specialists and Experts Open for Comment

September 11, 2019

PTAC is soliciting comments through October 1, 2019, on a new physician-focused payment model: Remote specialists and experts on demand improving care and saving costs.

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ET3 Model FAQs and Application

Payment Innovation: Innovation Center

ET3 Model FAQs and Application

September 11, 2019

CMMI has updated the Emergency Triage, Treat, and Transport Model frequently asked questions resource.

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Comprehensive ESRD Care Model: Year 2 Report

Payment Innovation: Innovation Center

Comprehensive ESRD Care Model: Year 2 Report

September 11, 2019

CMMI has posted the second annual report for the Comprehensive End-Stage Renal Disease Care Model.

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HRSA Seeks Nominations for Advisory Committee on Training in Primary Care Medicine and Dentistry

Payment Innovation: Other

HRSA Seeks Nominations for Advisory Committee on Training in Primary Care Medicine and Dentistry

September 04, 2019

The Health Resources & Administration Services is soliciting nominations for the Advisory Committee on Training in Primary Care Medicine and Dentistry.

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ONC Awards the Sequoia Project a Cooperative Agreement to Support Nationwide Interoperability

Payment Innovation: Other

ONC Awards the Sequoia Project a Cooperative Agreement to Support Nationwide Interoperability

September 04, 2019

The Office of the National Coordinator for Health Information Technology has announced that The Sequoia Project has been awarded a cooperative agreement to serve as the Recognized Coordinating Entity.

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New Episode of CMS Beyond the Policy Podcast Posted

Payment Innovation: Other

New Episode of CMS Beyond the Policy Podcast Posted

September 04, 2019

CMS released episode 6 of their podcast, CMS: Beyond the Policy.

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MedPAC Discusses Quality and Innovation Issues at September Meeting

Payment Innovation: Other

MedPAC Discusses Quality and Innovation Issues at September Meeting

September 04, 2019

The Medicare Payment Advisory Commission is hosting their next public meeting on September 5-6, 2019 in Washington DC.

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

September 04, 2019

CMS has updated its QPP resource center.

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MIPS Targeted Review Request Deadline: September 30

Payment Innovation: Quality Payment Program

MIPS Targeted Review Request Deadline: September 30

September 04, 2019

Clinicians are able to request targeted review of their MIPS final score until September 30.

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Final Evaluation Report: GNE Demonstration

Payment Innovation: Innovation Center

Final Evaluation Report: GNE Demonstration

September 04, 2019

The CMS Innovation Center has posted a final evaluation of the Graduate Nurse Education Demonstration.

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Utah Medicaid Waivers

Insurance Coverage: Waivers

Utah Medicaid Waivers

August 28, 2019

CMS has approved Utah’s 1115 waiver, implementing a “bridge plan” while the state submits additional waivers.

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CMS HOPE Tool Conference Call

Payment Innovation: Other

CMS HOPE Tool Conference Call

August 27, 2019

CMS will host an Open Door Forum conference call to discuss the status of the Hospice Outcomes and Patient Evaluation (HOPE) tool, previously known as Developing a Hospice Patient Assessment Tool, on Thursday, September 12, 2019.

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CMS Open Payments Expansion Conference Call

Payment Innovation: Other

CMS Open Payments Expansion Conference Call

August 27, 2019

CMS will host an Open Door Forum conference call to discuss proposed changes to the Open Payments program on Thursday, August 29, 2019

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HRSA RFI: Access to Rural Health Care

Payment Innovation: Other

HRSA RFI: Access to Rural Health Care

August 27, 2019

HRSA and the HHS Rural Health Task Force are seeking information about access to health care in rural communities.

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

August 27, 2019

CMS has updated its QPP resource center.

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CMS Hosting MIPS Value Pathways Webinar

Payment Innovation: Quality Payment Program

CMS Hosting MIPS Value Pathways Webinar

August 27, 2019

CMS will host a webinar to discuss the MIPS Value Pathways as proposed in a CMS Request for Information appearing in the 2020 Medicare Physician Fee Schedule Proposed Rule.

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Voluntary Kidney Model Webinar Slides Posted

Payment Innovation: Innovation Center

Voluntary Kidney Model Webinar Slides Posted

August 27, 2019

CMS hosted a webinar on August 15, providing an overview of the new Kidney Care First and Comprehensive Kidney Care Contracting Models; the slides are available for download.

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CMS Hosts Listening Session on Hospital Quality Star Rating System

Payment Innovation: Other

CMS Hosts Listening Session on Hospital Quality Star Rating System

August 21, 2019

CMS will host a listening session on Hospital Quality Star Rating System on September 19.

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CMS Brings Health Plan Quality Ratings to All Exchanges

Payment Innovation: Other

CMS Brings Health Plan Quality Ratings to All Exchanges

August 21, 2019

For the first time CMS will require the display of the five-star Quality Rating System available nationwide for health plans offered on the Health Insurance Exchanges beginning in the 2020 Open Enrollment Period.

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GAO Requests HITAC Nominations

Payment Innovation: Other

GAO Requests HITAC Nominations

August 21, 2019

GAO is requesting nominations to the Health Information Technology Advisory Committee.

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

August 21, 2019

CMS has updated its QPP resource center.

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PTAC Update: Registration Open for September Meeting; Preliminary Report Posted on Telemedicine Proposal

Payment Innovation: PTAC

PTAC Update: Registration Open for September Meeting; Preliminary Report Posted on Telemedicine Proposal

August 21, 2019

PTAC recently opened registration for a public meeting on Monday, September 16, 2019 from 12:30 pm to 3:30 pm EDT. A preliminary review team report has been posted to their website on the ACCESS Telemedicine: An Alternative Healthcare Delivery Model for Rural Cerebral Emergencies proposal which will be the focus of the upcoming PTAC public meeting.

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ET3 Model Webinar Slides Posted

Payment Innovation: Innovation Center

ET3 Model Webinar Slides Posted

August 21, 2019

Emergency Triage, Treat, and Transport (ET3) Model Webinar Slides Posted

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Primary Care First Model Options Webinar Slides Posted

Payment Innovation: Innovation Center

Primary Care First Model Options Webinar Slides Posted

August 21, 2019

Slides from recent webinars on the Primary Care First Model Options are now available.

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New York 1115 Waiver Application Summary

Insurance Coverage: Waivers

New York 1115 Waiver Application Summary

August 15, 2019

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.

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

August 13, 2019

CMS has uploaded new materials to the QPP Resource Library

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CMS Solicits Comments on Proposed MIPS Cost Measures

Payment Innovation: Quality Payment Program

CMS Solicits Comments on Proposed MIPS Cost Measures

August 13, 2019

CMS is proposing 10 episode-based cost measures and revisions to the current Medicare Spending per Beneficiary and Total per Capita Cost measures in the recently released 2020 PFS Proposed Rule.

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Register for the 2020 Self-Nomination Application Virtual Office Hours

Payment Innovation: Quality Payment Program

Register for the 2020 Self-Nomination Application Virtual Office Hours

August 13, 2019

CMS will hold virtual office hours for participants to learn more about the 2020 MIPS Qualified Registry and Qualified Clinical Data Registry Self-Nomination process.

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Innovation Center Hosts Radiation Oncology Model Listening Session

Payment Innovation: Innovation Center

Innovation Center Hosts Radiation Oncology Model Listening Session

August 13, 2019

CMMI will host a webinar on the proposed Radiation Oncology Model.

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CMS Hosts a Webinar on the Voluntary Kidney Models

Payment Innovation: Innovation Center

CMS Hosts a Webinar on the Voluntary Kidney Models

August 13, 2019

CMMI will host a webinar to provide details on the Kidney Care First and the Comprehensive Kidney Care Contracting models.

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CMS Approves Colorado and North Dakota 1332 Waiver Applications

Insurance Coverage: Waivers

CMS Approves Colorado and North Dakota 1332 Waiver Applications

August 12, 2019

On July 31, 2019, the Centers for Medicare and Medicaid Services (CMS) approved Section 1332 waiver applications for Colorado and North Dakota to implement state reinsurance programs. Below is a summary of the waivers.

ORIGINAL ANALYSIS

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Upcoming Medicare Learning Network Webinars

Payment Innovation: Other

Upcoming Medicare Learning Network Webinars

August 06, 2019

CMS will host a series of webinars on recently released payment and quality regulations.

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

Payment Innovation: Other

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

August 06, 2019

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

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

August 06, 2019

CMS uploaded new materials to the QPP Resource Library.

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Attend Wave 3 Clinical Subcommittee Measure-Specific Workgroup Meetings

Payment Innovation: Quality Payment Program

Attend Wave 3 Clinical Subcommittee Measure-Specific Workgroup Meetings

August 06, 2019

CMS has contracted with Acumen, LLC to develop episode-based cost measures for potential use in the MIPS cost performance category.

POST

macra
New Case Study Published for the Accountable Health Communities Model

Payment Innovation: Innovation Center

New Case Study Published for the Accountable Health Communities Model

August 06, 2019

CMS published a case study which describes a successful navigation approach from one bridge organization that could inform practice at another AHC Model site.  

POST

macra
CMS Discontinues MAQI Demonstration

Payment Innovation: Innovation Center

CMS Discontinues MAQI Demonstration

August 06, 2019

CMS announced the MAQI Demonstration will be discontinued due to the low rates of participation. Therefore, CMS will not be accepting applications for MAQI for 2019.

POST

Top 5 Takeaways: 2020 Medicare Physician Fee Schedule Proposed Rule

Insight: original analysis

Top 5 Takeaways: 2020 Medicare Physician Fee Schedule Proposed Rule

August 06, 2019

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, which includes proposals related to Medicare physician payment and the Quality Payment Program. The proposed regulations will be published in the Federal Register on August 14, 2019. Comments are…

ORIGINAL ANALYSIS

macra
Hospice Quality Reporting Program Online Courses Now Available

Payment Innovation: Other

Hospice Quality Reporting Program Online Courses Now Available

July 30, 2019

CMs uploaded two new resources regarding the Hospice Quality Reporting Program.

POST

macra
CMS Holds Hospital IQR and Promoting Interoperability Programs Webinar

Payment Innovation: Other

CMS Holds Hospital IQR and Promoting Interoperability Programs Webinar

July 30, 2019

CMS will be hosting an education webinar for participants in the Hospital Inpatient Quality Reporting and Promoting Interoperability Programs.

POST

macra
Innovation Center Hosts Office Hour on Primary Care First Model

Payment Innovation: Innovation Center

Innovation Center Hosts Office Hour on Primary Care First Model

July 30, 2019

The Innovation Center will be hosting office hours on August 6, 2019, at 12 pm ET on Primary Care First model payments.

POST

macra
New ET3 Model Overview Infographic Available

Payment Innovation: Innovation Center

New ET3 Model Overview Infographic Available

July 30, 2019

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

POST

macra
CMS Releases New ACO Case Studies

Payment Innovation: Innovation Center

CMS Releases New ACO Case Studies

July 30, 2019

CMS released three new case studies highlighting ACOs participating in the Next Gen model and MSSP.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

July 30, 2019

CMS uploaded new materials to the QPP Resource Library.

POST

macra
CMS Releases CY 2020 PFS Proposed Rule

Payment Innovation: Quality Payment Program

CMS Releases CY 2020 PFS Proposed Rule

July 30, 2019

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).

POST

macra
CMS Releases CY 2020 PFS, OPPS and ASC Proposed Rules

Payment Innovation: Regulation

CMS Releases CY 2020 PFS, OPPS and ASC Proposed Rules

July 29, 2019

On July 29, 2019, CMs published the CY 2020 Proposed Rules for PFS, OPPS and ASC.

POST

prescription-drug

Prescription Drug: Legislation

Summary of Senate Finance Prescription Drug Package

July 24, 2019

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

POST

macra
National Comprehensive Cancer Network Holds Summit on Quality in Cancer Care

Payment Innovation: Other

National Comprehensive Cancer Network Holds Summit on Quality in Cancer Care

July 23, 2019

The National Comprehensive Cancer Network is holding its oncology policy summit on September 12, 2019.

POST

macra
2020 Medicaid and CHIP Core Set Open for Comments Through August 5

Payment Innovation: Other

2020 Medicaid and CHIP Core Set Open for Comments Through August 5

July 23, 2019

Recommendations for the 2020 Medicaid and CHIP Core Set are open through August 5.

POST

macra
CMS Updates Medicaid and CHIP Scorecard

Payment Innovation: Other

CMS Updates Medicaid and CHIP Scorecard

July 23, 2019

On July 18, 2019, CMS updated the data within the Medicaid and CHIP Scorecard.

POST

macra
LAN Launches Roadmap APM Video Series

Payment Innovation: Other

LAN Launches Roadmap APM Video Series

July 23, 2019

LAN launched a new educational video series covering the Roadmap for Driving High Performance in APMs.

POST

macra
Proposal to Cover Acupuncture in Medicare

Payment Innovation: Other

Proposal to Cover Acupuncture in Medicare

July 23, 2019

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

POST

macra
Ways and Means Committee Launches Rural and Underserved Communities Health Task Force

Payment Innovation: Other

Ways and Means Committee Launches Rural and Underserved Communities Health Task Force

July 23, 2019

Congress launched a Rural and Underserved Communities Health Task Force.

POST

macra
MedPAC Releases 2019 Health Care Spending Data Book

Payment Innovation: Other

MedPAC Releases 2019 Health Care Spending Data Book

July 23, 2019

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

POST

macra
CMS Updates Data Element Library

Payment Innovation: Other

CMS Updates Data Element Library

July 23, 2019

The Data Element Library posted new updates.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

July 23, 2019

CMS uploaded new materials to the QPP Resource Library.

POST

macra
CMS Hosts Webinar on Quality Payment Program Performance

Payment Innovation: Quality Payment Program

CMS Hosts Webinar on Quality Payment Program Performance

July 23, 2019

CMS to host two webinars on 2017 QPP Performance information published on Physician Compare.

POST

macra
CMS Announces New MSSP ACOs

Payment Innovation: Quality Payment Program

CMS Announces New MSSP ACOs

July 23, 2019

CMS Administrator Verma shared ACO participation information for the July 1 MSSP start date.

POST

macra
AHRQ National Advisory Council Meets July 24

Payment Innovation: Other

AHRQ National Advisory Council Meets July 24

July 16, 2019

The National Advisory Council for Healthcare Research and Quality will meet on July 24 to discuss people living with multiple chronic conditions.

POST

macra

Payment Innovation: Other

CMS Issues Updates to the Home Health Quality Reporting Program

July 16, 2019

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

POST

macra
OIG Reports Find Hospice Deficiencies Posing Risks to Medicare Beneficiaries

Payment Innovation: Other

OIG Reports Find Hospice Deficiencies Posing Risks to Medicare Beneficiaries

July 16, 2019

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

POST

macra
Patient-Driven SNF Payment Model Will Go into Effect October 1, 2019

Payment Innovation: Other

Patient-Driven SNF Payment Model Will Go into Effect October 1, 2019

July 16, 2019

There is a hard transition between SNF payment models. All RUG-IV payments will end on September 30, 2019, and all PDPM payments will begin on October 1, 2019.

POST

macra
HHS Seeking Participants for Quality Summit

Payment Innovation: Other

HHS Seeking Participants for Quality Summit

July 16, 2019

HHS is seeking 15 industry stakeholders to join a summit responsible for drafting the Health Quality Roadmap required by President Trump’s recent Executive Order on health care transparency.

POST

macra
CMS Responds to ACO Concerns About Smoking Cessation Quality Measure

Payment Innovation: Quality Payment Program

CMS Responds to ACO Concerns About Smoking Cessation Quality Measure

July 16, 2019

CMS has announced that it will change a tobacco-use quality measure from a pay-for-performance measure to a pay-for-reporting measure.

POST

macra
CMS Hosts Self-Nomination Registry and QCDR Office Hours on August 14, 2019

Payment Innovation: Quality Payment Program

CMS Hosts Self-Nomination Registry and QCDR Office Hours on August 14, 2019

July 16, 2019

With the 2020 MIPS Performance Period Self-Nomination period underway, CMS will host a 2020 Self-Nomination Application Virtual Office Hours.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

July 16, 2019

CMS uploaded new materials to the QPP Resource Library.

POST

macra
2017 QPP Performance Information Now Available on Physician Compare

Payment Innovation: Quality Payment Program

2017 QPP Performance Information Now Available on Physician Compare

July 16, 2019

CMS has added new performance information to the Physician Compare website.

POST

macra
MIPS 2018 vs 2017: Fewer Eligible Participants but Greater Proportion to Receive Positive Payment Adjustment

Payment Innovation: Quality Payment Program

MIPS 2018 vs 2017: Fewer Eligible Participants but Greater Proportion to Receive Positive Payment Adjustment

July 16, 2019

CMS shares preliminary participation data for the Quality Payment Program during 2018.

POST

macra
CY 2020 MA VBID Marketing and Communications Guidelines Posted

Payment Innovation: Innovation Center

CY 2020 MA VBID Marketing and Communications Guidelines Posted

July 16, 2019

CMMI posts CY 2020 marketing and communications guidelines for the Medicare Advantage Value-Based Insurance Design model.

POST

macra
White House Will Nominate Adam Boehler for International Development Finance Corporation

Payment Innovation: Innovation Center

White House Will Nominate Adam Boehler for International Development Finance Corporation

July 16, 2019

White House to nominate current CMMI head to International Development Finance Corporation.

POST

macra
Mandatory Radiation Oncology and ESRD Models Announced

Payment Innovation: Innovation Center

Mandatory Radiation Oncology and ESRD Models Announced

July 16, 2019

CMS releases proposed rule announcing two new mandatory Medicare payment models: the Radiation Oncology model and the ESRD Treatment Choices Model.

POST

health-reform-20

Insurance Coverage: Congress

House E&C Committee Holds Markup of Surprise Billing Bills

July 12, 2019

The House E&C Health Subcommittee held a markup of several bills, including the No Surprises Act (H.R. 3630), which addresses surprise billing.

POST

prescription-drug

Prescription Drug: Pricing

Administration Withdraws Rebate Overhaul Proposal

July 11, 2019

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.

POST

prescription-drug

Prescription Drug: Litigation

Judge Axes Price Disclosure Rule for Drug Ads

July 09, 2019

  The Trump administration cannot force drug manufacturers to disclose prices in their pharmaceutical ads to consumers, a federal judge ruled Monday.  

EXTERNAL LINK

prescription-drug

Prescription Drug: Other

CMS Posts Agenda for June 24 CLFS Annual Public Meeting

July 09, 2019

On June 7, CMS posted the agenda for the annual public CLFS meeting.

POST

macra
Upcoming Health IT Advisory Committee Meeting on July 11

Payment Innovation: Other

Upcoming Health IT Advisory Committee Meeting on July 11

July 09, 2019

The Health IT Advisory Committee of the ONC is meeting on July 11 from 9:30 am to 12:30 pm ET.

POST

macra
2020 MIPS Self-Nomination Materials for Registries and QCDRs Now Available

Payment Innovation: Quality Payment Program

2020 MIPS Self-Nomination Materials for Registries and QCDRs Now Available

July 09, 2019

The 2020 performance period MIPS Self-Nomination materials were posted to the QPP Resource Library.

POST

macra
2018 MIPS Final Scores Impacting 2020 Medicare FFS Payments Now Available

Payment Innovation: Quality Payment Program

2018 MIPS Final Scores Impacting 2020 Medicare FFS Payments Now Available

July 09, 2019

CMS released final scores for the 2018 Merit-based Incentive Payment System.

POST

macra
Innovation Center Hosts Webinar on the Primary Care First Seriously Ill Population Payment Option Model

Payment Innovation: Innovation Center

Innovation Center Hosts Webinar on the Primary Care First Seriously Ill Population Payment Option Model

July 09, 2019

Innovation Center to host a webinar on the Primary Care First Seriously Ill Population Payment Option Model.

POST

macra
2018 Open Payments Data Now Available

Payment Innovation: Other

2018 Open Payments Data Now Available

July 02, 2019

On June 28, CMS released the 2018 Open Payments data.

POST

macra
CMS Commits $50 Million to Assist States with Substance Use Disorder Treatment and Recovery

Payment Innovation: Other

CMS Commits $50 Million to Assist States with Substance Use Disorder Treatment and Recovery

July 02, 2019

CMS released a Notice of Funding Opportunity for planning grants to address the opioid crisis.

POST

macra
CMS Releases Additional Data Related to Risk Adjustment Data Validation Proposed Rule

Payment Innovation: Other

CMS Releases Additional Data Related to Risk Adjustment Data Validation Proposed Rule

July 02, 2019

CMS released additional materials related to the RADV audits proposed rule.

POST

macra
HIMMS Conference Subject of Latest Policy Podcast from CMS

Payment Innovation: Other

HIMMS Conference Subject of Latest Policy Podcast from CMS

July 02, 2019

CMS released another episode of its podcast.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

July 02, 2019

CMS uploaded new materials to the QPP Resource Library.

POST

macra
PTAC Solicits Comments on Eye Care Emergency Department Avoidance Proposed Payment Model

Payment Innovation: PTAC

PTAC Solicits Comments on Eye Care Emergency Department Avoidance Proposed Payment Model

July 02, 2019

PTAC is soliciting comments on the EyEDA Model.

POST

macra
CMS Provides Tutorial on Diabetes Prevention Program Expanded Model

Payment Innovation: Innovation Center

CMS Provides Tutorial on Diabetes Prevention Program Expanded Model

July 02, 2019

CMS published a tutorial on enrolling in the MDPP Expanded Model.

POST

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

Payment Innovation: Innovation Center

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

July 02, 2019

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

POST

macra
Executive Order Calls for Greater Alignment of Quality Measures and Data Reporting Across Programs

Payment Innovation: Other

Executive Order Calls for Greater Alignment of Quality Measures and Data Reporting Across Programs

June 25, 2019

President Trump signed an executive order on June 24 containing guidance regarding price, quality and data transparency.

POST

macra
CMS Hosts Office Hours for Cost Measure Development

Payment Innovation: Quality Payment Program

CMS Hosts Office Hours for Cost Measure Development

June 25, 2019

CMS is holding office hours to provide updates on recent work in MIPS cost measure development.

POST

macra
Call for Nominations: Behavioral Health Measures TEP

Payment Innovation: Quality Payment Program

Call for Nominations: Behavioral Health Measures TEP

June 25, 2019

CMS is accepting nominations for a TEP for developing and maintaining behavioral health measures.

POST

macra
MIPS Data Validation and Audits to Begin June 2019 for Performance Years 2017 and 2018

Payment Innovation: Quality Payment Program

MIPS Data Validation and Audits to Begin June 2019 for Performance Years 2017 and 2018

June 25, 2019

CMS will conduct data validation and audits of select MIPS eligible clinicians for performance years 2017 and 2018.

POST

macra
BPCI Advanced Update: FAQ Documents Posted

Payment Innovation: Innovation Center

BPCI Advanced Update: FAQ Documents Posted

June 25, 2019

New FAQ documents for the BPCI Advanced Model have been uploaded.

POST

macra
Innovation Center Presents Two Primary Care First Webinars

Payment Innovation: Innovation Center

Innovation Center Presents Two Primary Care First Webinars

June 25, 2019

The Innovation Center will hold a two-part webinar series on the Primary Care First model.

POST

health-reform-20

Insurance Coverage: Legislation

HELP Committee Moved Forward with Cost Containment Bill

June 20, 2019

A day after a hearing on the HELP Committee’s cost containment discussion draft, the Lower Health Care Costs Act, committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) released an updated version of the bill (S. 1895) along with a notice that the committee will hold a markup of the legislation on June…

POST

diagnostic

Diagnostics: Other

CMS Releases Full Agenda for June 24 CLFS Public Meeting

June 20, 2019

On June 20, CMS released the full agenda for the annual public CLFS meeting.

EXTERNAL LINK

macra
MedPAC Releases June 2019 Report to Congress: Considers a Number of Payment Innovations for Clinician Payment, Medicare Advantage and Part B Drugs

Payment Innovation: Other

MedPAC Releases June 2019 Report to Congress: Considers a Number of Payment Innovations for Clinician Payment, Medicare Advantage and Part B Drugs

June 18, 2019

MedPAC released its June 2019 Report to Congress: Medicare and the Health Care Delivery System.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

June 18, 2019

CMS uploaded new materials to the QPP Resource Library.

POST

macra
PTAC Recommends Testing of Payment Model for Older Adults with Chronic Conditions

Payment Innovation: PTAC

PTAC Recommends Testing of Payment Model for Older Adults with Chronic Conditions

June 18, 2019

PTAC recommends testing of the CAPABLE Provider Focused Payment Model.

POST

health-reform-20

Insurance Coverage: Regulation

Final Rule Issued on Health Reimbursement Arrangements

June 14, 2019

The Departments of the Treasury, Health and Human Services (HHS), and Labor published the final rule Health Reimbursement Arrangements and Other Account-Based Group Health Plans. This rule expands health reimbursement arrangements (HRAs). Under the rule, employers can provide employees with tax-preferred funds to purchase coverage on the individual market through individual coverage HRAs. Additionally, the…

EXTERNAL LINK

health-reform-20

Insurance Coverage: Congress

Ways and Means Holds Hearing on Medicare for All

June 13, 2019

The House Ways and Means Committee held a hearing on Medicare for All, the first time a committee with health care jurisdiction has considered the policy. In addition to voicing support for the Medicare for All Act, many Democrats also brought up other proposals to expand coverage, such as lowering the Medicare eligibility age, creating…

EXTERNAL LINK

health-reform-20
South Carolina 1115 Waiver Application Summary

Insurance Coverage: Waivers

South Carolina 1115 Waiver Application Summary

June 11, 2019

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…

POST

macra
Call for Nominations for AHRQ National Advisory Council

Payment Innovation: Other

Call for Nominations for AHRQ National Advisory Council

June 11, 2019

AHRQ is seeking nominations for the National Advisory Council for Healthcare Research and Quality.

POST

macra
CMS Issues RFI on Patients over Paperwork Initiative

Payment Innovation: Other

CMS Issues RFI on Patients over Paperwork Initiative

June 11, 2019

On June 6, CMS issued an RFI on Patients over Paperwork.

POST

macra
Provider Groups Send Letter to Congress Calling for Changes to MACRA

Payment Innovation: Quality Payment Program

Provider Groups Send Letter to Congress Calling for Changes to MACRA

June 11, 2019

Over 100 provider groups issued a letter to Congress calling for changes to MACRA.

POST

macra
New Resource on the 2019 Qualifying APM Participant Methodology

Payment Innovation: Quality Payment Program

New Resource on the 2019 Qualifying APM Participant Methodology

June 11, 2019

CMS released a Qualifying APM Participants Methodology Fact Sheet for 2019.

POST

macra

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

June 11, 2019

CMS uploaded new materials to the QPP Resource Library.

POST

macra
CMS Suspends Free Technical Assistance to Large Practices on July 17, 2019

Payment Innovation: Quality Payment Program

CMS Suspends Free Technical Assistance to Large Practices on July 17, 2019

June 11, 2019

CMS will end the free technical assistance provided to large practices on July 17, 2019.

POST

macra
PTAC Solicits Comments on Oncology Care Model 2.0

Payment Innovation: PTAC

PTAC Solicits Comments on Oncology Care Model 2.0

June 11, 2019

PTAC is seeking comments on the Oncology Care Model 2.0 until July 1, 2019.

POST

diagnostic

Diagnostics: Other

CMS Posts Agenda for June 24 CLFS Annual Public Meeting

June 07, 2019

On June 7, CMS posted the agenda for the annual public CLFS meeting.

POST

health-reform-20
Utah Per Capita Cap 1115 Waiver Summary

Insurance Coverage: Waivers

Utah Per Capita Cap 1115 Waiver Summary

June 06, 2019

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…

POST

macra
Reminder: 2019 Call for MIPS Promoting Interoperability Measures and Improvement Activities is Open

Payment Innovation: Quality Payment Program

Reminder: 2019 Call for MIPS Promoting Interoperability Measures and Improvement Activities is Open

June 04, 2019

The MIPS Annual Call for Measures and Activities is open.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

June 04, 2019

CMS uploaded new resources to the QPP Resource Library.

POST

macra
CMS Hosts Webinars on the Development and Impact of Quality Measures

Payment Innovation: Quality Payment Program

CMS Hosts Webinars on the Development and Impact of Quality Measures

June 04, 2019

CMS is holding two webinars providing an overview of quality measures.

POST

macra
CMS Releases 2019 Measure Development Plan Annual Report

Payment Innovation: Quality Payment Program

CMS Releases 2019 Measure Development Plan Annual Report

June 04, 2019

CMS posted the 2019 Quality Measure Development Plan Annual Report.

POST

macra
PTAC Calls on CMS for More Comprehensive Approach to Wound Care Delivery

Payment Innovation: PTAC

PTAC Calls on CMS for More Comprehensive Approach to Wound Care Delivery

June 04, 2019

The PTAC report concludes that a more comprehensive approach to wound care is needed.

POST

macra
Podcast on the CMS Innovation Center with Focus on Current and Future Model Development Now Available

Payment Innovation: Quality Payment Program

Podcast on the CMS Innovation Center with Focus on Current and Future Model Development Now Available

June 04, 2019

CMS released the newest episode of its Beyond the Policy podcast.

POST

macra
CMMI Hosts Webinar on June 11 for the ET3 Model RFA

Payment Innovation: Innovation Center

CMMI Hosts Webinar on June 11 for the ET3 Model RFA

June 04, 2019

CMMI will hold a webinar on the ET3 Model RFA on June 11.

POST

macra
GAO Appoints MedPAC Members

Payment Innovation: Other

GAO Appoints MedPAC Members

May 28, 2019

The GAO appointed new MedPAC members.

POST

macra

Payment Innovation: Quality Payment Program

QCDR Self Nomination Webinar on June 11

May 28, 2019

CMS is hosting a QCDR Self-Nomination Application Demo for 2020 on June 11.

POST

macra
OIG Report Finds Challenges with ACO Care Coordination

Payment Innovation: Quality Payment Program

OIG Report Finds Challenges with ACO Care Coordination

May 28, 2019

A recent OIG report finds challenges with ACO care coordination.

POST

macra
Recent Updates from the Innovation Center

Payment Innovation: Innovation Center

Recent Updates from the Innovation Center

May 28, 2019

The Innovation Center recently posted several documents to their website.

POST

macra
ET3 Model Request for Applications Now Available

Payment Innovation: Innovation Center

ET3 Model Request for Applications Now Available

May 28, 2019

The RFA and FAQ for the ET3 model are now available.

POST

macra
Direct Contracting Geographic Model RFI Deadline Extended to May 30, 2019

Payment Innovation: Innovation Center

Direct Contracting Geographic Model RFI Deadline Extended to May 30, 2019

May 28, 2019

The Direct Contracting Geographic Model RFI deadline was extended to May 30, 2019.

POST

macra
CMS Holds Webinar on Post-Acute Care Quality Reporting Programs Resources

Payment Innovation: Other

CMS Holds Webinar on Post-Acute Care Quality Reporting Programs Resources

May 21, 2019

CMS holds a webinar on post-acute care quality reporting programs on June 5.

POST

macra
CMS Hosts Meeting on Improved Access, Quality and Outcome in Maternal Health in Rural Communities

Payment Innovation: Other

CMS Hosts Meeting on Improved Access, Quality and Outcome in Maternal Health in Rural Communities

May 21, 2019

CMS is holding a meeting on June 12 focusing on access to maternal health services.

POST

macra
MACPAC Chair and Vice Chair Appointed

Payment Innovation: Other

MACPAC Chair and Vice Chair Appointed

May 21, 2019

The GAO appointed MACPAC’s Chair and Vice Chair.

POST

macra
GAO Recommends CMS Improve Transparency Policy for Section 1115 Waivers

Payment Innovation: Other

GAO Recommends CMS Improve Transparency Policy for Section 1115 Waivers

May 21, 2019

On May 17, the GAO released a report recommending an improved transparency policy for Section 1115 waivers.

POST

macra
CMS Presents All-Payer Combination Option Overview Webinar

Payment Innovation: Quality Payment Program

CMS Presents All-Payer Combination Option Overview Webinar

May 21, 2019

CMS is holding a webinar on May 21 on the All-Payer Combination Option.

POST

macra
Updated eCQM Specifications and Materials for 2020 Reporting Now Available

Payment Innovation: Quality Payment Program

Updated eCQM Specifications and Materials for 2020 Reporting Now Available

May 21, 2019

CMS posted the eCQM specifications for 2020 reporting.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

May 21, 2019

CMS uploaded new resources to the QPP Resource Library.

POST

macra
ONC Releases Data Brief on Use of Electronic Records by Office-Based Physicians

Payment Innovation: Quality Payment Program

ONC Releases Data Brief on Use of Electronic Records by Office-Based Physicians

May 21, 2019

ONC released a report on the use of electronic records by office-based physicians.

POST

macra
Registration Open for June 17 PTAC Public Meeting and Public Comments Accepted Until June 12 on Asthma Proposal

Payment Innovation: PTAC

Registration Open for June 17 PTAC Public Meeting and Public Comments Accepted Until June 12 on Asthma Proposal

May 21, 2019

Registration opened for PTAC’s June 17 public meeting, with asthma proposal comments accepted until June 12.

POST

macra
Reminder: Applications for the InCK NOFO are due June 10, 2019

Payment Innovation: Innovation Center

Reminder: Applications for the InCK NOFO are due June 10, 2019

May 21, 2019

The Innovation Center released updated FAQs for the InCK Notice of Funding Opportunity.

POST

prescription-drug

Prescription Drug: Regulation

CMS Releases Final Part D Rule

May 17, 2019

On May 16, 2018, CMS released the final Part D and Medicare Advantage rule aimed at lowering drug prices.

POST

macra

Payment Innovation: Other

CMS Posts Letter of Intent for Direct Contracting Models

May 15, 2019

CMS posted the LOI for the new Direct Contracting models.

POST

macra
Now Available: Medicare Promoting Interoperability Hardship Exception Applications for Hospitals and CAHs

Payment Innovation: Other

Now Available: Medicare Promoting Interoperability Hardship Exception Applications for Hospitals and CAHs

May 15, 2019

Hardship exception applications are now available for the Medicare Promoting Interoperability Programs.

POST

macra
NOIA Submission Period for Medicare Shared Savings Program Begins June 11

Payment Innovation: Other

NOIA Submission Period for Medicare Shared Savings Program Begins June 11

May 15, 2019

The NOIA submission period for the Medicare Shared Savings Program begins June 11.

POST

macra
CMS Releases All-Payer Guidance

Payment Innovation: Quality Payment Program

CMS Releases All-Payer Guidance

May 15, 2019

CMS releases all-payer guidance for the 2020 performance period.

POST

macra
CMS Hosts Webinar on the MIPS Improvement Activities Performance Category on May 23

Payment Innovation: Quality Payment Program

CMS Hosts Webinar on the MIPS Improvement Activities Performance Category on May 23

May 15, 2019

CMS to hold webinar on the MIPS Improvement Activities performance category on May 23.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

May 15, 2019

CMS uploaded new resources to the QPP Resource Library.

POST

macra
CMS Schedules Webinar on 2019 MIPS Group Participation

Payment Innovation: Quality Payment Program

CMS Schedules Webinar on 2019 MIPS Group Participation

May 15, 2019

CMS is hosting a webinar on May 16 about MIPS group participation for 2019.

POST

macra
CPC+ First Annual Report Posted

Payment Innovation: Innovation Center

CPC+ First Annual Report Posted

May 15, 2019

CMS released the first annual report of the CPC+ payment model.

POST

macra
View Archives of Hearings on Innovation for Health IT and Prescription Drugs

Payment Innovation: Other

View Archives of Hearings on Innovation for Health IT and Prescription Drugs

May 08, 2019

Congress held two innovation-related hearings on March 7.

POST

macra
Innovation Center Hosts Webinar on MDPP on May 29

Payment Innovation: Innovation Center

Innovation Center Hosts Webinar on MDPP on May 29

May 08, 2019

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

POST

macra
CMS and Treasury Issued an RFI on Section 1332 Waivers

Payment Innovation: Other

CMS and Treasury Issued an RFI on Section 1332 Waivers

May 08, 2019

The CMS and Treasury Department issued an RFI on Section 1332 waivers.

POST

macra
Innovation Center Hosts Webinar on InCK Model on May 15

Payment Innovation: Innovation Center

Innovation Center Hosts Webinar on InCK Model on May 15

May 08, 2019

The Innovation Center will host a webinar on the InCK model on May 15.

POST

macra
CMS Requests Additional Information on MAQI Demonstration

Payment Innovation: Innovation Center

CMS Requests Additional Information on MAQI Demonstration

May 08, 2019

CMS issued a request for comments on the MAQI demonstration.

POST

macra
CMS Holds Webinar on Advanced APMs on May 9

Payment Innovation: Quality Payment Program

CMS Holds Webinar on Advanced APMs on May 9

May 08, 2019

CMS will hold a webinar on May 9 to provide an overview of Advanced APMs.

POST

macra
New Feature for APM Entities Added to QPP Lookup Tool

Payment Innovation: Quality Payment Program

New Feature for APM Entities Added to QPP Lookup Tool

May 08, 2019

A new feature was added to the QPP Lookup Tool for APM entities.

POST

macra
Senate Finance Holds MACRA Hearing on May 8

Payment Innovation: Quality Payment Program

Senate Finance Holds MACRA Hearing on May 8

May 08, 2019

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

POST

prescription-drug

Prescription Drug: Regulation

CMS Issues Final Rule on Drug Pricing Transparency

May 08, 2019

The Centers for Medicare and Medicaid Services (CMS) released the Final Rule on requiring list prices to be included in direct-to-consumer television advertisements for prescription drug that are reimbursable under Medicare or Medicaid. List price is defined as the wholesale acquisition cost (WAC) for a “typical 30-day regimen or for a typical course of treatment”…

EXTERNAL LINK

prescription-drug

Prescription Drug: Other

House Appropriations Releases Report Accompanying Appropriations Bill

May 08, 2019

The House Appropriations Committee released the Committee Report to accompany the Departments of Labor, Health and Human Services, Education and Related Agencies appropriations bill. Notably, the report includes strong language expressing concern related to the Administration’s proposal to change the six protected categories of drugs in Medicare Part D.

EXTERNAL LINK

health-reform-20

Insurance Coverage: Legislation

Senate Dems Introduce Choose Medicare Act, Public Option

May 01, 2019

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…

EXTERNAL LINK

health-reform-20

Insurance Coverage: Legislation

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

May 01, 2019

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…

EXTERNAL LINK

health-reform-20

Insurance Coverage: Legislation

Montana Passes Bill to Continue Medicaid Expansion

May 01, 2019

The Montana state legislature passed a bill to continue Medicaid expansion in the state, adding new community engagement requirements. Montana’s expansion, which was first passed in 2015, extends Medicaid coverage to those earning up to 138 percent of the federal poverty level. Beginning July 1, 2020, qualifying beneficiaries age 19 to 55 will be required to complete…

EXTERNAL LINK

health-reform-20

Insurance Coverage: Congress

Senate HELP Committee Holds Second Hearing on Electronic Health Information Implementation

May 01, 2019

The Senate HELP Committee will hold its second hearing on implementing the electronic health information provisions of the 21st Century Cures Act. Don Rucker, National Coordinator for Health Information Technology at the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) Chief Medical Officer Kate Goodrich will be testifying.

EXTERNAL LINK

health-reform-20

Insurance Coverage: Legislation

House Appropriations Committee Holds First Subcommittee Markup

May 01, 2019

The House Appropriations Committee will hold the first subcommittee markup of the year next week: Labor-HHS-Education.

EXTERNAL LINK

health-reform-20

Insurance Coverage: Legislation

House Rules Committee to Hold Medicare for All Hearing

May 01, 2019

The House Rules Committee will hold a hearing on Medicare for All proposals, the first time this concept will be in the spotlight.

EXTERNAL LINK

prescription-drug

Prescription Drug: Pricing

House E&C Health Subcommittee to Hold Medicare Prescription Drug Cost Hearing

May 01, 2019

The House Energy and Commerce Health Subcommittee will hold a hearing on prescription drug costs in Medicare. Drug pricing continues to be a hot topic on Capitol Hill as lawmakers review several proposals to lower costs.

EXTERNAL LINK

prescription-drug

Prescription Drug: Legislation

House Judiciary Committee Marks Up Cost Reduction Bills

May 01, 2019

On Tuesday, April 30th, the House Judiciary Committee will mark-up several bills aimed at reducing the cost of prescription drugs. These bills are: H.R. 965, the “CREATES Act”; H.R. 2375, the “Preserve Access to Affordable Generics and Biosimilars Act”; H.R. 2374, the “Stop Significant and Time-wasting Abuse Limiting Legitimate Innovation of New Generics Act”; and…

EXTERNAL LINK

health-reform-20

Insurance Coverage: Budget Information

CBO Releases Single Payer Analysis

May 01, 2019

The Congressional Budget Office has released an analysis of single payer policy approaches.

EXTERNAL LINK

macra
CMS Issues Letter to State Medicaid Directors

Payment Innovation

CMS Issues Letter to State Medicaid Directors

April 30, 2019

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.

POST

macra
CMS Releases FY 2020 IPPS Proposed Rule

Payment Innovation: Other

CMS Releases FY 2020 IPPS Proposed Rule

April 30, 2019

CMS calls for increased payments to rural hospitals and for new technologies in the recently released proposed rule.

POST

macra
ACO Application Opens for Medicare Shared Savings Program

Payment Innovation: Innovation Center

ACO Application Opens for Medicare Shared Savings Program

April 30, 2019

CMS announces the Notice of Intent to Apply and application cycle dates for a January 1, 2020, start date for the Medicare Shared Savings Program Pathways to Success.

POST

macra
CMS Presents Primary Care First and Direct Contracting Informational Sessions

Payment Innovation: Innovation Center

CMS Presents Primary Care First and Direct Contracting Informational Sessions

April 30, 2019

CMS and CMMI will hold informational sessions on recently announced payment models. CMS announced two new pathways encompassing five new payment models intended to move organizations toward value based payments and away from fee-for-service.

POST

macra
CMS Innovation Center Report to Congress

Payment Innovation: Innovation Center

CMS Innovation Center Report to Congress

April 30, 2019

CMMI releases report to Congress.

POST

macra
CMS Releases Medicare Advantage Quality Data

Payment Innovation: Innovation Center

CMS Releases Medicare Advantage Quality Data

April 30, 2019

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

POST

macra
BPCI Advanced Second Cohort Application Period Started

Payment Innovation: Innovation Center

BPCI Advanced Second Cohort Application Period Started

April 30, 2019

On October 1, 2018, the first cohort of Participants in the BPCI Advanced Model started participation in CMMI’s Advanced Alternative Payment model. CMS announced the second application period for BPCI Advanced on April 24, 2019.

POST

diagnostic
GAO Finds Significant Medicare & Medicaid Overpayments in Laboratory and Other Services

Diagnostics

GAO Finds Significant Medicare & Medicaid Overpayments in Laboratory and Other Services

April 25, 2019

GAO releases report criticizing CMS’s oversight of its medical documentation requirements.

POST

diagnostic
CMS Opens Registration for CLFS Public Meeting

Diagnostics: Payment Rates

CMS Opens Registration for CLFS Public Meeting

April 25, 2019

CMS has opened registration for the June 24, 2019 CLFS Public Meeting.

POST

diagnostic
CMS Releases Codes Up for Review at the CLFS Public Meeting

Diagnostics: Payment Rates

CMS Releases Codes Up for Review at the CLFS Public Meeting

April 25, 2019

CMS has released its list of new and reconsidered Clinical Diagnostic Laboratory codes for review at the CY 2020 Lab Public Meeting.

POST

macra
CMS Issues Final Rule for the 2020 Annual Notice of Benefit and Payment Parameters

Payment Innovation: Other

CMS Issues Final Rule for the 2020 Annual Notice of Benefit and Payment Parameters

April 23, 2019

CMs released the final rule for the 2020 annual Notice of Benefit and Payment Parameters.

POST

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

Payment Innovation: Other

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

April 23, 2019

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

POST

macra
Comment Period for Interoperability Rules Extended to June 3

Payment Innovation: Other

Comment Period for Interoperability Rules Extended to June 3

April 23, 2019

HHS extended the comment period for two proposed interoperability rules to June 3.

POST

macra
Quality Proposals from IRF, IPF and Hospice FY 2020 Payment Rules

Payment Innovation: Other

Quality Proposals from IRF, IPF and Hospice FY 2020 Payment Rules

April 23, 2019

CMS released proposed regulations for FY 2020 Medicare payment for IRF, IPF and Hospice.

POST

macra
Administration Announces New Innovation Center Models

Payment Innovation: Innovation Center

Administration Announces New Innovation Center Models

April 23, 2019

CMS and the Innovation Center announced five new payment models moving towards value based payments.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

April 23, 2019

CMS uploaded new resources to the QPP Resource Library.

POST

macra
Participate in MIPS Study and Earn 2019 Improvement Activity Credit

Payment Innovation: Quality Payment Program

Participate in MIPS Study and Earn 2019 Improvement Activity Credit

April 23, 2019

Participants in a MIPS study can earn 2019 Improvement Activity credit.

POST

macra
2019 Call for MIPS Promoting Interoperability Measures and Improvement Activities is Open

Payment Innovation: Quality Payment Program

2019 Call for MIPS Promoting Interoperability Measures and Improvement Activities is Open

April 23, 2019

The 2019 call for MIPS Promoting Interoperability measures and Improvement Activities is open.

POST

macra
2019 MIPS Improvement Activities Performance Category Call for Technical Expert Panel

Payment Innovation: Quality Payment Program

2019 MIPS Improvement Activities Performance Category Call for Technical Expert Panel

April 23, 2019

CMS is requesting nominations for the MIPS Improvement Activities Technical Expert Panel.

POST

macra
HRSA Hosts Webinar on Rural Maternal Health Grants on April 30

Payment Innovation: Other

HRSA Hosts Webinar on Rural Maternal Health Grants on April 30

April 16, 2019

HRSA will host a webinar on April 30 about rural maternal health grants.

POST

macra
CMS Offers AI Health Outcomes Challenge Webinar

Payment Innovation: Other

CMS Offers AI Health Outcomes Challenge Webinar

April 16, 2019

CMS is holding a webinar on the CMS Artificial Intelligence Health Outcomes Challenge on April 18.

POST

macra
Quality and Safety of Nursing Home Care Under Scrutiny

Payment Innovation: Other

Quality and Safety of Nursing Home Care Under Scrutiny

April 16, 2019

The quality and beneficiary safety of nursing home care is under scrutiny.

POST

macra
CMS Releases ACO Care Coordination Toolkit

Payment Innovation: Innovation Center

CMS Releases ACO Care Coordination Toolkit

April 16, 2019

CMS released a public ACO Care Coordination Toolkit and case studies series.

POST

macra
Innovation Center Holds Second Webinar on InCK Funding Opportunity

Payment Innovation: Innovation Center

Innovation Center Holds Second Webinar on InCK Funding Opportunity

April 16, 2019

The Innovation Center is holding its second webinar on the InCK Model Notice of Funding Opportunity.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

April 16, 2019

CMS uploaded new resources to the Quality Payment Program Resource Library.

POST

macra
Upcoming Webinar on MIPS APM Scoring Standards on April 24

Payment Innovation: Quality Payment Program

Upcoming Webinar on MIPS APM Scoring Standards on April 24

April 16, 2019

CMS is hosting a webinar on April 24 on the MIPS APM scoring standards.

POST

diagnostic
CMS Releases List of New CLIA-Waived Tests

Diagnostics: Other

CMS Releases List of New CLIA-Waived Tests

April 16, 2019

CMS releases list of 12 new CLIA-waived tests

EXTERNAL LINK

The First 100 Days: House Health Policy Recap

Insight: original analysis

The First 100 Days: House Health Policy Recap

April 15, 2019

Let me count the ways to 100. 1. Affordable Care Act. 2. Insurance Expansion. 3. Drug Pricing. 4. Surprise Billing. 5… Ok, maybe let me count to four.

ORIGINAL ANALYSIS

macra
CMS Podcast on 2019 Quality Conference Now Available

Payment Innovation: Other

CMS Podcast on 2019 Quality Conference Now Available

April 09, 2019

CMS posted a podcast episode on the 2019 Quality Conference.

POST

macra
Innovation and Quality Highlights from MedPAC April 2019 Meeting

Payment Innovation: Other

Innovation and Quality Highlights from MedPAC April 2019 Meeting

April 09, 2019

MedPAC discussed innovation and quality topics at its April 2019 meeting.

POST

macra
CMS Releases CY 2020 MA and Part D Flexibility Final Rule

Payment Innovation: Other

CMS Releases CY 2020 MA and Part D Flexibility Final Rule

April 09, 2019

CMS released the CY 2020 MA and Part D Flexibility Final Rule.

POST

macra
Innovation Center Posts Fifth Annual Report of State Initiative Models

Payment Innovation: Innovation Center

Innovation Center Posts Fifth Annual Report of State Initiative Models

April 09, 2019

The Innovation Center posted the fifth annual report of their State Initiative Models.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

April 09, 2019

CMS uploaded new resources to the Quality Payment Program Resource Library.

POST

macra
CMS Opens Web Interface and CAHPS Survey Registration

Payment Innovation: Quality Payment Program

CMS Opens Web Interface and CAHPS Survey Registration

April 09, 2019

CMS opens CMS Web Interface registration and the CAHPS for MIPS survey for 2019.

POST

macra
Preliminary 2018 MIPS Performance Feedback Data Now Available

Payment Innovation: Quality Payment Program

Preliminary 2018 MIPS Performance Feedback Data Now Available

April 09, 2019

The preliminary 2018 MIPS performance feedback data is now available.

POST

macra
Upcoming CMS MIPS Webinars on Facility-based Measurement and the PI Performance Category

Payment Innovation: Quality Payment Program

Upcoming CMS MIPS Webinars on Facility-based Measurement and the PI Performance Category

April 09, 2019

CMS is holding two webinars on facility-based measurement and the PI performance category for MIPS.

POST

health-reform-20

Insurance Coverage: Legislation

Democratic Senators Introduce the Medicare Choice Act

April 08, 2019

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

POST

diagnostic

Diagnostics: Regulation

CMS Extends Comment Period on Proposed Changes to Proficiency Testing

April 04, 2019

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

EXTERNAL LINK

health-reform-20

Insurance Coverage: Waivers

Utah Medicaid 1115 Waiver Summary

April 03, 2019

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…

POST

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

Payment Innovation: Innovation Center

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

April 02, 2019

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

POST

macra
CMS Releases Medicare Advantage Final Rate Notice and Call Letter

Payment Innovation: Other

CMS Releases Medicare Advantage Final Rate Notice and Call Letter

April 02, 2019

CMS released the final Rate Notice and Call Letter for Medicare Advantage.

POST

macra
HRSA Announces Funding Opportunity to Test Network Approach to Rural Maternal Care

Payment Innovation: Other

HRSA Announces Funding Opportunity to Test Network Approach to Rural Maternal Care

April 02, 2019

HRSA announces funding opportunity to test network approach to rural maternal care.

POST

macra
MedPAC Discusses Innovation and Quality at April 2019 Public Meeting

Payment Innovation: Other

MedPAC Discusses Innovation and Quality at April 2019 Public Meeting

April 02, 2019

MedPAC to discuss innovation and quality topics at their April 2019 public meeting.

POST

macra
CMS Announces Artificial Intelligence Health Outcomes Challenge

Payment Innovation: Other

CMS Announces Artificial Intelligence Health Outcomes Challenge

April 02, 2019

CMS announces the Artificial Intelligence Health Outcomes Challenge.

POST

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

Payment Innovation: Other

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

April 02, 2019

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

POST

macra
Innovation Center Releases Information on APM Component of InCK Model

Payment Innovation: Innovation Center

Innovation Center Releases Information on APM Component of InCK Model

April 02, 2019

The Innovation Center releases information on the APM component of the InCK model.

POST

macra
Innovation Center Hosts Webinar on MOM Model Application Process

Payment Innovation: Innovation Center

Innovation Center Hosts Webinar on MOM Model Application Process

April 02, 2019

The Innovation Center will hold a webinar on the MOM Model application process on April 4, 2019.

POST

macra
CMS Releases 2017 Quality Payment Program Experience Report

Payment Innovation: Quality Payment Program

CMS Releases 2017 Quality Payment Program Experience Report

April 02, 2019

CMS releases the 2017 Quality Payment Program Experience Report.

POST

macra
CMS Offering a Supplemental 30-Day Preview Period for Physician Compare

Payment Innovation: Quality Payment Program

CMS Offering a Supplemental 30-Day Preview Period for Physician Compare

April 02, 2019

CMS is offering a supplemental 30-day preview period for Physician Compare.

POST

diagnostic

Diagnostics: PAMA

CMS Responds to Senator Grassley’s Inquiry on PAMA implementation

March 29, 2019

EXTERNAL LINK

prescription-drug

Prescription Drug: Regulation

CMS Issues Pair of Rules on Line Item Extension Drugs

March 29, 2019

CMS issues pair of final rules addressing line item extension drugs.

POST

diagnostic

Diagnostics: Other

CMS Announces 2019 CLFS Public Meeting

March 29, 2019

The CLFS Public Meeting will be June 24, 2019 at CMS headquarters in Baltimore, MD.

POST

health-reform-20

Insurance Coverage: Waivers

Kentucky and Arkansas Work Requirements Blocked

March 29, 2019

U.S. District Judge James Boasberg ruled that the federal government failed to justify adding work requirements to Kentucky and Arkansas’ Medicaid program. Both decisions remand the Arkansas and Kentucky waivers back to HHS.

POST

health-reform-20

Insurance Coverage: Litigation

Judge Strikes Down Association Health Plans

March 29, 2019

On Thursday, a federal judge blocked the Trump Administration’s final rule to expand Association Health Plans (AHP). The judge noted that the “Final Rule exceeds the statutory authority delegated by Congress in ERISA.”

EXTERNAL LINK

diagnostic

Diagnostics: PAMA

Senator Grassley quizzes CMS about PAMA implementation

March 27, 2019

Here is the link to the inquiry.

EXTERNAL LINK

health-reform-20

Insurance Coverage: Waivers

Ohio Section 1115 Waiver Approval

March 19, 2019

On March 15, 2019, CMS approved Ohio’s Medicaid 1115 waiver, allowing the state to implement work requirements for certain Medicaid recipients.

ORIGINAL ANALYSIS

macra
HCPLAN Hosts Webinar on APM Roadmap on April 3, 2019

Payment Innovation: Other

HCPLAN Hosts Webinar on APM Roadmap on April 3, 2019

March 19, 2019

HCPLAN to host webinar on APM roadmap on April 3, 2019.

POST

macra
CMS Retires PQRS Website

Payment Innovation: Other

CMS Retires PQRS Website

March 19, 2019

CMS will retire the PQRS program website.

POST

macra
MedPAC’s March 2019 Report to Congress: Quality, Innovation and Transparency Updates

Payment Innovation: Other

MedPAC’s March 2019 Report to Congress: Quality, Innovation and Transparency Updates

March 19, 2019

MedPAC released their March 2019 Report to Congress.

POST

macra
CMS Holds Call on Data Element Library for Post-Acute Care

Payment Innovation: Other

CMS Holds Call on Data Element Library for Post-Acute Care

March 19, 2019

CMS will hold a call on the Data Element Library for post-acute care.

POST

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

Payment Innovation: Other

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

March 19, 2019

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

POST

macra
CMS Publishes Guidance on 1115 Waiver Evaluations

Payment Innovation: Other

CMS Publishes Guidance on 1115 Waiver Evaluations

March 19, 2019

CMS published guidance for states on 1115 waiver evaluations.

POST

macra
CMS Updates Drug Spending Dashboards

Payment Innovation: Other

CMS Updates Drug Spending Dashboards

March 19, 2019

CMS updated its drug spending dashboards with 2017 data.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

March 19, 2019

CMS has updated its QPP Resource Library.

POST

macra
REMINDER: April 2, 2019, 8 pm ET, is the 2018 MIPS Data Submission Deadline

Payment Innovation: Quality Payment Program

REMINDER: April 2, 2019, 8 pm ET, is the 2018 MIPS Data Submission Deadline

March 19, 2019

April 2, 2019, 8 pm ET, is the 2018 MIPS Data Submission Deadline.

POST

macra
2017 MIPS Performance Feedback Web-Based Training Now Available

Payment Innovation: Quality Payment Program

2017 MIPS Performance Feedback Web-Based Training Now Available

March 19, 2019

CMS released new MIPS web-based training course.

POST

prescription-drug
Bipartisan Legislation Introduced by Senators Grassley and Klobuchar

Prescription Drug: Legislation

Bipartisan Legislation Introduced by Senators Grassley and Klobuchar

March 19, 2019

The bill would temporarily allow drugs to be imported from certain other countries if facing a shortage or lack of competition.

POST

prescription-drug
Members Send Letter to HHS Opposing Changes to Protected Classes

Prescription Drug: Other

Members Send Letter to HHS Opposing Changes to Protected Classes

March 15, 2019

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.

POST

prescription-drug

Prescription Drug: Other

CMS Updates Drug Spending Dashboards

March 15, 2019

CMS updated its drug spending dashboards with data for 2017.

POST

prescription-drug
Prescription Drug Legislation Considered

Prescription Drug: Legislation

Prescription Drug Legislation Considered

March 15, 2019

House E&C Health Subcommittee holds legislative hearing to examine seven bills related to lowering the cost of prescription drugs.

POST

health-reform-20
Democrats Launch Investigation on STLDI

Insurance Coverage: Congress

Democrats Launch Investigation on STLDI

March 15, 2019

House Committee on Energy and Commerce Democrats have launched an investigation into Short-Term, Limited Duration Insurance plans.

POST

health-reform-20
Section 1115 Guidance

Insurance Coverage: Waivers

Section 1115 Guidance

March 15, 2019

On March 14th CMS published tools and guidance for states on how to monitor and evaluate 1115 waivers that implement work requirements, require monthly premiums, implement premium assistance programs, waive retroactive eligibility, or implement non-eligibility periods for failing to meet requirements. Additionally, CMS published monitoring and evaluation guidance and tools for states that are implementing…

EXTERNAL LINK

prescription-drug
President’s FY 2020 Budget Includes Drug Proposals

Prescription Drug: Original Analysis

President’s FY 2020 Budget Includes Drug Proposals

March 13, 2019

The White House FY 2020 budget proposal

POST

macra
CMS Holds Webinar on the Review, Dispute and Correction Periods for Open Payments Program

Payment Innovation: Other

CMS Holds Webinar on the Review, Dispute and Correction Periods for Open Payments Program

March 12, 2019

CMS will present a live Q&A session on March 27, 2019, for Open Payments system users. The session will open with a brief presentation on the review, dispute and correction periods, and the Open Payments team will be available to respond to any questions.

POST

macra
Five Takeaways from March 2019 MedPAC Meeting

Payment Innovation: Other

Five Takeaways from March 2019 MedPAC Meeting

March 12, 2019

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

POST

macra
CMS Hosts Additional Webinars on MIPS and MACRA Measures

Payment Innovation: Quality Payment Program

CMS Hosts Additional Webinars on MIPS and MACRA Measures

March 12, 2019

CMS will host additional webinars on MIPS and MACRA measures.

POST

macra
CMS Hosts Webinar on the MIPS Cost Performance Category in 2019

Payment Innovation: Quality Payment Program

CMS Hosts Webinar on the MIPS Cost Performance Category in 2019

March 12, 2019

CMS will hold a webinar on March 12, 2019 to provide an overview of the MIPS Cost performance category of the in 2019 (Year 3).

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

March 12, 2019

CMS has updated its QPP resource center.

POST

macra
CMS Seeks Nominations of Clinical Experts for Subcommittees Developing Cost Measures

Payment Innovation: Quality Payment Program

CMS Seeks Nominations of Clinical Experts for Subcommittees Developing Cost Measures

March 12, 2019

CMS is accepting nominations until April 12, 2019, of physicians and other practitioners interested in providing clinical input for the development of episode-based cost measures to be used to implement the Cost Performance Category of the Merit-based Incentive Payment System.

POST

macra
President’s Budget Proposes to Revamp and Streamline MIPS and Advanced APMs

Payment Innovation: Quality Payment Program

President’s Budget Proposes to Revamp and Streamline MIPS and Advanced APMs

March 12, 2019

On March 11, 2019, President Trump submitted to Congress his budget request for FY 2020. It calls for a 12% cut in funding for HHS and includes two key proposals related to the Quality Payment Program.

POST

macra
PTAC Update: Declines to Recommend Wound Care Models and Solicits Comments on a New Telemedicine Proposal

Payment Innovation: PTAC

PTAC Update: Declines to Recommend Wound Care Models and Solicits Comments on a New Telemedicine Proposal

March 12, 2019

PTAC met on March 11, 2019, in Washington, DC, to review two proposed payment models related to wound care services and did not recommend either model.

POST

prescription-drug

Prescription Drug: Legislation

Accelerated Drug Approval for Prescription Therapies (ADAPT) Act

March 11, 2019

On March 6, 2019, Senator Mike Braun (R-IN) introduced the Accelerated Drug Approval for Prescription Therapies (ADAPT) Act (S. 658), which would create an expedited drug approval process at FDA specifically for drugs that are currently approved for sale in developed countries.

EXTERNAL LINK

prescription-drug

Prescription Drug: Legislation

Drug Price Transparency (DPT) Act

March 11, 2019

On March 6, 2019, Senator Mike Braun (R-IN) introduced the Drug Price Transparency (DPT) Act (S. 657), which would extend the idea of the HHS OIG PBM rebate rule to the commercial insurance market and prohibit PBMs from receiving any rebates or reductions in price from drug manufacturers.

EXTERNAL LINK

prescription-drug

Prescription Drug: Issue Primers

Trump Administration Drug Pricing Blueprint Policies and Proposals Tracker

March 08, 2019

McDermottPlus’ American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs Policies and Proposals Tracker

POST

health-reform-20

Insurance Coverage: CMS

State Innovation Waivers for ACA

March 06, 2019

EXTERNAL LINK

health-reform-20
Section 1115 State Waivers List

Insurance Coverage: CMS

Section 1115 State Waivers List

March 06, 2019

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

EXTERNAL LINK

Five Unanswered Questions on the Medicare for All Act

Insight: original analysis

Five Unanswered Questions on the Medicare for All Act

March 06, 2019

On February 27, 2019, Representative Pramila Jayapal (D-WA) and more than 100 co-sponsors in the House of Representatives introduced the Medicare for All Act (HR 1384). The bill, like its predecessors, creates a single payer, government-funded health care program. The new program would cover enumerated medical benefits, prescription drugs, vision, dental, mental health and substance…

ORIGINAL ANALYSIS

macra
CMS Extends Deadline to March 14 for Hospital IQR and the Promoting Interoperability Programs

Payment Innovation: Other

CMS Extends Deadline to March 14 for Hospital IQR and the Promoting Interoperability Programs

March 05, 2019

The deadline for submitting eCQM data for the CY 2018 reporting period, pertaining to the FY 2019 payment determination, has been extended to March 14, 2019, at 11:59 pm PT.

POST

macra
NQF Accepting Nominations and Soliciting Comments on Future Core Measure Sets

Payment Innovation: Other

NQF Accepting Nominations and Soliciting Comments on Future Core Measure Sets

March 05, 2019

NQF Accepting Nominations for Opioid TEP, Patient & Caregiver Engagement Advisory Group and Soliciting Comments on Future Core Measure Sets

POST

macra
CMS Updates Hospital Quality Info and Proposes Changes to Hospital Star Ratings

Payment Innovation: Other

CMS Updates Hospital Quality Info and Proposes Changes to Hospital Star Ratings

March 05, 2019

CMS has updated hospital performance data on the Hospital Compare website and on data.medicare.gov. The update included specific measures of hospitals’ quality of care, many of which are updated quarterly, and the Overall Hospital Star Ratings, which were last updated in December 2017.

POST

macra
Annual Call for MIPS Quality Measures is Open

Payment Innovation: Quality Payment Program

Annual Call for MIPS Quality Measures is Open

March 05, 2019

CMS invites eligible clinicians, professional associations and medical associations to submit MIPS quality measures for consideration for future years.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

March 05, 2019

CMS has updated its QPP Resoure Center.

POST

macra
MedPAC to Discuss MACRA-Mandated Report on Clinician Payment in Medicare

Payment Innovation: Quality Payment Program

MedPAC to Discuss MACRA-Mandated Report on Clinician Payment in Medicare

March 05, 2019

MedPAC is scheduled to discuss this report at their public meeting on March 7, 2019.

POST

macra
Innovation Center Hosts Webinar on ET3 Model

Payment Innovation: Innovation Center

Innovation Center Hosts Webinar on ET3 Model

March 05, 2019

CMMI will hold a repeat webinar on March 7, 2019, from 2 to 3 pm EST, to provide an overview of the Emergency Triage, Treat and Transport (ET3) Model.

POST

macra
Year 1 Evaluation of Million Hearts Program Positive but with Substantial Room for Improvement

Payment Innovation: Innovation Center

Year 1 Evaluation of Million Hearts Program Positive but with Substantial Room for Improvement

March 05, 2019

Launched by the Centers for Medicare and Medicaid Services (CMS) in 2017, the Million Hearts Cardiovascular Disease (CVD) Risk Reduction Model (Million Heart Model) tests whether providing targeted incentives to health care providers to reduce CVD risk lowers the incidence of first-time heart attacks and strokes among Medicare beneficiaries ages 40-79 who have not had…

POST

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CMS Releases MLN Article to Assist with Determining Applicable Laboratory Status

Diagnostics: Guidance

CMS Releases MLN Article to Assist with Determining Applicable Laboratory Status

March 04, 2019

CMS releases MLN Article on determining applicable laboratory status

EXTERNAL LINK

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Actuaries Weigh in on Expanding Public Insurance

Insurance Coverage: Stakeholder Engagement

Actuaries Weigh in on Expanding Public Insurance

March 04, 2019

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.

POST

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Diagnostics: PAMA

CMS Releases Laboratory Data Collection FAQ

February 28, 2019

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

EXTERNAL LINK

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AHRQ Grant Announcement to Advance a High Valued Healthcare System

Payment Innovation: Other

AHRQ Grant Announcement to Advance a High Valued Healthcare System

February 27, 2019

AHRQ is interested in receiving health services research grant applications to advance the national goal of achieving a high value healthcare system in support of the Health and Human Services Value-Based Transformation Initiative.

POST

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CMS Hosts Listening Session on Interoperability and Patient Access Proposed Rule

Payment Innovation: Other

CMS Hosts Listening Session on Interoperability and Patient Access Proposed Rule

February 27, 2019

CMS will host a listening session on the Interoperability and Patient Access Proposed Rule.

POST

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CMS Approves Drug Price Negotiations for Colorado Medicaid

Payment Innovation: Other

CMS Approves Drug Price Negotiations for Colorado Medicaid

February 27, 2019

Colorado has become the latest state to receive approval from CMS for negotiating drug prices for Medicaid recipients using value-based contracting arrangements.

POST

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CMS Hosts Webinar on New eCQMs Finalized for 2019

Payment Innovation: Quality Payment Program

CMS Hosts Webinar on New eCQMs Finalized for 2019

February 27, 2019

CMS will host a webinar titled “Eligible Clinician New eCQMs Finalized for 2019” on March 11, 2019, from 1 to 2 pm EST.

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Webinar on CME Counting as MIPS Improvement Activity

Payment Innovation: Quality Payment Program

Webinar on CME Counting as MIPS Improvement Activity

February 27, 2019

CMS and the Accreditation Council for Continuing Medical Education will host a webinar on March 6, 2019, on continuing medical education as MIPS Improvement Activity.

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

February 27, 2019

CMS has updated its QPP Resource Center

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CMS Hosts Webinar on the VBID and Part D Payment Modernization Model

Payment Innovation: Innovation Center

CMS Hosts Webinar on the VBID and Part D Payment Modernization Model

February 27, 2019

CMMI will hold a webinar on February 28, 2019, at 3 pm ET. It will provide a deep dive into the application processes and information about model designs for the Part D Payment Modernization Model and the Medicare Advantage Value-Based Insurance Design model for interested Part D sponsors and MA organizations.

POST

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Innovation Center Hosts Webinar on ET3 Model

Payment Innovation: Innovation Center

Innovation Center Hosts Webinar on ET3 Model

February 27, 2019

CMMI will hold a webinar on February 27, from 1 to 2 pm ET, to provide an overview of the Emergency Triage, Treat and Transport Model. EMS providers, payers, beneficiaries and other interested stakeholders are encouraged to attend.

POST

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CMS Launches Podcast

Payment Innovation: Other

CMS Launches Podcast

February 20, 2019

CMS launches “CMS: Beyond the Policy,” a new podcast highlighting updates and changes to policies and programs.

POST

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CMS Hosts Two-Part Webinar Series on 2019 QCDR Measure Development and Review Process

Payment Innovation: Quality Payment Program

CMS Hosts Two-Part Webinar Series on 2019 QCDR Measure Development and Review Process

February 20, 2019

CMS is hosting a two-part webinar series to provide information about the 2019 Qualified Clinical Data Registry (QCDR) measures for the Merit-based Incentive Payment System.

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Call for Nominations: Measure Applications Partnership

Payment Innovation: Other

Call for Nominations: Measure Applications Partnership

February 20, 2019

The Call for Nominations for organizations and individual subject matter experts to serve on the Measure Applications Partnership is open.

POST

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Grassley Queries CMS on Update of Recovery of Improper EHR Incentive Payments

Payment Innovation: Other

Grassley Queries CMS on Update of Recovery of Improper EHR Incentive Payments

February 20, 2019

In a letter to CMS, Senate Finance Chairman Chuck Grassley (R-IA) pressed the agency for an update on their recovery of improper electronic health record incentive payments.

POST

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

February 20, 2019

CMS has updated its QPP Resources

POST

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Innovation Center Hosts Webinar on MOM Model Application Process

Payment Innovation: Innovation Center

Innovation Center Hosts Webinar on MOM Model Application Process

February 20, 2019

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.

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New Payment Model Will Redesign Medicare Ambulance Services: Five Takeaways

Insight: original analysis

New Payment Model Will Redesign Medicare Ambulance Services: Five Takeaways

February 20, 2019

CMS released its latest payment innovation model, “Emergency Triage, Treat and Transport”, which will incentivize reducing costs for the emergency transport and care of Medicare fee-for-service beneficiaries by allowing ambulance suppliers to be paid by Medicare for transport not only to emergency departments but also to alternative sites, such as urgent care centers or primary…

ORIGINAL ANALYSIS

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Medicaid Expansion Bill Introduced

Insurance Coverage: Legislation

Medicaid Expansion Bill Introduced

February 14, 2019

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.

EXTERNAL LINK

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Senators Cassidy and Warner Introduce PAVE Act

Payment Innovation: Other

Senators Cassidy and Warner Introduce PAVE Act

February 13, 2019

Senators Cassidy and Warner Introduce Patient Affordability, Value and Efficiency (PAVE) Act.

POST

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Bipartisan House and Senate Letters in Support of Medicare Advantage

Payment Innovation: Other

Bipartisan House and Senate Letters in Support of Medicare Advantage

February 13, 2019

The House and Senate sent letters to Centers for Medicare and Medicaid Services Administrator Seema Verma in support of the Medicare Advantage program.

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ONC Releases Proposed Rule to Advance Interoperability

Payment Innovation: Other

ONC Releases Proposed Rule to Advance Interoperability

February 13, 2019

ONC releases proposed rule to implement certain provisions of the 21st Century Cures Act.

POST

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CMS Hosts Webinar on Feb 21: Overview of APMs for 2019 Performance Year

Payment Innovation: Quality Payment Program

CMS Hosts Webinar on Feb 21: Overview of APMs for 2019 Performance Year

February 13, 2019

CMS will host a webinar on February 21 at 2 pm EST to provide a basic overview of Alternative Payment Models for the 2019 Performance Year of the Quality Payment Program.

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

February 13, 2019

CMS Updates QPP Resources

POST

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Preliminary 2019 MIPS Eligibility Available on the QPP Website

Payment Innovation: Quality Payment Program

Preliminary 2019 MIPS Eligibility Available on the QPP Website

February 13, 2019

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

POST

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CMS Identifies Error in Application of 2019 MIPS Payment Adjustment

Payment Innovation: Quality Payment Program

CMS Identifies Error in Application of 2019 MIPS Payment Adjustment

February 13, 2019

CMS discovers an error in the application of the 2019 MIPS payment adjustment where Medicare Administrative Contractors applied the adjustment to Part B drugs.

POST

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PTAC Submits Report to the Secretary; Registration Open for Upcoming Public Meeting

Payment Innovation: PTAC

PTAC Submits Report to the Secretary; Registration Open for Upcoming Public Meeting

February 13, 2019

PTAC recommends the Making Accountable Sustainable Oncology Networks model to HHS.

POST

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Independence at Home: Year Three Evaluation Factsheet Posted

Payment Innovation: Innovation Center

Independence at Home: Year Three Evaluation Factsheet Posted

February 13, 2019

The CMS Innovation Center has posted a factsheet on year three evaluation results for the Independence at Home Demonstration.

POST

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InCK Model: Notice of Funding Opportunity and Webinar on February 19

Payment Innovation: Innovation Center

InCK Model: Notice of Funding Opportunity and Webinar on February 19

February 13, 2019

The CMS Innovation Center has announced a funding opportunity for the Integrated Care for Kids model and a webinar on Feb. 19.

POST

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BPCI Update: Quality Measures Factsheets Now Available

Payment Innovation: Innovation Center

BPCI Update: Quality Measures Factsheets Now Available

February 13, 2019

The CMS Innovation Center has posted factsheets for the seven quality measures selected for use in the Bundled Payments for Care Improvement Advanced model.

POST

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Maternal Opioid Misuse Model Funding Opportunity Announced

Payment Innovation: Innovation Center

Maternal Opioid Misuse Model Funding Opportunity Announced

February 13, 2019

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.

POST

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Medicare Buy-in Bill Introduced

Insurance Coverage: Legislation

Medicare Buy-in Bill Introduced

February 13, 2019

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.

EXTERNAL LINK

diagnostic

Diagnostics: Payment Rates

CMS Posts HCPCS Codes for Collecting/Reporting Applicable Lab Info

February 08, 2019

CMS posts HCPCS codes for collecting and reporting applicable lab information for the 2019 data collection period.

EXTERNAL LINK

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Prescription Drug: Legislation

The Medicare Negotiation and Competitive Licensing Act (S. 377)

February 07, 2019

POST

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Prescription Drug: Legislation

The Medicare Negotiation and Competitive Licensing Act (H.R. 1046)

February 07, 2019

POST

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Bill Introduced to Reverse STLDI Plan Expansion

Insurance Coverage: Legislation

Bill Introduced to Reverse STLDI Plan Expansion

February 06, 2019

On February 6, 2019, Representative Kathy Castor (D-FL) introduced H.R. 1010 which would rollback the Administration’s short-term limited duration regulation.

EXTERNAL LINK

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New Resource: FY 2019 IPPS Promoting Interoperability Factsheet

Payment Innovation: Other

New Resource: FY 2019 IPPS Promoting Interoperability Factsheet

February 05, 2019

CMS publishes factsheet as companion to final IPPS rule.

POST

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HHS and OIG Releases Proposal Targeting PBMs

Payment Innovation: Other

HHS and OIG Releases Proposal Targeting PBMs

February 05, 2019

HHS and OIG release proposed rule targeting pharmacy benefits managers.

POST

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Trade Association Calls on Congress to Eliminate MIPS Exclusions

Payment Innovation: Quality Payment Program

Trade Association Calls on Congress to Eliminate MIPS Exclusions

February 05, 2019

AMA recommends eliminating MIPS exclusions in letter to House Speaker Nancy Pelosi.

POST

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CMS Appoints New Senior Medical Advisor for Innovation

Payment Innovation: Innovation Center

CMS Appoints New Senior Medical Advisor for Innovation

February 05, 2019

CMS has appointed Dr. Anand Shah as the Senior Medical Advisor for Innovation at CMS.

POST

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BPCI Update: CMS Posts Details on Model Years 1 and 2

Payment Innovation: Innovation Center

BPCI Update: CMS Posts Details on Model Years 1 and 2

February 05, 2019

The CMS Innovation Center has  posted a number of documents related to the Bundled Payments for Care Improvement Advanced Model (BPCI Advanced).

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CMS Posts Applications for the MA VBID Model

Payment Innovation: Innovation Center

CMS Posts Applications for the MA VBID Model

February 05, 2019

CMS Innovation Center posts request for the applications and guidance documents for Medicare Advantage Value-based Insurance Design model

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diagnostic
CMS Proposes Rule on Proficiency Testing

Diagnostics: Regulation

CMS Proposes Rule on Proficiency Testing

February 04, 2019

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.

POST

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CMS Launches App on What Original Medicare Covers

Payment Innovation: Other

CMS Launches App on What Original Medicare Covers

January 29, 2019

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

POST

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CMS Restarts Open Payment Webinar Series

Payment Innovation: Other

CMS Restarts Open Payment Webinar Series

January 29, 2019

CMS announces the return of Wednesday Webinars, presented by the Open Payments team.

POST

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CMS Hosts MIPS Data Submission Office Hours in February and March 2019

Payment Innovation: Quality Payment Program

CMS Hosts MIPS Data Submission Office Hours in February and March 2019

January 29, 2019

CMS is hosting two 2018 Merit-based Incentive Payment System (MIPS) data submission office hours sessions in February and March.

POST

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

January 29, 2019

CMS has updated its QPP Resource Library.

POST

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Archived Recording on the 2020 Application Cycle of MA VBID Model Webinar Now Available

Payment Innovation: Innovation Center

Archived Recording on the 2020 Application Cycle of MA VBID Model Webinar Now Available

January 29, 2019

Innovation Center to rebroadcast webinar on the 2020 application cycle of the Medicare Advantage Value-Based Insurance Design Model on Wednesday, January 30, 2019 from 1:00 p.m. to 2:00 p.m. EST.

POST

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DelBene Leads Letter to CMS to Delay MSSP Application Timeline

Payment Innovation: Innovation Center

DelBene Leads Letter to CMS to Delay MSSP Application Timeline

January 29, 2019

Representative Suzan DelBene (D-WA) requests an extension to the application timeline for the new Pathways to Success, Medicare Shared Savings Program Accountable Care Organizations.

POST

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McDermottPlus Launches 2019 CMS/CMMI Payment Model Tracker

Payment Innovation: Innovation Center

McDermottPlus Launches 2019 CMS/CMMI Payment Model Tracker

January 29, 2019

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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Prescription Drug: Pricing , Regulation

Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses

January 25, 2019

EXTERNAL LINK

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Administration Releases Marketplace Proposed Rule

Insurance Coverage: Regulation

Administration Releases Marketplace Proposed Rule

January 24, 2019

On January 24, 2019, the Centers for Medicare and Medicaid Services issued a proposed rule on payment parameters for the Health Insurance Marketplaces.

EXTERNAL LINK

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Medicaid Extenders Act of 2019

Insurance Coverage: Legislation

Medicaid Extenders Act of 2019

January 24, 2019

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.

EXTERNAL LINK

diagnostic
CMS Holds Informational Call on PAMA Data Collection

Diagnostics: Guidance

CMS Holds Informational Call on PAMA Data Collection

January 24, 2019

CMS hosts informational Open Door Forum to discuss the 2019 PAMA Data Collection process and related requirements.

POST

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DelBene Leads Letter to CMS to Delay MSSP Application Timeline

Insurance Coverage: Congress

DelBene Leads Letter to CMS to Delay MSSP Application Timeline

January 23, 2019

On January 23, 2019, Representative Suzan DelBene led a letter to to the Centers for Medicare and Medicaid Services Administrator, Seema Verma, expressing concern related to the deadlines for the Medicare Shared Savings Program.

EXTERNAL LINK

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MedPAC Recommends Replacing Current Hospital Quality Program with Hospital Value Incentive Program and Votes on 2020 Payment Recommendations

Payment Innovation: Other

MedPAC Recommends Replacing Current Hospital Quality Program with Hospital Value Incentive Program and Votes on 2020 Payment Recommendations

January 23, 2019

MedPAC votes to revamp the Hospital Value Based Purchasing Program at January meeting.

POST

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Opportunities to Participate in a Technical Expert Panel

Payment Innovation: Quality Payment Program

Opportunities to Participate in a Technical Expert Panel

January 23, 2019

CMS has announced opportunities to participate in a Technical Expert Panel. Individuals with expertise in the relevant fields including clinicians, statisticians, quality improvement, methodologists and pertinent measure developers, as well as consumers, are encouraged to submit nominations.

POST

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CMS Hosts Webinar on MIPS for Year 3 of QPP

Payment Innovation: Quality Payment Program

CMS Hosts Webinar on MIPS for Year 3 of QPP

January 23, 2019

CMS will host a webinar on January 24, from 1 to 2 pm EST, on the MIPS 2019 Performance Year (Year 3) of the QPP.

POST

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

January 23, 2019

CMS has added additional resources to its QPP Resource Center

POST

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CMS Solicits Recommendations on New Measure Sets for MIPS and Comments on Existing Measure Sets

Payment Innovation: Quality Payment Program

CMS Solicits Recommendations on New Measure Sets for MIPS and Comments on Existing Measure Sets

January 23, 2019

CMS requests recommendations on new measure sets for the quality performance category and/or revisions to existing specialty measure sets for the quality performance category for program year 2020 of the MIPS program. Recommendations will be accepted until the close of business on Monday, February 11, 2019.

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GAO Report Considers Advantages of Voluntary vs Mandatory Payment Models

Payment Innovation: Innovation Center

GAO Report Considers Advantages of Voluntary vs Mandatory Payment Models

January 23, 2019

GAO releases report that identifies the characteristics of model participants and the advantages to using either voluntary or mandatory participants for episode-based payment models.

POST

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CMS Announces New Part D Payment Modernization Model

Payment Innovation: Innovation Center

CMS Announces New Part D Payment Modernization Model

January 23, 2019

CMMI releases new Part D Payment Modernization Model.

POST

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CMS Releases Updates to MA VBID Demonstration

Payment Innovation: Innovation Center

CMS Releases Updates to MA VBID Demonstration

January 23, 2019

CMMI releases updates to the Medicare Advantage Value-Based Insurance Design Demonstration.

POST

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Congressional Inquiry on Insurance Fee Spending

Insurance Coverage: Congress

Congressional Inquiry on Insurance Fee Spending

January 20, 2019

EXTERNAL LINK

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Pre-existing Conditions Protection Act of 2019

Insurance Coverage: Legislation

Pre-existing Conditions Protection Act of 2019

January 19, 2019

On January 18, 2019, Representative Greg Walden introduced the Pre-existing Conditions Protection Act of 2019 (H.R. 692) which would prohibit pre-existing conditions exclusion in the individual and group health insurance markets.

EXTERNAL LINK

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MedPAC Scheduled to Discuss MSSP on January 18

Payment Innovation: Other

MedPAC Scheduled to Discuss MSSP on January 18

January 16, 2019

MedPAC is scheduled to discuss an analysis of the Medicare Shared Savings Program at their public meeting on January 17-18, 2019.

POST

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GAO Releases Report on Challenges to Electronically Matching Patients’ Records Across Providers

Payment Innovation: Other

GAO Releases Report on Challenges to Electronically Matching Patients’ Records Across Providers

January 16, 2019

GAO released a report required by the 21st Century Cures Act detailing the challenges to electronically matching patients’ records across providers.

POST

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CMS Hosts Webinar on Eligible Clinician eCQM Diabetes Measures

Payment Innovation: Quality Payment Program

CMS Hosts Webinar on Eligible Clinician eCQM Diabetes Measures

January 16, 2019

CMS will host a webinar on January 30 from 12 to 1 pm EST on the Diabetes electronic clinical quality measures.

POST

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QPP Participation Status Tool Updated

Payment Innovation: Quality Payment Program

QPP Participation Status Tool Updated

January 16, 2019

The QPP participation status tool now includes third snapshot of 2018 Qualifying APM participants and MIPS APMs data.

POST

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CMS Updates QPP Resources for 2019

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources for 2019

January 16, 2019

CMS has updated its QPP Resource Library.

POST

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House Ways and Means Bipartisan Letter on CMMI

Payment Innovation: Innovation Center

House Ways and Means Bipartisan Letter on CMMI

January 10, 2019

Congress requests greater transparency from CMMI.

POST

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MIPS 2018 Data Submission Period is Now Open

Payment Innovation: Quality Payment Program

MIPS 2018 Data Submission Period is Now Open

January 10, 2019

CMS officially opened the data submission period for MIPS eligible clinicians who participated in Year 2 (2018) of the Quality Payment Program.

POST

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CMS Updates QPP Resources for 2019

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources for 2019

January 10, 2019

CMS has uploaded new resources to the QPP Resource Library for the 2019 Quality Payment Program.

POST

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PTAC Updates Submission Guidelines and CMMI Releases Model Development and Testing Factsheet

Payment Innovation: PTAC

PTAC Updates Submission Guidelines and CMMI Releases Model Development and Testing Factsheet

January 10, 2019

PTAC has released updated submission guidelines.

POST

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ONC Releases Report to Congress: Adoption Increasing but Recommend Areas for Improvement

Payment Innovation: Other

ONC Releases Report to Congress: Adoption Increasing but Recommend Areas for Improvement

January 10, 2019

ONC releases its 2018 Report to Congress.

POST

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CMS Hosts Webinar on ESRD Quality Incentive Program

Payment Innovation: Other

CMS Hosts Webinar on ESRD Quality Incentive Program

January 10, 2019

CMS will host a webinar on January 15 from 2 to 3 pm ET on the End-Stage Renal Disease Quality Incentive Program.

POST

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

Payment Innovation: Other

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

January 10, 2019

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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Prescription Drug: Legislation

The Medicare Drug Price Negotiation Act (S. 99)

January 10, 2019

POST

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Prescription Drug: Legislation

The Medicare Drug Price Negotiation Act (H.R. 448)

January 10, 2019

POST

prescription-drug

Prescription Drug: Legislation

Empowering Medicare Seniors to Negotiate Drug Prices Act of 2019 (S. 62)

January 09, 2019

POST

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

Insight: original analysis

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

January 08, 2019

On December 31, 2018 CMS published the Medicare Shared Savings Program; Accountable Care Organizations—Pathways to Success and Extreme and Uncontrollable Circumstances Policies for Performance Year 2017 final rule.

ORIGINAL ANALYSIS

prescription-drug

Prescription Drug: Legislation

Medicare Prescription Drug Price Negotiation Act of 2019

January 08, 2019

POST

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Insurance Coverage: CMS

CMS Releases Final Weekly ACA Enrollment for the 2019

January 06, 2019

CMS releases final weekly ACA Enrollment for the 2019 enrollment period.

EXTERNAL LINK

diagnostic

Diagnostics: Date of Service

CMS Extends Enforcement Discretion of “Date of Service” Rule

January 03, 2019

CMS extends enforcement discretion of “Date of Service” Rule until July 1, 2019.

EXTERNAL LINK

diagnostic
CMS Publishes CLIA User Fee Update

Diagnostics: Guidance

CMS Publishes CLIA User Fee Update

January 02, 2019

On December 28, 2018 CMS published its CLIA User Fee Update.

EXTERNAL LINK

prescription-drug

Prescription Drug: Original Analysis

Court Issues Permanent Injunction Blocking Medicare 340B Payment Cuts

December 27, 2018

POST

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CMS Releases Final Rule Overhauling Medicare ACO Program

Payment Innovation: Regulation

CMS Releases Final Rule Overhauling Medicare ACO Program

December 21, 2018

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

POST

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CMS to Create New Office for Regulatory Reform

Payment Innovation: Other

CMS to Create New Office for Regulatory Reform

December 19, 2018

CMS Administrator Verma announced that the agency will be creating an office for regulatory reform. Once established, the purpose of the office will be to reduce “regulatory burden” for providers and other stakeholders created by CMS programs.

POST

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HHS Releases HIPAA RFI

Payment Innovation: Other

HHS Releases HIPAA RFI

December 19, 2018

HHS has released a request for information about how HIPAA rules could be modified to further the Secretary’s goal of promoting coordinated care. Comments are due February 11, 2019.

POST

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

December 19, 2018

CMS has updated its QPP Resource Center

POST

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CMS Hosts Webinar on Preventive Care and Screening eCQMs

Payment Innovation: Quality Payment Program

CMS Hosts Webinar on Preventive Care and Screening eCQMs

December 19, 2018

CMS will host a webinar on Preventive Care and Screening eCQMs on January 15

POST

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Key QPP Dates and Deadlines

Payment Innovation: Quality Payment Program

Key QPP Dates and Deadlines

December 19, 2018

As 2018 comes to a close, we are approaching key deadlines for the Quality Payment Program.

POST

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PTAC Recommends an Oncology Alternative Payment Model

Payment Innovation: PTAC

PTAC Recommends an Oncology Alternative Payment Model

December 19, 2018

At its December 10, 2018, public meeting, PTAC voted unanimously to recommend the proposed “Making Accountable Sustainable Oncology Networks (MASON)” alternative payment model to the secretary of the Department of Health and Human Services.

POST

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Federal District Court Invalidates Affordable Care Act

Insurance Coverage: Original Analysis

Federal District Court Invalidates Affordable Care Act

December 17, 2018

Late on Friday, December 14, 2018, a federal district judge in Texas struck down the Affordable Care Act (ACA) in its entirety. The district court did not, however, issue an injunction requiring immediate compliance. The decision and the ensuing developments are nonetheless potentially significant and merit attention by health care stakeholders.

ORIGINAL ANALYSIS

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HHS Announces CHPL Data Challenge Winners

Payment Innovation: Other

HHS Announces CHPL Data Challenge Winners

December 11, 2018

ONC announces winners of the Certified Health IT Product List (CHPL) Data Challenge.

POST

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MedPAC Considers Draft Recommendation to Revamp Hospital Value Based Purchasing Program

Payment Innovation: Other

MedPAC Considers Draft Recommendation to Revamp Hospital Value Based Purchasing Program

December 11, 2018

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

POST

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

December 11, 2018

CMS has added new resources to its QPP Resource Center

POST

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Now Available: MIPS Web-based Training Course

Payment Innovation: Quality Payment Program

Now Available: MIPS Web-based Training Course

December 11, 2018

A new web-based training course titled, Quality Payment Program: Merit-based Incentive Payment System Participation in 2018, is available through the MLN Learning Management System.

POST

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Updated List of Advanced APMs Released

Payment Innovation: Quality Payment Program

Updated List of Advanced APMs Released

December 11, 2018

CMS HAS recently posted an updated list of Alternative Payment Models.

POST

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Administration Releases Report on Healthcare Competition

Payment Innovation: Other

Administration Releases Report on Healthcare Competition

December 04, 2018

Departments of Health, Treasury and Labor release report titled “Reforming America’s Healthcare System Through Choice and Competition.”

POST

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

Payment Innovation: Other

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

December 04, 2018

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.

POST

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ONC Releases Draft Strategy to Reduce Health IT Burden

Payment Innovation: Other

ONC Releases Draft Strategy to Reduce Health IT Burden

December 04, 2018

On November 28, 2018, the Office of the National Coordinator for Health IT released a draft strategy to help reduce administrative and regulatory burden on clinicians caused by the use of health information technology.

POST

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

Payment Innovation: Other

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

December 04, 2018

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

POST

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

December 04, 2018

CMS has released MIPS-related QPP resources.

POST

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Physician Compare Preview Period is Now Open

Payment Innovation: Quality Payment Program

Physician Compare Preview Period is Now Open

December 04, 2018

Physician compare preview period is open through December 31, 2018.

POST

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Call for Comments: MIPS Outcome Measures

Payment Innovation: Quality Payment Program

Call for Comments: MIPS Outcome Measures

December 04, 2018

CMS is soliciting comments on two inpatient quality measures they are adapting for the Merit-based Incentive Payment System. Comments are due Jan 4, 2019.

POST

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

Payment Innovation: Quality Payment Program

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

December 04, 2018

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

POST

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CMS Releases MUC List

Payment Innovation: Quality Payment Program

CMS Releases MUC List

December 04, 2018

CMS releases MUC list.

POST

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CMS Hosts InCK Model Q&A Session on Dec. 13

Payment Innovation: Innovation Center

CMS Hosts InCK Model Q&A Session on Dec. 13

December 04, 2018

CMS will host a Q&A session on the Integrated Care for Kids Model on December 13, 2018 from 3 to 4 pm ET to respond to inquiries about the Model and the upcoming Notice of Funding Opportunity

POST

diagnostic

Diagnostics: Payment Rates

Medicare Laboratory Tests: Implementation of New Rates May Lead to Billions in Excess Payments

November 30, 2018

EXTERNAL LINK

prescription-drug

Prescription Drug: Regulation

Ceiling Price Effective Date

November 30, 2018

EXTERNAL LINK

diagnostic
FDA Releases Draft Guidance and Announces Webinar on CLIA Waiver Applications

Diagnostics: Guidance

FDA Releases Draft Guidance and Announces Webinar on CLIA Waiver Applications

November 28, 2018

The FDA has updated and released two draft guidance documents that aim to help manufacturers of in vitro diagnostic devices apply for and receive CLIA waivers.

POST

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Hargan Announces Innovation and Investment Summit Core Participants

Payment Innovation: Other

Hargan Announces Innovation and Investment Summit Core Participants

November 27, 2018

HH) announces core participants in the Deputy Secretary’s Innovation and Investment Summit.  The first meeting is December 18, 2018.

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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

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

November 27, 2018

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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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

November 27, 2018

CMS has updated the QPP resource library.

POST

prescription-drug

Prescription Drug: Original Analysis

Administration Offers Up New Proposals to Cut Drug Costs

November 26, 2018

POST

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CMS Hosts Webinars on Clinical Quality Language Basics on Nov. 27 and Nov. 29

Payment Innovation: Other

CMS Hosts Webinars on Clinical Quality Language Basics on Nov. 27 and Nov. 29

November 20, 2018

CMS will host a webinar on November 27, 2018 from 12 to 1 pm ET introducing the Clinical Quality Language logic expression language.

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ONC Holds 2018 Annual Meeting on Nov. 29

Payment Innovation: Other

ONC Holds 2018 Annual Meeting on Nov. 29

November 20, 2018

The Office of the National Coordinator for Health Information Technology will hold their 2018 Annual Meeting from November 29 ­to 30 in Washington, DC.

POST

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CMS Reports, Announcements and Webinars on Payment Innovation and Other Initiatives

Payment Innovation: Other

CMS Reports, Announcements and Webinars on Payment Innovation and Other Initiatives

November 20, 2018

CMS releases various payment innovation-related announcements.

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HELPS Hosts Health Care Affordability and Innovation Hearing on Nov. 28

Payment Innovation: Other

HELPS Hosts Health Care Affordability and Innovation Hearing on Nov. 28

November 20, 2018

HELP committee holds final hearing on in health care cost series.

POST

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PTAC Update: Preliminary Review Team Reports Released for Dec. 10 Public Meeting

Payment Innovation: PTAC

PTAC Update: Preliminary Review Team Reports Released for Dec. 10 Public Meeting

November 20, 2018

PTAC released Preliminary Review Team  reports for two physician-focused payment model proposals that are on the agenda for the public meeting scheduled for December 10, 2018.

POST

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CMS Announces Medicaid Demonstration to Expand Mental Health Treatment Services

Payment Innovation: Other , Quality Payment Program

CMS Announces Medicaid Demonstration to Expand Mental Health Treatment Services

November 13, 2018

CMS announces Medicaid demonstration to expand mental health treatment services.

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Innovation Center Posts New Resources

Payment Innovation: Innovation Center

Innovation Center Posts New Resources

November 13, 2018

CMS has updated it’s Innovation Center resources.

POST

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CMS Updates QPP Participation Status Tool with APM QP Snapshot Data

Payment Innovation: Quality Payment Program

CMS Updates QPP Participation Status Tool with APM QP Snapshot Data

November 13, 2018

CMS Updates QPP participation tool.

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CMS Hosts Webinar on 2019 Medicare PFS Final Rule on Nov. 19

Payment Innovation: Quality Payment Program

CMS Hosts Webinar on 2019 Medicare PFS Final Rule on Nov. 19

November 13, 2018

CMS to host webinar covering the 2019 MPFS final rule on November 19.

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

November 13, 2018

CMS has added additional resources to the QPP Resource Center.

POST

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93% of MIPS Eligible Clinicians Will Receive a Positive MIPS Payment Adjustment in 2019

Payment Innovation: Quality Payment Program

93% of MIPS Eligible Clinicians Will Receive a Positive MIPS Payment Adjustment in 2019

November 13, 2018

CMS has announced that 93 percent of MIPS eligible clinicians will receive a positive MIPS payment adjustment in 2019 based on their performance in 2017. Overall, 95 percent of eligible clinicians avoided a negative payment adjustment. The chart below summarizes the results.

POST

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Exchange Program Integrity Proposed Rule

Insurance Coverage: Regulation

Exchange Program Integrity Proposed Rule

November 09, 2018

The Centers for Medicare and Medicaid Services issued a proposed rule on the Health Insurance Exchanges.

EXTERNAL LINK

Top 10 Takeaways: 2019 Medicare Physician Fee Schedule

Insight: original analysis

Top 10 Takeaways: 2019 Medicare Physician Fee Schedule

November 06, 2018

On November 1, 2018, the Centers for Medicare & Medicaid Services released the CY 2019 Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Medicare Part B [CMS-1693F] Final Rule, which includes policies related to Medicare physician payment and the Quality Payment Program (QPP). The regulations will be published in the…

ORIGINAL ANALYSIS

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CMS Hosts Webinar on the 2019 Quality Payment Program Final Rule

Payment Innovation: Quality Payment Program

CMS Hosts Webinar on the 2019 Quality Payment Program Final Rule

November 06, 2018

CMS will host a webinar on Thursday, November 15, 2018 on the 2019 Quality Payment Program Final Rule.

POST

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

November 06, 2018

CMS has posted new QPP resources.

POST

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PTAC Update: PTAC Submits Four Reports to the Secretary and One New Proposal Open for Comment

Payment Innovation: PTAC

PTAC Update: PTAC Submits Four Reports to the Secretary and One New Proposal Open for Comment

November 06, 2018

The PTAC is soliciting comments on a proposal for a new physician-focused payment model.

POST

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MedPAC Discuss Advanced APMs and Other Value-based Issues at November 2018 Meeting

Payment Innovation: Other

MedPAC Discuss Advanced APMs and Other Value-based Issues at November 2018 Meeting

November 06, 2018

MedPAC discussed a number of topics at its November meeting, including Advanced APMS.

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CMS Releases CY 2019 MPFS/QPP Final Rule

Payment Innovation: Regulation

CMS Releases CY 2019 MPFS/QPP Final Rule

November 01, 2018

CMS has posted the CY 2019 MPFS/QPP Final Rule.

POST

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Institute for Medicaid Innovation Survey Finds Medicaid MCOs Are Increasingly Using Value-based Payment Models

Payment Innovation: Other

Institute for Medicaid Innovation Survey Finds Medicaid MCOs Are Increasingly Using Value-based Payment Models

October 30, 2018

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.

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CMS Releases Proposed Rule on Medicare Advantage, Medicare Part D, PAC and Medicaid

Payment Innovation: Other

CMS Releases Proposed Rule on Medicare Advantage, Medicare Part D, PAC and Medicaid

October 30, 2018

CMS releases proposed rule implementing certain provisions of the Bipartisan Budget Act of 2018.  Under this proposed rule, MA plans would be able to offer telehealth benefits beyond what is currently allowable under the traditional Medicare telehealth benefit.

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CMS Announces MOM Model

Payment Innovation: Innovation Center

CMS Announces MOM Model

October 30, 2018

CMS announces the Material Opioid Misuse (MOM) model as part of the agency’s strategy for combating the opioid crisis.

POST

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

October 30, 2018

CMS has uploaded a number of new resources to the QPP resource center, including web-based training courses.

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CMS Extends Cost Measure Field Testing to Nov. 5

Payment Innovation: Quality Payment Program

CMS Extends Cost Measure Field Testing to Nov. 5

October 30, 2018

CMS is extending the timeframe for submitting feedback on the 2018 field testing of cost measures until Monday, November 5, 2018, at 12:00 pm EDT.

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

Payment Innovation: Quality Payment Program

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

October 30, 2018

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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prescription-drug

Prescription Drug: Original Analysis

CMS Requests Comment on Potential IPI Model for Part B Drugs

October 25, 2018

POST

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Prescription Drug: Pricing , Regulation

ANPRM IPI Model for Medicare Part B Drugs

October 25, 2018

EXTERNAL LINK

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Administration Announces State Relief and Empowerment Waivers

Insurance Coverage: Administration

Administration Announces State Relief and Empowerment Waivers

October 23, 2018

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Payment Innovation: Other

LAN Releases Updated Report on APM Adoption

October 23, 2018

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

POST

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ASPE’s Social Risk Request for Information

Payment Innovation: Other

ASPE’s Social Risk Request for Information

October 23, 2018

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

POST

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GAO Makes PTAC Appointments

Payment Innovation: PTAC

GAO Makes PTAC Appointments

October 23, 2018

On October 18, 2018 the GAO announced the appointment of two new members to the Physician-Focused Payment Model Technical Advisory Committee (PTAC).

POST

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Upcoming QPP Webinars

Payment Innovation: Quality Payment Program

Upcoming QPP Webinars

October 23, 2018

CMS has scheduled several QPP webinars geared towards Physicians Compare and the CMS Web Interface for ACOs and Groups

POST

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CMS Releases Guidance on How 2019 Payment Adjustments Will Be Indicated on Claims

Payment Innovation: Quality Payment Program

CMS Releases Guidance on How 2019 Payment Adjustments Will Be Indicated on Claims

October 23, 2018

CMS has released guidance to help MIPS eligible clinicians understand how to identify and interpret the application of positive, neutral and/or negative MIPS payment adjustments to be applied to payments for certain claims submitted for services furnished in calendar year 2019 based on clinicians’ 2017 MIPS final scores.

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Prescription Drug: Pricing , Regulation

Regulation to Require Drug Pricing Transparency

October 18, 2018

EXTERNAL LINK

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MedPAC Releases 2018 Payment Basics – A Series of Briefs on the Various Medicare Payment Systems

Payment Innovation: Other

MedPAC Releases 2018 Payment Basics – A Series of Briefs on the Various Medicare Payment Systems

October 16, 2018

MedPAC releases 2018 Payment Basics, a series of briefs on the various Medicare payment systems.

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CMS Announces Changes to the Oversight of Medicare Accrediting Organizations

Payment Innovation: Other

CMS Announces Changes to the Oversight of Medicare Accrediting Organizations

October 16, 2018

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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Blueprint for the CMS Measures Management System Version 14.0 Released

Payment Innovation: Other

Blueprint for the CMS Measures Management System Version 14.0 Released

October 16, 2018

POST

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

Payment Innovation: Other

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

October 16, 2018

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

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Updates to QPP Resource Library

Payment Innovation: Quality Payment Program

Updates to QPP Resource Library

October 16, 2018

CMS has uploaded a number of new resources to the Quality Payment Program (QPP) Resource Library.

POST

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QPP Website Update: 2018 Performance Feedback for MIPS Quality Data Submitted via Claims Now Available

Payment Innovation: Quality Payment Program

QPP Website Update: 2018 Performance Feedback for MIPS Quality Data Submitted via Claims Now Available

October 16, 2018

CMS has updated the QPP website so individual eligible clinicians who choose to submit their Quality performance category data via claims can access performance feedback for the 2018 performance year on an ongoing basis.

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CMS Announces Field Testing of 13 Cost Measures through October 31, 2018

Payment Innovation: Quality Payment Program

CMS Announces Field Testing of 13 Cost Measures through October 31, 2018

October 16, 2018

CMSis conducting field testing for 13 cost measures before consideration of their potential use in the MIPS cost performance category in 2020 or beyond. Note: These are not the same measures currently in use for the 2017 and 2018 MIPS performance periods.

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CMS Hosts Webinar on Patient Relationship Categories and Codes

Payment Innovation: Quality Payment Program

CMS Hosts Webinar on Patient Relationship Categories and Codes

October 16, 2018

CMS to host webinar on patient relationship categories and codes on Wednesday, October 17, 2018.

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CMS Announces Participants in BPCI Advanced and Releases Evaluation Report for BPCI Initiative

Payment Innovation: Quality Payment Program

CMS Announces Participants in BPCI Advanced and Releases Evaluation Report for BPCI Initiative

October 10, 2018

CMS announces BPCI participants and releases its 5th evaluation report on the initiative.

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Legislation Introduced to Address MA Benchmark Cap

Payment Innovation: Other

Legislation Introduced to Address MA Benchmark Cap

October 02, 2018

POST

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CMS Announces Multi-Year eMedicare Initiative to Empower Beneficiaries

Payment Innovation: Other

CMS Announces Multi-Year eMedicare Initiative to Empower Beneficiaries

October 02, 2018

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CMS Releases CY 2019 Medicare Advantage Program Landscape Files

Payment Innovation: Other

CMS Releases CY 2019 Medicare Advantage Program Landscape Files

October 02, 2018

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MedPAC Considers Episode-based Payments for Post-Acute Care

Payment Innovation: Other

MedPAC Considers Episode-based Payments for Post-Acute Care

October 02, 2018

MedPAC will consider a staff analysis of two aspects of a stay-based unified prospective payment system (PPS) for post-acute care at its October meeting.

POST

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CMS Opens Virtual Groups Election Period for MIPS 2019 Performance Year

Payment Innovation: Quality Payment Program

CMS Opens Virtual Groups Election Period for MIPS 2019 Performance Year

October 02, 2018

CMS recently opened the annual virtual group election period for the MIPS 2019 Performance Year.

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Save the Date: Physician Compare National Provider Call

Payment Innovation: Quality Payment Program

Save the Date: Physician Compare National Provider Call

October 02, 2018

Save the Date: Physician Compare National Provider Call October 3, 2018 1:30 – 3:00 PM ET

POST

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QPP Developer Resource: CMS Open Sources Code for Developers that Calculates QPP Quality Measures from Claims Data

Payment Innovation: Quality Payment Program

QPP Developer Resource: CMS Open Sources Code for Developers that Calculates QPP Quality Measures from Claims Data

October 02, 2018

CMS open-sources QPP code responsible for calculating quality measures from Medicare claims data submitted by eligible clinicians via Quality Data Codes. This code is intended for developers interested in the calculation mechanism supporting QPP Claims to Quality.

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CMS Announces Field Testing of Cost Measures

Payment Innovation: Quality Payment Program

CMS Announces Field Testing of Cost Measures

October 02, 2018

CMS and its contractor, Acumen, will conduct field testing in October 2018 for 13 cost measures. These measures will be considered for use in the MIPS Cost Performance Category in 2020 or beyond.

POST

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GAO Makes Appointments to PCORI Governing Board

Payment Innovation: Other

GAO Makes Appointments to PCORI Governing Board

September 25, 2018

GAO announces PCORI board member appointments.

POST

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Representative DelBene Circulates Dear Colleague Letter on MIPS Low Volume Threshold

Payment Innovation: Quality Payment Program

Representative DelBene Circulates Dear Colleague Letter on MIPS Low Volume Threshold

September 25, 2018

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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CMS Awards Funding for Quality Measure Development

Payment Innovation: Quality Payment Program

CMS Awards Funding for Quality Measure Development

September 25, 2018

CMS announces the selection of seven applicants to receive cooperative agreement awards through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Funding Opportunity: Measure Development for the Quality Payment Program (QPP).

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Deputy Secretary Hargan Announces Collaboration to Accelerate Innovation and Investment in Healthcare – Call for Participants

Payment Innovation: Innovation Center

Deputy Secretary Hargan Announces Collaboration to Accelerate Innovation and Investment in Healthcare – Call for Participants

September 25, 2018

HHS accepting recommendations for participants in the  “Deputy Secretary’s Innovation and Investment Summit” working group.

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CMS Releases 2019 Preliminary CLFS Payment Determinations

Diagnostics: Payment Rates

CMS Releases 2019 Preliminary CLFS Payment Determinations

September 21, 2018

CMS releases CY 2019 preliminary recommendations for codes reviewed during summer the 2018 Lab Public Meeting.

EXTERNAL LINK

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

Diagnostics: OIG

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

September 20, 2018

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

POST

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Senate Hearings on Health Care Costs

Payment Innovation: Other

Senate Hearings on Health Care Costs

September 18, 2018

Senate HELP Committee to hold hearings on health care costs.

POST

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Payment Innovation: Other

GAO Recommends that DOD Use Common Key Quality Measures

September 18, 2018

GAO recommends that for all providers, the DOD use common key quality measures, expand their range, and develop consistent performance standards and requirements.

POST

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NQF Releases Report on Quality Measures for Rural Communities

Payment Innovation: Other

NQF Releases Report on Quality Measures for Rural Communities

September 18, 2018

POST

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Payment Innovation: Quality Payment Program

MIPS Resource: CMS Posts Infographic on 2019 Payment Adjustments

September 18, 2018

CMS recently posted an infographic on 2019 MIPS adjustments for the 2017 Performance Year.

POST

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CMS Posts Slides and Recording from Integrated Care for Kids Model Webinar

Payment Innovation: Innovation Center

CMS Posts Slides and Recording from Integrated Care for Kids Model Webinar

September 18, 2018

CMS Innovation Center posts resources from Integrated Care for Kids payment model webinar.

POST

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UPDATED: CMS Announces “Slight” Adjustments to 2017 Final MIPS Scores

Payment Innovation: Quality Payment Program

UPDATED: CMS Announces “Slight” Adjustments to 2017 Final MIPS Scores

September 18, 2018

CMS announces “slight” adjustments to some 2017 MIPS final scores.

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

Payment Innovation: Quality Payment Program

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

September 11, 2018

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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PTAC Recommends Models for Implementation and Limited Scale Testing at September 2018 Meeting

Payment Innovation: PTAC

PTAC Recommends Models for Implementation and Limited Scale Testing at September 2018 Meeting

September 11, 2018

POST

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MIPS Resource: CMS Posts Details on Beneficiary Assignment Methodology for Groups and Virtual Groups

Payment Innovation: Quality Payment Program

MIPS Resource: CMS Posts Details on Beneficiary Assignment Methodology for Groups and Virtual Groups

September 11, 2018

CMS recently posted a report that describes the process used by CMS for assigning beneficiaries to a group or a virtual group participating in the Merit-based Incentive Payment System.

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Five Key Takeaways: CJR Year 1 Performance Evaluation

Insight: original analysis

Five Key Takeaways: CJR Year 1 Performance Evaluation

September 11, 2018

A recently released evaluation of the CMS Comprehensive Care for Joint Replacement Model found a statistically significant reduction in spending in both high cost and low cost areas during the first performance year. Here are our five key takeaways.

ORIGINAL ANALYSIS

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Insurance Coverage: Litigation

Texas Judge Hears Arguments in ACA Case

September 07, 2018

POST

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CMS Webinar on All-Payer Combination Option

Payment Innovation: Quality Payment Program

CMS Webinar on All-Payer Combination Option

September 05, 2018

POST

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CMS Posts Medicaid Other Payer Advanced APMs List and Eligible Clinician Initiated Submission Form

Payment Innovation: Quality Payment Program

CMS Posts Medicaid Other Payer Advanced APMs List and Eligible Clinician Initiated Submission Form

September 05, 2018

CMS posts two new APM resources related to other payer Advanced APMs.

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Payment Innovation: Other

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

September 05, 2018

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.

POST

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CMS Hosts Virtual Office Hours on the 2019 MIPS Performance Period Self-Nomination Process

Payment Innovation: Quality Payment Program

CMS Hosts Virtual Office Hours on the 2019 MIPS Performance Period Self-Nomination Process

September 05, 2018

On September 20, 2018, CMS is hosting a virtual office hours session on the 2019 MIPS self-nomination process.

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2018 MIPS Resources for Anesthesiologists, Cardiologists and Radiologists Posted on QPP Resource Center

Payment Innovation: Quality Payment Program

2018 MIPS Resources for Anesthesiologists, Cardiologists and Radiologists Posted on QPP Resource Center

September 05, 2018

CMS has posted resource documents on the Merit-based Incentive Payment System (MIPS) for anesthesiologists, cardiologists and radiologists.

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CMS Posts 2018 MIPS Data Validation Criteria

Payment Innovation: Quality Payment Program

CMS Posts 2018 MIPS Data Validation Criteria

September 05, 2018

CMS posts validation criteria for the 2018 Merit-based Incentive Payment System (MIPS) program.

POST

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Integrated Care for Kids (InCK) Model Overview Webinar

Payment Innovation: Innovation Center

Integrated Care for Kids (InCK) Model Overview Webinar

September 05, 2018

POST

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CMS Releases 2017 MSSP ACO Performance Data

Payment Innovation: Quality Payment Program

CMS Releases 2017 MSSP ACO Performance Data

September 05, 2018

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

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Top 5 Takeaways: CMS’s Proposed Overhaul of the MSSP ACOs

Insight: original analysis

Top 5 Takeaways: CMS’s Proposed Overhaul of the MSSP ACOs

August 30, 2018

On August 17, 2018, CMS released proposed rule that would make sweeping changes to the Medicare Shared Savings Program, a federal program that incentivizes integrated health provider networks to form Accountable Care Organizations. Comments are due October 16, 2018. Our top 5 takeaways follow.

ORIGINAL ANALYSIS

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Insurance Coverage: Legislation

Senate Republicans Introduce Pre-existing Conditions Protection Bill

August 28, 2018

The Ensuring Coverage for Patients with Pre-Existing Conditions Act (S. 3388) was introduced on August 23rd by Senate Republicans in an effort to protect pre-existing conditions.

POST

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Payment Innovation: Quality Payment Program

CMS Hosts 2019 Performance Period MIPS Self-Nomination JIRA Demonstration Webinar on August 30th

August 28, 2018

CMS is hosting a webinar at 2:00 PM ET on August 30, 2018, on the 2019 Performance Period MIPS self-nomination process.

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Payment Innovation: Quality Payment Program

Call for Nomination: Improvement Activities TEP

August 28, 2018

CMS has issued a call for nominations for its MIPS Improvement Activities Technical Expert Panel (TEP). CMS is seeking feedback from a group of stakeholders, consumers, patients and experts who can contribute direction and thoughtful input on the improvement activities during development and maintenance.

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Payment Innovation: Quality Payment Program

Registration Open for 2018 LAN Summit

August 28, 2018

The Health Care Payment Learning & Action Network (LAN) is hosting their 2018 Fall Summit on Monday, October 22 at the Sheraton Tysons Hotel in Tysons, VA.

POST

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Payment Innovation: Quality Payment Program

ONC Releases Request for Information

August 28, 2018

The Office of the National Coordinator for Health IT released a request for information on criteria to measure the performance of certified electronic health record technology, as required by the 21st Century Cures Act.

POST

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OIG Releases Request for Information on Anti-Kickback Statute and Beneficiary Inducements

Payment Innovation: Other

OIG Releases Request for Information on Anti-Kickback Statute and Beneficiary Inducements

August 28, 2018

The OIG published a request for information seeking stakeholder input on potential new safe harbors to the Anti-Kickback Statute and exceptions to the beneficiary inducement prohibition in the Civil Monetary Penalty Law to remove impediments to care coordination and value-based care.

POST

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Payment Innovation: Innovation Center

CMS Releases Next Gen ACO Model Evaluation

August 28, 2018

CMS released the first annual report on the Next Generation Accountable Care Organization (ACO) model.  The report provides results from the 18 active Next Gens who participated beginning January 2016.

POST

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CMS Announces Integrated Care for Kids Model to Address the Opioid Crisis

Payment Innovation: Innovation Center

CMS Announces Integrated Care for Kids Model to Address the Opioid Crisis

August 28, 2018

On August 23, 2018, CMS announced a new model that is intended to address the opioid crisis for children.

POST

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CMS Awards $8.6 Million to Strengthen States Insurance Markets

Insurance Coverage: Administration

CMS Awards $8.6 Million to Strengthen States Insurance Markets

August 21, 2018

Administration announces State Flexibility to Stabilize the Market Grant Program which will provide funding to 30 states and the District of Columbia for state exchanges.

POST

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CMS Posts Virtual Groups Toolkit for 2019 MIPS Performance Year

Payment Innovation: Quality Payment Program

CMS Posts Virtual Groups Toolkit for 2019 MIPS Performance Year

August 21, 2018

CMS hosts virtual group webinar on August 27, 2018 at 2pm ET

POST

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Payment Innovation: Other

2016 Physician Quality Reporting System Experience Report and the 2018 Value Modifier Experience Report Are Now Available

August 21, 2018

POST

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Registration Open for September 6-7, 2018, PTAC Meeting

Payment Innovation: PTAC

Registration Open for September 6-7, 2018, PTAC Meeting

August 21, 2018

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) recently opened registration for public meeting on September 6-7, 2018.

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Payment Innovation: Quality Payment Program

Quality Payment Program Exception Applications Now Available

August 14, 2018

Applications are due by December 31, 2018

POST

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Payment Innovation: Quality Payment Program

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

August 14, 2018

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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CMS Releases Proposed Rule Overhauling Medicare Shared Savings Program

Payment Innovation: Regulation

CMS Releases Proposed Rule Overhauling Medicare Shared Savings Program

August 14, 2018

On August 9th, CMS released the Medicare Shared Savings Program proposed rule.

POST

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CMS Opens Application for Medicare Advantage Qualifying Incentive Arrangement Demonstration

Payment Innovation: Quality Payment Program

CMS Opens Application for Medicare Advantage Qualifying Incentive Arrangement Demonstration

August 07, 2018

CMS is now accepting applications for the Medicare Advantage Qualifying Incentive Arrangement demonstration project under the Medicare Access and CHIP Reauthorization Act Quality Payment Program.

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Payment Innovation: Quality Payment Program

CMS Hosts QPP Conference Calls

August 07, 2018

The Centers for Medicare & Medicaid Services (CMS) is hosting two Quality Payment Program (QPP)-related conference calls.

POST

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Payment Innovation: Other

CMS Solicits Feedback on QPP Website

August 07, 2018

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