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Featured Content

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.

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

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MACPAC Publishes Agenda and Moves April Public Meeting Online

Payment Innovation: Other

MACPAC Publishes Agenda and Moves April Public Meeting Online

April 01, 2020

MACPAC posted the agenda for their April 2 public meeting which will be hosted online. Registration for the online meeting can be accessed here.

POST

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MedPAC Releases Agenda for Closed-door April Meeting

Payment Innovation: Other

MedPAC Releases Agenda for Closed-door April Meeting

April 01, 2020

MedPAC posted the agenda for the next meeting scheduled for April 2. Due to the coronavirus outbreak, the Commission has announced that the April meeting will not be open to the public. MedPAC will post a transcript of the meeting by COB on Friday, April 3.

POST

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CMS Issues Guidance on Open Payment Data Submission

Payment Innovation: Other

CMS Issues Guidance on Open Payment Data Submission

April 01, 2020

CMS has issued guidance related to Open Payment reporting. The agency has indicated they do not have the authority to extend the deadline for reporting entities past the current March 30th deadline but can provide some flexibility.

POST

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

April 01, 2020

CMS uploaded new and updated materials to the QPP Resource Library.

POST

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Pharmaceutical Manufacturers Announced for the Part D Senior Savings Model

Payment Innovation: Innovation Center

Pharmaceutical Manufacturers Announced for the Part D Senior Savings Model

April 01, 2020

On March 23, CMS announced the three participating pharmaceutical manufacturers for the new Part D Senior Savings Model. The pharmaceutical manufacturers participating in the model include Eli Lilly and Company, Novo Nordisk, and Sanofi-Aventis.

POST

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COVID-19 Activities and Actions Update

Payment Innovation: COVID-19

COVID-19 Activities and Actions Update

April 01, 2020

As part of the ongoing White House Coronavirus Task Force efforts, CMS and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting organizations, and taken other related actions.

POST

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CMS Expands Accelerated Payment Program

Payment Innovation: COVID-19

CMS Expands Accelerated Payment Program

April 01, 2020

On March 28, 2020, CMS announced an expansion of its accelerated payment program to help provide financial relief to Medicare providers and suppliers affected by COVID-19.

POST

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Trump Administration Calls on Hospitals to Report COVID-19 Data

Payment Innovation: COVID-19

Trump Administration Calls on Hospitals to Report COVID-19 Data

April 01, 2020

On March 29, 2020, the Trump Administration and CMS sent a letter to hospitals across the country requesting immediate and daily reporting of COVID-19 testing data from in-house laboratories.

POST

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CMS Approves Sweeping Changes to Expand Care During the National Emergency

Payment Innovation: COVID-19

CMS Approves Sweeping Changes to Expand Care During the National Emergency

April 01, 2020

On March 30, CMS announced several new temporary waivers and an interim final rule to expand beneficiary access to services during the coronavirus disease 2019 (COVID-19) outbreak.

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Oklahoma Draft Block Grant Waiver Application

Insurance Coverage: Waivers

Oklahoma Draft Block Grant Waiver Application

March 31, 2020

On March 16, 2020, Oklahoma Governor Kevin Stitt issued a draft Section 1115 waiver application to expand the state’s Medicaid program (SoonerCare) and make other modifications

ORIGINAL ANALYSIS

diagnostic
CMS issues guidance on broad waivers and flexibilities related to COVID-19.

Diagnostics

CMS issues guidance on broad waivers and flexibilities related to COVID-19.

March 30, 2020

On March 30,CMS announced a broad range of waivers and flexibilities for providers as the country is faced with the COVID-19 public health emergency.

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Congress passes CARES Act

Diagnostics

Congress passes CARES Act

March 27, 2020

On March 27, 2020, the President signed the Coronavirus Aid, Relief, and Economic Security (CARES) Act.

POST

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FDA updates its FAQ on COVID-19 testing and gives EUA to additional tests

Diagnostics

FDA updates its FAQ on COVID-19 testing and gives EUA to additional tests

March 25, 2020

On March 28, FDA again updated its FAQ regarding specimen collection for COVID-19 testing.

POST

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FDA updates its FAQ on COVID-19 testing and gives EUA to additional tests

Diagnostics

FDA updates its FAQ on COVID-19 testing and gives EUA to additional tests

March 25, 2020

On March 23, FDA updated its FAQ regarding specimen collection for COVID-19 testing.

POST

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

March 24, 2020

CMS uploaded new and updated materials to the QPP Resource Library.

POST

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MIPS 2019 Performance Year Submission Deadline Extended

Payment Innovation: Quality Payment Program

MIPS 2019 Performance Year Submission Deadline Extended

March 24, 2020

On March 23, 2020, CMS extended the deadline for clinicians to submit data for the 2019 performance year of the MIPS.

POST

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Primary Care First Deadline Extended

Payment Innovation: Innovation Center

Primary Care First Deadline Extended

March 24, 2020

In light of the recent COVID-19 outbreak and its impact on the healthcare industry, CMS extended the payer solicitation period for the PCF Model until May 20, 2020.

POST

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CMS Approves 11 Additional Medicaid Section 1135 Waivers

Payment Innovation: COVID-19

CMS Approves 11 Additional Medicaid Section 1135 Waivers

March 24, 2020

This announcement from the Centers for Medicare and Medicaid Services (CMS) brings the total number of approved Section 1135 waivers for states to 13.

POST

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COVID-19 Activities and Actions Update

Payment Innovation: COVID-19

COVID-19 Activities and Actions Update

March 24, 2020

As part of the ongoing White House Coronavirus Task Force efforts, CMS and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting organizations, and taken other related actions.

POST

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FDA issues guidance on unauthorized fraudulent COVID-19 test kits

Diagnostics

FDA issues guidance on unauthorized fraudulent COVID-19 test kits

March 22, 2020

On March 20, the FDA issued new guidance alerting consumers about the unauthorized, fraudulent COVID-19 test kits.

POST

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FDA gives EUA for first point-of-care COVID-19 test

Diagnostics

FDA gives EUA for first point-of-care COVID-19 test

March 22, 2020

Since March 19, the FDA announced four additional Emergency Use Authorizations granted for diagnostic tests for COVID-19 including the first point-of-care test.

POST

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FDA gives EUA to additional tests for diagnostic testing for COVID-19

Diagnostics

FDA gives EUA to additional tests for diagnostic testing for COVID-19

March 19, 2020

Since March 17, the FDA announced three additional Emergency Use Authorizations granted for diagnostic tests for COVID-19.

POST

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MACPAC Publishes March 2020 Report to Congress

Payment Innovation: Other

MACPAC Publishes March 2020 Report to Congress

March 18, 2020

MACPAC released its March 2020 Report to Congress on Friday, March 13, 2020.

POST

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

March 18, 2020

CMS uploaded new and updated materials to the QPP Resource Library.

POST

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CMS Schedules Office Hours for MA VBID Model

Payment Innovation: Innovation Center

CMS Schedules Office Hours for MA VBID Model

March 18, 2020

On Thursday, March 19, the Centers for Medicare and Medicaid Services will host office hours on the MA VBID Model.

POST

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CMS Announced New Insulin Payment Model

Payment Innovation: Innovation Center

CMS Announced New Insulin Payment Model

March 18, 2020

CMS has announced a new, voluntary, Part D Senior Savings Model that would lower Medicare beneficiaries’ out-of-pocket costs for insulin to a maximum $35 copay per 30-day supply throughout the benefit year.

POST

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Trump Administration Expands Medicare Telehealth Benefits

Payment Innovation: COVID-19

Trump Administration Expands Medicare Telehealth Benefits

March 18, 2020

On March 17, 2020, CMS and other agencies released further guidance on the use of telehealth during the declared national emergency related to the coronavirus (COVID-19) pandemic.

POST

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MedPAC Publishes March 2020 Report to Congress

Payment Innovation: Other

MedPAC Publishes March 2020 Report to Congress

March 18, 2020

MedPAC published the March 2020 Report to Congress on Friday, March 13, 2020.

POST

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COVID-19 Activities and Actions

Payment Innovation: COVID-19

COVID-19 Activities and Actions

March 18, 2020

As part of ongoing White House Coronavirus Task Force efforts, CMS and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting organizations, and taken other related actions.

POST

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AMA Adopts New CPT Code for COVID-19 Lab Testing

Payment Innovation: COVID-19

AMA Adopts New CPT Code for COVID-19 Lab Testing

March 18, 2020

AMA CPT® Editorial Panel adopted a new CPT® code that describes the laboratory testing for COVID-19. The new CPT® code is effective as of March 13, 2020.

POST

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CMS Approves First State Request for 1135 Medicaid Waiver in Florida

Payment Innovation: COVID-19 , COVID-19

CMS Approves First State Request for 1135 Medicaid Waiver in Florida

March 18, 2020

On March 13, 2020, President Trump declared the COVID-19 situation a national emergency which enables the CMS to waive certain requirements in Medicare, Medicaid, and CHIP under Section 1135 authority.

POST

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LOINC special use codes created for SARS-CoV-2

Diagnostics

LOINC special use codes created for SARS-CoV-2

March 17, 2020

In response to the emergent health situation, special use codes have been developed for SARS-CoV-2 testing.

POST

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FDA gives EUA to additional tests and issues policy on diagnostic testing for COVID-19

Diagnostics

FDA gives EUA to additional tests and issues policy on diagnostic testing for COVID-19

March 17, 2020

Since March 13, the FDA announced three additional Emergency Use Authorizations granted for diagnostic tests for COVID-19.

POST

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AMA created a new code for novel coronavirus testing

Diagnostics

AMA created a new code for novel coronavirus testing

March 16, 2020

Following its CPT Editorial Panel meeting, the AMA created a new code for novel coronavirus testing.

POST

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FDA took two additional steps in response to the coronavirus (COVID-19) outbreak

Diagnostics

FDA took two additional steps in response to the coronavirus (COVID-19) outbreak

March 13, 2020

On March 12, 2020, the FDA took two additional steps to address the coronavirus (COVID-19) outbreak.

POST

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Pricing Announced for the Two New HCPCS Codes for Coronavirus Testing

Diagnostics

Pricing Announced for the Two New HCPCS Codes for Coronavirus Testing

March 12, 2020

CMS has announced that the two new HCPCS codes created for coronavirus testing – U0001 (for tests developed by the CDC) and U0002 (for non-CDC laboratory tests) – will be priced by the local Medicare Administrative Contractors.

POST

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AMA is Expediting Code Development for Novel Coronavirus Test

Diagnostics

AMA is Expediting Code Development for Novel Coronavirus Test

March 11, 2020

The AMA is holding a special CPT Editorial Panel meeting this week to consider a code for novel coronavirus tests.

POST

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CMS Promoting Interoperability Webinar Scheduled for March 19

Payment Innovation: Other

CMS Promoting Interoperability Webinar Scheduled for March 19

March 10, 2020

CMS has scheduled a webinar on Thursday, March 19, to discuss the Annual Call for Measures for consideration in the Medicare Promoting Interoperability Program.

POST

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MedPAC Discusses Innovation Improvements and Mandated Report to Congress

Payment Innovation: Other

MedPAC Discusses Innovation Improvements and Mandated Report to Congress

March 10, 2020

MedPAC met on March 5-6 to consider presentations and recommendations from MedPAC staff related to quality improvement, risk adjustment and payment innovation.

POST

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Bipartisan Bill Relaxes Federal Telehealth Requirements in the Wake of COVID-19

Payment Innovation: Other

Bipartisan Bill Relaxes Federal Telehealth Requirements in the Wake of COVID-19

March 10, 2020

President Trump signed the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 (P.L. 116-123) into law.

POST

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CMS COVID-19 Activities and Actions

Payment Innovation: Other

CMS COVID-19 Activities and Actions

March 10, 2020

As part of ongoing White House Coronavirus Task Force efforts, the CMS has issued a number of resource documents, refocused activities related to state survey agencies and accrediting organizations; and taken other related actions.

POST

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ONC and CMS to Host Webinars on the Recently Released Interoperability and Information Blocking Final Rules

Payment Innovation: Other

ONC and CMS to Host Webinars on the Recently Released Interoperability and Information Blocking Final Rules

March 10, 2020

ONC released its long awaited final rule adopting exceptions to the Cures Act’s information blocking prohibition and updates to the ONC’s health IT certification program.

POST

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PTAC Publishes Reports Evaluating Proposals Considered as of December 2019

Payment Innovation: PTAC

PTAC Publishes Reports Evaluating Proposals Considered as of December 2019

March 10, 2020

PTAC published two new reports evaluating the models that PTAC reviewed and submitted to the Secretary of Health and Human Services for consideration

POST

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CMS Publishes Projected Timeline for Key Dates Related to Direct Contracting Model

Payment Innovation: Innovation Center

CMS Publishes Projected Timeline for Key Dates Related to Direct Contracting Model

March 10, 2020

CMS published a calendar highlighting key dates for stakeholders interested in the Direct Contracting Model.

POST

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Congress Introduces New Legislation for Diagnostics Regulation

Diagnostics

Congress Introduces New Legislation for Diagnostics Regulation

March 06, 2020

Reps. Larry Bucshon, R-Ind., and Diana DeGette, D-Colo., introduced the Verifying Accurate Leading-edge IVCT Development Act of 2020 (VALID).

POST

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CMS Develops a Second HCPCS Code for Coronavirus Testing

Diagnostics

CMS Develops a Second HCPCS Code for Coronavirus Testing

March 06, 2020

CMS created a second HCPCS code that providers and laboratories may use to report Coronavirus lab testing. Code U0001 will be for the CDC testing laboratory tests for patients with SARS-CoV-2.

POST

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MACPAC Commissioners Support VBP State Comparison Report

Payment Innovation: Other

MACPAC Commissioners Support VBP State Comparison Report

March 03, 2020

MACPAC held a public meeting on February 27-28, 2020.

POST

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MedPAC Agenda Available for the March 2020 Public Meeting

Payment Innovation: Other

MedPAC Agenda Available for the March 2020 Public Meeting

March 03, 2020

MedPAC has posted the agenda for the next public meeting scheduled for March 5-6, 2020.

POST

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

March 03, 2020

CMS uploaded new and updated materials to the QPP Resource Library.

POST

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Top 5 Takeaways from the 2020 CMS Quality Conference

Payment Innovation: Quality Payment Program

Top 5 Takeaways from the 2020 CMS Quality Conference

March 03, 2020

CMS hosted the 2020 Quality Conference from February 25-27, 2019.

POST

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PTAC Update: Revised Proposal Open for Comment and Secretary’s Responses to Recommendations

Payment Innovation: PTAC

PTAC Update: Revised Proposal Open for Comment and Secretary’s Responses to Recommendations

March 03, 2020

PTAC is soliciting comments through March 20, 2020, on a revised payment model: “The ‘Medical Neighborhood’ AAPM,” proposed by the American College of Physicians and the National Committee for Quality Assurance.

POST

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Ambulance Model Applicants Announced

Payment Innovation: Innovation Center

Ambulance Model Applicants Announced

March 03, 2020

CMMI has selected 205 applicants across 36 states and the District of Columbia to participate in the ET3 Model.

POST

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Independence at Home Demonstration: Year Five Evaluation Report Posted

Payment Innovation: Innovation Center

Independence at Home Demonstration: Year Five Evaluation Report Posted

March 03, 2020

CMS posted the evaluation report and a summary of the findings for Year Five of the IAH Demonstration.

POST

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Maryland All-Payer Model Resulted in $975 Million in Total Savings

Payment Innovation: Innovation Center

Maryland All-Payer Model Resulted in $975 Million in Total Savings

March 03, 2020

CMS released the final evaluation report and a summary of the findings for the MDAPM.

POST

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Second Annual Report Published: Medicare Care Choices Model Provided Additional Transitional Support to Hospice Care

Payment Innovation: Innovation Center

Second Annual Report Published: Medicare Care Choices Model Provided Additional Transitional Support to Hospice Care

March 03, 2020

CMS released the second annual report and a summary of the findings at a glance for the MCCM.

POST

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FDA Posts a Number of New Items Related to Coronavirus

Diagnostics

FDA Posts a Number of New Items Related to Coronavirus

March 02, 2020

On February 29, 2020, the FDA issued a new guidance document (immediately in effect) on its policy for diagnostic testing in laboratories certified to perform high complexity testing under CLIA prior to EUA for COVID-19 during the public health emergency.

POST

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FDA Issues Two CLIA-Related Final Guidance Documents

Diagnostics

FDA Issues Two CLIA-Related Final Guidance Documents

February 26, 2020

The FDA issued two final guidance documents.

POST

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MACPAC Releases Agenda for February 2020 Public Meeting

Payment Innovation: Other

MACPAC Releases Agenda for February 2020 Public Meeting

February 25, 2020

MACPAC posted the agenda for their next public meeting scheduled for February 27, 2020.

POST

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ONC Publishes Strategy to Reduce Administrative Burden Related to Health IT

Payment Innovation: Other

ONC Publishes Strategy to Reduce Administrative Burden Related to Health IT

February 25, 2020

CMS and the ONC recently released the Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs.

POST

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CMS Releases RFI on Rural Maternal and Infant Health

Payment Innovation: Other

CMS Releases RFI on Rural Maternal and Infant Health

February 25, 2020

Seema Verma, Administrator of the CMS, released a Request for Information (RFI) to seek public comments regarding rural maternal and infant health care.

POST

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March 31 Deadline for MIPS Data Submission

Payment Innovation: Quality Payment Program

March 31 Deadline for MIPS Data Submission

February 25, 2020

The deadline for eligible clinicians to submit 2019 performance year data for the MIPS is March 31 at 8:00 PM (EDT).

POST

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CMS Updates QPP Resources

Payment Innovation: PTAC , Quality Payment Program

CMS Updates QPP Resources

February 25, 2020

CMS uploaded new materials to the QPP Resource Library.

POST

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PTAC Update: March 16 Agenda Update

Payment Innovation: PTAC

PTAC Update: March 16 Agenda Update

February 25, 2020

PTAC has updated the agenda for the scheduled March 16 public meeting.

POST

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Top 5 Takeaways: CMS Proposes to Extend and Expand CJR

Payment Innovation: Innovation Center

Top 5 Takeaways: CMS Proposes to Extend and Expand CJR

February 25, 2020

CMS issued a proposed rule that would make modifications to the CJR Model.

POST

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CMS Hosts Webinar on Value-Based Insurance Design (VBID) Model

Payment Innovation: Innovation Center

CMS Hosts Webinar on Value-Based Insurance Design (VBID) Model

February 25, 2020

CMS will host a webinar to discuss the CY 2021 Hospice Capitation Payment Rate Actuarial Methodology for the Hospice Benefit Component of the VBID Model.

POST

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AMA Posts CPT Editorial Panel Agenda for May 2020 meeting

Diagnostics

AMA Posts CPT Editorial Panel Agenda for May 2020 meeting

February 21, 2020

The AMA posted the laboratory / pathology agenda items for the May 2020 CPT Editorial Panel meeting.

POST

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CMS Issues Revised Guidance on AUC Reporting

Diagnostics

CMS Issues Revised Guidance on AUC Reporting

February 20, 2020

CMS issues revised guidance on where line level ordering professional information should be reported on institutional claims and with an updated list of clinical decision support mechanisms.

POST

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CMS Develops New HCPCS Code for Coronavirus Testing

Diagnostics

CMS Develops New HCPCS Code for Coronavirus Testing

February 13, 2020

CMS created a new HCPCS code that providers and laboratories may use to report Coronavirus lab testing.

POST

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Deadline to Submit Promoting Interoperability CY 2019 Data: March 2

Payment Innovation: Other

Deadline to Submit Promoting Interoperability CY 2019 Data: March 2

February 11, 2020

The deadline for hospitals to submit registration and meaningful use attestations for the Promoting Interoperability program for the 2019 performance year is March 2, 2020.

POST

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CMS Releases MA Advance Notice, Policy and Technical Changes Proposed Rule

Payment Innovation: Other

CMS Releases MA Advance Notice, Policy and Technical Changes Proposed Rule

February 11, 2020

CMS issued two documents affecting the MA program.

POST

Medicare Advantage Advance Notice and Policy and Technical Changes Proposed Rule

Insight: original analysis

Medicare Advantage Advance Notice and Policy and Technical Changes Proposed Rule

February 11, 2020

On February 5, 2020, CMS issued two documents impacting the Medicare Advantage program: (1) the Medicare and Medicaid Programs: Contract Year 2021 and 2022 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly Proposed Rule; and (2) the…

ORIGINAL ANALYSIS

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White House Releases FY2021 Budget Proposal Requesting $94.5 Billion in HHS Discretionary Spending

Payment Innovation: Other

White House Releases FY2021 Budget Proposal Requesting $94.5 Billion in HHS Discretionary Spending

February 11, 2020

The White House released its $4.8 trillion FY 2021 budget proposal. The budget outlines the Administration’s priorities for the upcoming fiscal year.

POST

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PTAC Update: March 16 Meeting Registration Open and Additional Preliminary Reports Posted

Payment Innovation: PTAC

PTAC Update: March 16 Meeting Registration Open and Additional Preliminary Reports Posted

February 11, 2020

PTAC posted the agenda and opened registration for the March 16 public meeting.

POST

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CMS Posts Office Hours Slides for Direct Contracting Model

Payment Innovation: Innovation Center

CMS Posts Office Hours Slides for Direct Contracting Model

February 11, 2020

CMS hosted office hours on the Direct Contracting Model.

POST

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CMS Posts Slides from Recent VBID Model Webinar

Payment Innovation: Innovation Center

CMS Posts Slides from Recent VBID Model Webinar

February 11, 2020

Medicare Advantage VBID Model team hosted a webinar to provide information and answer questions about the hospice benefit component that will be added to the VBID Model in 2021.

POST

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Prescription Drug Pricing Tracker

Prescription Drug: Original Analysis

Prescription Drug Pricing Tracker

February 07, 2020

There are a lot of moving parts when it comes to prescription drug cost reform. Keep up-to-date with our tracker! (Updated 02.07.2020)

POST

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Stakeholders Push for the Adoption of CMS and ONC Interoperability Rules

Payment Innovation: Other

Stakeholders Push for the Adoption of CMS and ONC Interoperability Rules

February 05, 2020

Technology companies and other stakeholders submitted a letter urging the Acting Director of the OMB and the Secretary of HHS to finalize new rules creating additional opportunities for data sharing.

POST

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CMS Updates Hospital Compare without Updating Evaluation Criteria

Payment Innovation: Other

CMS Updates Hospital Compare without Updating Evaluation Criteria

February 05, 2020

CMS announced an update to the hospital compare tool to include overall hospital star ratings.

POST

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CMS Releases HCPCS Codes for Certain Outpatient Services Requiring Prior Authorization

Payment Innovation: Other

CMS Releases HCPCS Codes for Certain Outpatient Services Requiring Prior Authorization

February 05, 2020

CMS released the list of hospital outpatient department services and the HCPCS billing codes that will require prior authorization provided after July 1, 2020.

POST

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Trump Administration Announces Medicaid Block Grant Proposal

Payment Innovation: Other

Trump Administration Announces Medicaid Block Grant Proposal

February 05, 2020

The initiative, called the HAO initiative, would allow states to submit a Section 1115 waiver to implement a block grant or per capita cap alternative for certain Medicaid populations while being granted increased flexibility to administer their Medicaid program.

POST

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

February 05, 2020

CMS uploaded new materials to the QPP Resource Library.

POST

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Listening Session: TEP Developing Episode-Based Physician Cost Measures

Payment Innovation: Quality Payment Program

Listening Session: TEP Developing Episode-Based Physician Cost Measures

February 05, 2020

CMS, in contract with Acumen, LLC, is convening a TEP to help develop episode-based cost measures during a two-day meeting on February 6 and 7.

POST

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CMS Announces MIPS Value Pathways Overview Webinar: Feb 12

Payment Innovation: Quality Payment Program

CMS Announces MIPS Value Pathways Overview Webinar: Feb 12

February 05, 2020

CMS scheduled a webinar to provide an overview of the Merit-based Incentive Payment System (MIPS) Value Pathways (MVPs) participation framework.

POST

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Annual Call for MIPS Measures and Activities: Promoting Interoperability and Improvement Activities

Payment Innovation: Quality Payment Program

Annual Call for MIPS Measures and Activities: Promoting Interoperability and Improvement Activities

February 05, 2020

CMS is currently accepting submissions for new measures to be included in the Merit-based Incentive Payment System MIPS Promoting Interoperability and Improvement Activities performance categories.

POST

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CMS Identifies Hospitals to Receive Lower Payments in FY 2020 Under the HAC Reduction Program

Payment Innovation: Quality Payment Program

CMS Identifies Hospitals to Receive Lower Payments in FY 2020 Under the HAC Reduction Program

February 05, 2020

CMS published the dataset listing the hospitals that will receive a one percent reduction in payments in FY 2020 under the HAC Reduction Program.

POST

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PTAC Update: New Oncology Medical Home Model Open for Comment

Payment Innovation: PTAC

PTAC Update: New Oncology Medical Home Model Open for Comment

February 05, 2020

PTAC is soliciting comments through February 18, 2020, on a new proposed payment model: PCOP Model.

POST

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House Introduces Legislation to Increase Oversight of CMMI

Payment Innovation: Innovation Center

House Introduces Legislation to Increase Oversight of CMMI

February 05, 2020

A bipartisan group of Representatives introduced the Strengthening Innovation in Medicare and Medicaid Act (H.R. 5741), a bill aimed at increasing transparency and accountability of the CMMI.

POST

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CMS Evaluates Episode-Based Payment Models

Payment Innovation: Innovation Center

CMS Evaluates Episode-Based Payment Models

February 05, 2020

CMS Innovation Center released a report in which seven episode-based payment models were evaluated to identify common themes and best practices from each of the included models.

POST

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Direct Contracting Office Hours on Feb 11

Payment Innovation: Innovation Center

Direct Contracting Office Hours on Feb 11

February 05, 2020

Center for Medicare and Medicaid Innovation (Innovation Center) will host office hours on the Direct Contracting model’s payment methodology.

POST

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2021 Notice of Benefits and Payment Parameters Outlines Value-Based Insurance Design

Payment Innovation: Innovation Center

2021 Notice of Benefits and Payment Parameters Outlines Value-Based Insurance Design

February 05, 2020

In the 2021 Notice of Benefit and Payment Parameters, the Centers for Medicare and Medicaid Services (CMS) outlines a value-based insurance design (VBID) for qualified health plans (QHPs) to incorporate into plans offered on the federal exchange.

POST

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CMS Reports on Rates of Social Determinants of Health Coding on FFS Claims in 2017

Payment Innovation: Other

CMS Reports on Rates of Social Determinants of Health Coding on FFS Claims in 2017

January 28, 2020

CMS began collecting data on SDOH through the use of z-codes in 2016.

POST

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CMS Seeks to Expand Services through Recent Coverage Decisions (Acupuncture for Low Back Pain and NGS for Advanced Breast and Ovarian Cancer)

Payment Innovation: Other

CMS Seeks to Expand Services through Recent Coverage Decisions (Acupuncture for Low Back Pain and NGS for Advanced Breast and Ovarian Cancer)

January 28, 2020

Centers for Medicare and Medicaid Services has announced two coverage decisions that will provide access to previously uncovered services for Medicare FFS beneficiaries.

POST

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ONC Data Brief: Opportunities to Improve Utilization of EMRs among Cancer Patients

Payment Innovation: Other

ONC Data Brief: Opportunities to Improve Utilization of EMRs among Cancer Patients

January 28, 2020

ONC released a data brief on access and use of online medical records among cancer patients.

POST

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CMS Announces Plan to Consolidate Physician Compare Tools

Payment Innovation: Other

CMS Announces Plan to Consolidate Physician Compare Tools

January 28, 2020

Seema Verma, CMS, announced in a blog post the agency’s plan to consolidate its eight current consumer-facing Medicare quality databases to one comprehensive tool for beneficiaries.

POST

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GAO Identifies Fiscal Sustainability Concerns with Medicare and Other Trust Funds

Payment Innovation: Other

GAO Identifies Fiscal Sustainability Concerns with Medicare and Other Trust Funds

January 28, 2020

Many federal programs, including Medicare and Social Security are funded through trust funds and other dedicated funds.

POST

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CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

January 28, 2020

CMS uploaded new materials to the QPP Resource Library.

POST

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Hospice Benefit in Value Based Insurance Design Model Webinar on Jan 30

Payment Innovation: Innovation Center

Hospice Benefit in Value Based Insurance Design Model Webinar on Jan 30

January 28, 2020

Medicare Advantage Value-Based Insurance Design (VBID) Model team will host a webinar on Thursday, January 30, 2020, on the hospice benefit component recently added to the VBID Model.

POST

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Direct Contracting Office Hours on Feb 4

Payment Innovation: Innovation Center

Direct Contracting Office Hours on Feb 4

January 28, 2020

Center for Medicare and Medicaid Innovation (Innovation Center) will host office hours on the Direct Contracting model’s payment methodology.

POST

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CMS Issues Decision Memo Broadening Coverage of Next Generation Sequencing Testing for Advanced Breast and Ovarian Cancer

Diagnostics

CMS Issues Decision Memo Broadening Coverage of Next Generation Sequencing Testing for Advanced Breast and Ovarian Cancer

January 27, 2020

CMS issues its decision memo that revises and expands on the coverage for next generation sequencing (NGS) as a diagnostic laboratory test for ovarian and breast cancer when selected criteria are met.

POST

diagnostic
CMS issues Transmittal on Revised Data Reporting Period under PAMA

Diagnostics

CMS issues Transmittal on Revised Data Reporting Period under PAMA

January 22, 2020

Following the passage of the LAB Act, CMS issued a transmittal that specifies the new data reporting period for CDLTs that are not ADLTs.

POST

macra
CMS Updates Open Payment Data

Payment Innovation: Other

CMS Updates Open Payment Data

January 21, 2020

CMS has updated the Open Payment dataset.

POST

macra
MedPAC Discusses Restructuring Medicare Benefits and Votes on Payment Update Recommendations

Payment Innovation: Other

MedPAC Discusses Restructuring Medicare Benefits and Votes on Payment Update Recommendations

January 21, 2020

MedPAC met on January 16 and 17 to vote on payment update recommendations and to discuss other recommendations to update the Medicare program.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

January 21, 2020

CMS uploaded new materials to the QPP Resource Library.

POST

macra
Registration Open for 2020 CMS Quality Conference

Payment Innovation: Quality Payment Program

Registration Open for 2020 CMS Quality Conference

January 21, 2020

CMS is hosting the 2020 CMS Quality Conference on February 25-27, 2020, in Baltimore, Maryland.

POST

macra
PA Rural Health Model: Year Two Participating Hospitals Announced

Payment Innovation: Innovation Center

PA Rural Health Model: Year Two Participating Hospitals Announced

January 21, 2020

CMS announced the 13 hospitals participating in the Pennsylvania Rural Health Model during performance year 2.

POST

macra
CMS Schedules Direct Contracting Model Webinar

Payment Innovation: Innovation Center

CMS Schedules Direct Contracting Model Webinar

January 21, 2020

CMS will host a webinar to discuss the payment methodologies for the Direct Contracting Model Options.

POST

macra
Primary Care First Deadlines Approaching

Payment Innovation: Innovation Center

Primary Care First Deadlines Approaching

January 21, 2020

The deadline for clinician practices to apply to participate in the Primary Care First (PCF) Model is Wednesday, January 22. Practices can create an account and submit an application through the Primary Care First application portal.

POST

macra
CMMI Hires New Chief Technology Officer

Payment Innovation: Innovation Center

CMMI Hires New Chief Technology Officer

January 21, 2020

Shannon Sartin announced in a blog post that she has been hired as the new Chief Technology Officer at the Center for Medicare and Medicaid Innovation (Innovation Center) where she will help oversee technology.

POST

diagnostic
CMS Publishes Q1 2020 CCI PTP Edits

Diagnostics

CMS Publishes Q1 2020 CCI PTP Edits

January 21, 2020

CMS publishes the CCI procedure-to-procedure (PTP) edits effective as of January 1, 2020, including the quarterly additions, deletions, and changes.

POST

macra
ONC Releases 2020-2025 Draft Health IT Strategic Plan

Payment Innovation: Other

ONC Releases 2020-2025 Draft Health IT Strategic Plan

January 15, 2020

HHS released the draft 2020-2025 Federal Health IT Strategic Plan for public comment.

POST

macra
CMS Hosts Webinar to Improve Processes and Enhance Interactions with MACs

Payment Innovation: Other

CMS Hosts Webinar to Improve Processes and Enhance Interactions with MACs

January 15, 2020

CMS has scheduled a webinar to engage with providers, practitioners, and suppliers about improving beneficiary quality of care and experience with MACs.

POST

macra
LAN Schedules Health Care Transformation Task Force Webinar on January 31

Payment Innovation: Other

LAN Schedules Health Care Transformation Task Force Webinar on January 31

January 15, 2020

LAN scheduled a webinar to engage with stakeholders on how to accelerate the adoption of two-sided risk APMs.

POST

macra
MedPAC Releases Agenda for January 2020 Public Meeting

Payment Innovation: Other

MedPAC Releases Agenda for January 2020 Public Meeting

January 15, 2020

MedPAC has posted the agenda for the next public meeting scheduled for January 16-17, 2020.

POST

macra
GAO Requests Nominations for MedPAC Commissioners

Payment Innovation: Other

GAO Requests Nominations for MedPAC Commissioners

January 15, 2020

The GAO published a request for nominations for the MedPAC.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

January 15, 2020

CMS uploaded new materials to the QPP Resource Library.

POST

macra
CMS Launches the MIPS Value Pathways Website

Payment Innovation: Quality Payment Program

CMS Launches the MIPS Value Pathways Website

January 15, 2020

In the CY 2020 Quality Payment Program proposed rule, CMS introduced the MIPS MVP.

POST

macra
CMS Schedules MIPS 2020 Overview Webinar on Jan 22

Payment Innovation: Quality Payment Program

CMS Schedules MIPS 2020 Overview Webinar on Jan 22

January 15, 2020

CMS scheduled a webinar to provide an overview of the 2020 MIPS performance year.

POST

macra
Upcoming Direct Contracting Model Options Webinar to Discuss Payment Methodologies

Payment Innovation: Innovation Center

Upcoming Direct Contracting Model Options Webinar to Discuss Payment Methodologies

January 15, 2020

CMS has scheduled a webinar to discuss the payment methodologies for the Direct Contracting Model Options.

POST

macra
CMS Schedules KCC Model Application Overview Webinar on Jan 16

Payment Innovation: Innovation Center

CMS Schedules KCC Model Application Overview Webinar on Jan 16

January 15, 2020

CMS is scheduled to host office hours for the KCC Model. Model applications are due January 22, 2020.

POST

macra
CMS Provides Additional Information and Holds Office Hours as the Primary Care First Application Deadline Approaches

Payment Innovation: Innovation Center

CMS Provides Additional Information and Holds Office Hours as the Primary Care First Application Deadline Approaches

January 15, 2020

The Primary Care First Model Options application deadline is Wednesday, January 22, 2020. In preparation for this deadline, the Centers for Medicare and Medicaid Services (CMS) has posted additional FAQ document and will be hosting one final office hour session.

POST

macra
CMS Announces New ACO Participation and Savings Numbers

Payment Innovation: Innovation Center

CMS Announces New ACO Participation and Savings Numbers

January 15, 2020

CMS Administrator Seema Verma touted the uptick in participation in two-sided risk arrangements in the redesigned Medicare Shared Savings Program for ACOs, which the agency overhauled in 2018.

POST

health-reform-20
Georgia 1115 Waiver Application

Insurance Coverage: Waivers

Georgia 1115 Waiver Application

January 14, 2020

Governor Brian Kemp of Georgia signed and enacted Senate Bill 106, otherwise known as the Patients First Act. This legislation authorizes the Georgia Department of Community Health to submit a Section 1115 Demonstration waiver to the Centers for Medicare and Medicaid Services (CMS).

POST

health-reform-20
Idaho 1115 Waiver Summary – Institutions for Mental Diseases

Insurance Coverage: Waivers

Idaho 1115 Waiver Summary – Institutions for Mental Diseases

January 14, 2020

Idaho submitted a new section 1115 waiver application to the Centers for Medicare and Medicaid Services (CMS).

POST

diagnostic
CMS Issues Additional Guidance on AUC Reporting

Diagnostics

CMS Issues Additional Guidance on AUC Reporting

January 09, 2020

CMS issues new guidance on where line level ordering professional information should be reported on institutional claims impacted by the Appropriate User Criteria Program for Advanced Diagnostic Imaging.

POST

macra
CMS Releases 2021 Advance Notice, Part I

Payment Innovation: Other

CMS Releases 2021 Advance Notice, Part I

January 07, 2020

On January 6, 2019, CMS released Part I of the 2021 Advance Notice limited to the risk adjustment methodology per the annual cycle of Medicare Advantage (MA) regulatory guidelines for the coming year.

POST

macra
Administration Issues Two Rules Designed to Increase Live Kidney Donations

Payment Innovation: Other

Administration Issues Two Rules Designed to Increase Live Kidney Donations

January 07, 2020

On December 17, 2019, the Trump Administration released two rules designed to increase live kidney donations.

POST

macra
Request for Feedback on Medicare Scope of Practice

Payment Innovation: Other

Request for Feedback on Medicare Scope of Practice

January 07, 2020

CMS is requesting feedback on eliminating Medicare specific regulations requiring supervision that exceeds other federal or state laws.

POST

macra
Opportunities to Participate in a Technical Expert Panel

Payment Innovation: Other

Opportunities to Participate in a Technical Expert Panel

January 07, 2020

CMS has announced opportunities to participate in Technical Expert Panels TEP.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

January 07, 2020

CMS uploaded new materials to the QPP Resource Library.

POST

macra
CMS Solicits New Specialty Measure Sets

Payment Innovation: Quality Payment Program

CMS Solicits New Specialty Measure Sets

January 07, 2020

CMS is accepting recommendations for new specialty specific measure sets, or adjustments to existing measure sets for 2021 performance year of the MIPS.

POST

macra
Submission Deadline for 2019 MIPS Data: March 31, 2020

Payment Innovation: Quality Payment Program

Submission Deadline for 2019 MIPS Data: March 31, 2020

January 07, 2020

Clinicians who participated in the MIPS during the 2019 performance year can now submit data through March 31, 2020.

POST

macra
CMS Releases Final 2018 QPP Performance Results: Max Positive 2020 Payment Adjustment is 1.68%

Payment Innovation: Quality Payment Program

CMS Releases Final 2018 QPP Performance Results: Max Positive 2020 Payment Adjustment is 1.68%

January 07, 2020

CMS released the final 2018 QPP performance results for the Merit-based Incentive Payment System (MIPS) which impacts 2020 payments.

POST

macra
CMS Hosts Measure-Specific Workgroup Webinars for Cost Measure Development

Payment Innovation: Quality Payment Program

CMS Hosts Measure-Specific Workgroup Webinars for Cost Measure Development

January 07, 2020

CMS, alongside contractor Acumen, LLC, will host several measure-specific workgroup webinars as part of Wave 3 of cost measure development.

POST

macra
MIPS Eligibility Lookup Tool: 2020 Data Now Available & 2019 Data Corrected

Payment Innovation: Quality Payment Program

MIPS Eligibility Lookup Tool: 2020 Data Now Available & 2019 Data Corrected

January 07, 2020

CMS have updated the Quality Payment Program Participation Status Lookup Tool to include initial provider eligibility status for the 2020 performance year.

POST

macra
CMS Misses December 31, 2019 Deadline for APM Incentive Payments

Payment Innovation: Quality Payment Program

CMS Misses December 31, 2019 Deadline for APM Incentive Payments

January 07, 2020

CMS issued an advisory notice on December 26, 2019, indicating the agency will fail to meet the self-imposed deadline of December 31, 2019, to distribute all CY 2019 Advanced APM incentive payments.

POST

macra
Kidney Care Choices Model: Clarifications to RFA

Payment Innovation: Innovation Center

Kidney Care Choices Model: Clarifications to RFA

January 07, 2020

On January 3, 2020, CMS released clarifications to the KCC Model’s RFA originally released on October 24, 2019.

POST

macra
CMS Schedules Direct Contracting Model Options Webinars and Office Hours

Payment Innovation: Innovation Center

CMS Schedules Direct Contracting Model Options Webinars and Office Hours

January 07, 2020

CMS will host several webinars and office hours for interested participants to ask questions and get additional information about the Direct Contracting Model Options.

POST

macra
CMS Announces Awardees for the Maternal Opioid Misuse and Integrates Care for Kids Models

Payment Innovation: Innovation Center

CMS Announces Awardees for the Maternal Opioid Misuse and Integrates Care for Kids Models

January 07, 2020

CMS announced the states that have been awarded funding to provide behavioral health and substance use services to children and pregnant women through the MOM and InCK models.

POST

macra
CMS MA VBID Update: 2020 Participants Announced and 2021 Hospice Benefit RFA Now Available

Payment Innovation: Innovation Center

CMS MA VBID Update: 2020 Participants Announced and 2021 Hospice Benefit RFA Now Available

January 07, 2020

CMS announced the 14 Medicare Advantage (MA) organizations participating in the MA Value-based Insurance Design (VBID) model for plan year 2020.

POST

macra
Brad Smith Appointed as New Head of the Innovation Center

Payment Innovation: Innovation Center

Brad Smith Appointed as New Head of the Innovation Center

January 07, 2020

On January 6, 2020, HHS and the CMS announced Brad Smith will serve as the Director of the Center for Medicare and Medicaid Innovation (Innovation Center) and Senior Advisor to Secretary Azar for Value-Based Transformation.

POST

diagnostic
Enforcement Discretion Period Ends for Laboratory Date of Service Exception Policy

Diagnostics

Enforcement Discretion Period Ends for Laboratory Date of Service Exception Policy

January 02, 2020

The enforcement discretion period that had been in place for the last 18 months regarding the laboratory Date of Service (DOS) exception policy ends on January 2, 2020.

POST

diagnostic
Congress Passes the LAB Act

Diagnostics

Congress Passes the LAB Act

December 20, 2019

On December 19, Congress passed the Laboratory Access for Beneficiaries (LAB) Act as part of an end-of-year spending package signed into law by the President on December 20.

POST

macra
Deadline to Dispute 2018 Open Payments is December 31

Payment Innovation: Other

Deadline to Dispute 2018 Open Payments is December 31

December 17, 2019

CMS posted the 2018 Open Payments data for review by physicians and teaching hospitals; the deadline to dispute any payments is December 31, 2019.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

December 17, 2019

CMS uploaded new materials to the QPP Resource Library.

POST

macra
Hospital Quality Star Rating Program: Summary from Listening Session Posted

Payment Innovation: Quality Payment Program

Hospital Quality Star Rating Program: Summary from Listening Session Posted

December 17, 2019

CMS published the final summary report of the September 19, 2019 public listening session on the Hospital Quality Star Rating program.

POST

macra
PTAC Submits Report on Telemedicine Proposal to Secretary: Recommends Further Development and Implementation

Payment Innovation: PTAC

PTAC Submits Report on Telemedicine Proposal to Secretary: Recommends Further Development and Implementation

December 17, 2019

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) submitted a new report to the Secretary of Health and Human Services (HHS) recommending the further development and implementation of the “ACCESS Telemedicine: An Alternative Healthcare Delivery Model for Rural Cerebral Emergencies.”

POST

macra
CMS Hosts Cross-Model Office Hours Session: Primary Care First, Direct Contracting, and Kidney Care Choices Models

Payment Innovation: Innovation Center

CMS Hosts Cross-Model Office Hours Session: Primary Care First, Direct Contracting, and Kidney Care Choices Models

December 17, 2019

The Center for Medicare and Medicaid Innovation (CMMI) will host an office hours session on December 19, 2019 from 12-1:30 PM ET. to describe the Primary Care First Model Options, Direct Contracting Model Options, and Kidney Care Choices Model.

POST

macra
MedPAC Considers 2021 Payment Updates for Doctors and Hospitals and Discusses MA

Payment Innovation: Other

MedPAC Considers 2021 Payment Updates for Doctors and Hospitals and Discusses MA

December 10, 2019

MedPAC met on December 5, 2019, to discuss 2021 payment updates for physicians, inpatient and outpatient hospital services and the annual update on the status of MA as they prepare their annual March Report to Congress.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

December 10, 2019

CMS uploaded new materials to the QPP Resource Library.

POST

macra
MIPS Eligibility Status Final 2019 Update Now Available

Payment Innovation: Quality Payment Program

MIPS Eligibility Status Final 2019 Update Now Available

December 10, 2019

The Centers for Medicare and Medicaid Services has published a portal for clinicians to check their eligibility status for participation in the Merit-based Incentive Payment System (MIPS).

POST

macra
Additional Kidney Care Choices Model Office Hours Posted

Payment Innovation: Innovation Center

Additional Kidney Care Choices Model Office Hours Posted

December 10, 2019

The Centers for Medicare and Medicaid Services has announced office hour sessions for the different payment options for the Kidney Care Choices Model.

POST

macra
CMS Hosting Primary Care First Payer Webinar on December 17

Payment Innovation: Innovation Center

CMS Hosting Primary Care First Payer Webinar on December 17

December 10, 2019

The Centers for Medicare and Medicaid Services will host a webinar providing an overview of the Primary Care First Model for payers interested in partnering with the agency on this model.

POST

macra
Registration Open for Direct Contracting December Webinars

Payment Innovation: Innovation Center

Registration Open for Direct Contracting December Webinars

December 10, 2019

The Centers for Medicare and Medicaid Services has scheduled several webinars and office hours to provide an overview and answer questions about the Direct Contracting Model.

POST

diagnostic
Appropriate Use Criteria Claims Processing Requirements Issued

Diagnostics

Appropriate Use Criteria Claims Processing Requirements Issued

December 09, 2019

CMS issues the claims processing requirements for the voluntary educational and operational testing period – set to begin on January 1, 2020 – for the Appropriate Use Criteria for Advanced Diagnostic Imaging.

POST

health-reform-20

Insurance Coverage: Waivers

Tennessee Block Grant Waiver Summary

December 03, 2019

On November 20, 2019, Tennessee submitted a Section 1115 waiver application to CMS, which, if approved, would implement a block grant for the state’s Medicaid program, TennCare.

POST

macra
CMS Hosts Webinar on the 2020 Medicare Promoting Interoperability Program

Payment Innovation: Other

CMS Hosts Webinar on the 2020 Medicare Promoting Interoperability Program

December 03, 2019

CMS will host a webinar on Thursday, January 16, 2020, to discuss changes to the Medicare Promoting Interoperability Program for eligible hospitals and critical access hospitals participating in 2020.

POST

macra
MedPAC Releases Agenda for December 2019 Public Meeting

Payment Innovation: Other

MedPAC Releases Agenda for December 2019 Public Meeting

December 03, 2019

MedPAC is scheduled to meet December 5 to 6, 2019.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

December 03, 2019

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

POST

macra
Final Report: Maryland All-Payer Model Reduced Medicare Expenditures by $975 Million

Payment Innovation: Innovation Center

Final Report: Maryland All-Payer Model Reduced Medicare Expenditures by $975 Million

December 03, 2019

CMMI posted the final evaluation report for the Maryland All-Payer Model.

POST

diagnostic
CMS Releases 2020 Final CLFS Payment Determinations

Diagnostics

CMS Releases 2020 Final CLFS Payment Determinations

December 02, 2019

CMS releases CY 2020 final payment determinations for the 90 codes reviewed during the summer 2019 CLFS Annual Public Meeting.

POST

macra
CMS Hosting Hospice Quality Reporting Program Forum on Dec. 4

Payment Innovation: Other

CMS Hosting Hospice Quality Reporting Program Forum on Dec. 4

November 26, 2019

CMS announced another Open Door Forum.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

November 26, 2019

CMS uploaded new materials to the QPP Resource Library.

POST

macra
PTAC Update: Proposal Open for Comment, Updated Submission Process, and PTAC Member Update

Payment Innovation: PTAC

PTAC Update: Proposal Open for Comment, Updated Submission Process, and PTAC Member Update

November 26, 2019

PTAC opened the comment period for an updated proposal: Remote specialists and experts on-demand improving care and saving costs.

POST

macra
CMS Publishes Beneficiary Engagement Toolkit for ACOs

Payment Innovation: Innovation Center

CMS Publishes Beneficiary Engagement Toolkit for ACOs

November 26, 2019

As part of a larger campaign to inform the public about ACOs, CMS launched a new toolkit highlighting how ACOs and ESRD ESCOs engage beneficiaries.

POST

macra
CMMI Posts Resources on Primary Care and Kidney Payment Models

Payment Innovation: Innovation Center

CMMI Posts Resources on Primary Care and Kidney Payment Models

November 26, 2019

CMMI uploaded resources on the Primary Care First and the Comprehensive Kidney Care Contracting models.

POST

macra
CMS Releases Direct Contracting Request for Applications

Payment Innovation: Innovation Center

CMS Releases Direct Contracting Request for Applications

November 26, 2019

CMS posted the RFA for participants interested in starting the Direct Contracting model.

POST

diagnostic
Pathology/Lab Agenda for February 2020 CPT Editorial Panel Published

Diagnostics

Pathology/Lab Agenda for February 2020 CPT Editorial Panel Published

November 20, 2019

The AMA has published the CPT Editorial Panel for the upcoming meeting from February 6 – 8, 2020 in San Francisco.

POST

macra
House Ways and Means Committee Seeks Input on Rural Health Solutions

Payment Innovation: Other

House Ways and Means Committee Seeks Input on Rural Health Solutions

November 19, 2019

The House Ways and Means Committee released a RFI on healthcare outcomes of rural communities to help inform future bipartisan legislation to improve care delivery in underserved and rural communities.

POST

macra
CMS Finalizes Hospital Transparency Requirements and Proposes Similar Policies for Certain Health Plans

Payment Innovation: Other

CMS Finalizes Hospital Transparency Requirements and Proposes Similar Policies for Certain Health Plans

November 19, 2019

In the latest response to the President’s Executive Order on Improving Price and Quality Transparency in American Healthcare, the Department of Health and Human Services released two rules related to requiring increased price transparency for hospitals and health plans.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

November 19, 2019

CMS uploaded new materials to the QPP Resource Library.

POST

macra
Call for Nominations: MIPS Improvement Activities Validation TEP

Payment Innovation: Quality Payment Program

Call for Nominations: MIPS Improvement Activities Validation TEP

November 19, 2019

CMS is currently accepting nominations for a TEP on the validation criteria for the Improvement Activities for the 2020 performance year of the MIPS.

POST

macra
CMMI Hosts Primary Care First Office Hours on Dec. 5

Payment Innovation: PTAC

CMMI Hosts Primary Care First Office Hours on Dec. 5

November 19, 2019

CMMI will host office hours on the recently announced Primary Care First Model.

POST

macra
PTAC Update: Public Meeting and Report on Eye Care Proposal Posted

Payment Innovation: PTAC

PTAC Update: Public Meeting and Report on Eye Care Proposal Posted

November 19, 2019

PTAC recently opened registration for the Monday, December 9, 2019, public meeting.

POST

macra
Warren, Blunt and Other Members of Congress Request Information from CMMI on Efforts to Address Maternal Mortality

Payment Innovation: Innovation Center

Warren, Blunt and Other Members of Congress Request Information from CMMI on Efforts to Address Maternal Mortality

November 19, 2019

Eight Democratic members of Congress led by Senators Warren and Rochester sent a letter to the CMMI to request information on the use of APMs to test innovative ways of delivering maternal healthcare.

POST

Introducing The Health Policy Breakroom Podcast: Final Medicare Payment Rules

Insight: original analysis

Introducing The Health Policy Breakroom Podcast: Final Medicare Payment Rules

November 14, 2019

McDermottPlus is pleased to present The Health Policy Breakroom, a podcast dedicated to health policy updates. Our inaugural episode provides an overview of the 2020 PFS, OPPS and ASC Final Rules recently released by CMS.

ORIGINAL ANALYSIS

macra
CMS Hosts Webinar on the 2020 QPP Final Rule on Nov. 19

Payment Innovation: Quality Payment Program

CMS Hosts Webinar on the 2020 QPP Final Rule on Nov. 19

November 13, 2019

CMS will be hosting a webinar on Tuesday, November 19 from 2:00 to 3:30 PM (ET) where they will review major changes to the QPP in the CY 2020 final rule.

POST

macra
MedPAC Discusses MA Quality Program, MA Benchmarks and MSSP Post-Acute Care Spending at November Public Meeting

Payment Innovation: Other

MedPAC Discusses MA Quality Program, MA Benchmarks and MSSP Post-Acute Care Spending at November Public Meeting

November 13, 2019

MedPAC met in Washington, DC on November 6-7, 2019. The Commission continued a discussion on redesigning the MA QBP.

POST

diagnostic
CMS Publishes CY 2020 National Correct Coding Initiative Policy Manual

Diagnostics

CMS Publishes CY 2020 National Correct Coding Initiative Policy Manual

November 13, 2019

CMS publishes the annual National Correct Coding Initiative (NCCI) policy manual for CY 2020.

POST

macra
MedPAC Discusses MA Quality Program, MA Benchmarks and MSSP Post-Acute Care Spending at November Public Meeting

Payment Innovation: Other

MedPAC Discusses MA Quality Program, MA Benchmarks and MSSP Post-Acute Care Spending at November Public Meeting

November 13, 2019

MedPAC met in Washington, DC on November 6-7, 2019. The Commission continued a discussion on redesigning the MA QBP.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

November 12, 2019

CMS uploaded new materials to the QPP Resource Library.

POST

macra
OCF Model Request for Information Deadline Extended to Dec. 13

Payment Innovation: Innovation Center

OCF Model Request for Information Deadline Extended to Dec. 13

November 12, 2019

CMS Center for Medicare & Medicaid Innovation released an informal RFI for feedback on the potential OCF Model.

POST

macra
CMS Hosts Webinars to Discuss KCC Model

Payment Innovation: Innovation Center

CMS Hosts Webinars to Discuss KCC Model

November 12, 2019

CMS Center for Medicare & Medicaid Innovation announced upcoming webinars to engage with stakeholders to discuss the KCC Model.

POST

macra
Report to Congress: Response to 21st Century Cure Act MEPD Demonstration

Payment Innovation: Innovation Center

Report to Congress: Response to 21st Century Cure Act MEPD Demonstration

November 12, 2019

CMS Center for Medicare & Medicaid Innovation posted the final report to Congress providing the results of the MEPD.

POST

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

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

diagnostic
CMS Issues Proposed Decision Memo on Reconsidered Next Generation Sequencing National Coverage Determination

Diagnostics

CMS Issues Proposed Decision Memo on Reconsidered Next Generation Sequencing National Coverage Determination

October 29, 2019

CMS issues a proposed decision memo that would revise and expand on the coverage for next generation sequencing (NGS) as a diagnostic laboratory test for ovarian and breast cancer when selected criteria are met.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

health-reform-20
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…

POST

diagnostic
CMS Publishes Application for new “U” codes for Laboratory Tests

Diagnostics

CMS Publishes Application for new “U” codes for Laboratory Tests

October 15, 2019

CMS has published its application for new “U” codes for advanced diagnostic laboratory tests (ADLTs) and FDA-cleared or approved clinical diagnostic laboratory tests (CDLTs).

POST

health-reform-20
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

+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

macra
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

POST

macra
QPP Training Courses Available

Payment Innovation: Quality Payment Program

QPP Training Courses Available

October 01, 2019

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

diagnostic
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

diagnostic
CMS Releases 2020 Preliminary CLFS Payment Determinations

Diagnostics

CMS Releases 2020 Preliminary CLFS Payment Determinations

September 27, 2019

CMS releases CY 2020 preliminary payment determinations for 90 codes reviewed during the summer 2019 CLFS Annual Public Meeting.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.”

POST

macra
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.

POST

health-reform-20
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.

POST

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

macra
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.

POST

macra
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

POST

macra
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.”

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

September 17, 2019

CMS has updated its QPP resource center.

POST

macra
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.

POST

macra
PTAC Update: Committee Recommends Rural Telemedicine Payment Model

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.

POST

macra
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,

POST

macra
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.

POST

health-reform-20

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.

POST

health-reform-20

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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

September 11, 2019

CMS has updated its QPP resource center.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

September 04, 2019

CMS has updated its QPP resource center.

POST

macra
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.

POST

macra
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.

POST

health-reform-20
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.

POST

macra
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.

POST

macra
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

POST

macra
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.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

August 27, 2019

CMS has updated its QPP resource center.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
CMS Updates QPP Resources

Payment Innovation: Quality Payment Program

CMS Updates QPP Resources

August 21, 2019

CMS has updated its QPP resource center.

POST

macra
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.

POST

macra
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

POST

macra
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.

POST

health-reform-20
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.

POST

macra
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

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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.

POST

health-reform-20
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

macra
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.

POST

macra
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.

POST

macra
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.

POST

macra
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

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
CMS Posts Agenda for June 24 CLFS Annual Public Meeting

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

diagnostic
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

health-reform-20
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

diagnostic

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

macra
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

macra
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

macra
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

macra
CMS Hosts Webinar on New eCQMs Finalized for 2019