Tag: CMS

COVID-19 Nursing Home Data and Inspection Results Released

On June 4, 2020, the Centers for Medicare & Medicaid Services (CMS) announced that they are posting the first set of COVID-19 nursing home data they have collected. The data update includes details on COVID-19 outbreaks at nursing homes and the r...

COVID-19 Activities and Actions Update

As part of the ongoing White House Coronavirus Task Force efforts, the Centers for Medicare and Medicaid Services (CMS) and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting o...

CMMI Provides Further Details on OCM COVID-19 Flexibilities

On Friday, June 5, 2020, the Centers for Medicare and Medicaid Innovation (CMMI) hosted a conference call to review the COVID-19 flexibilities announced for the Oncology Care Model (OCM). Under the OCM, physician practices have entered into payment a...

CMS Delays the Start of the Direct Contracting Model; Adds Second Cohort

On Friday, June 5, the Centers for Medicare and Medicaid Services (CMS) Innovation Center announced a series of updates to the Direct Contracting model timeline and financial methodology. The model’s Implementation Period will now begin October 1, ...

CMS Extends Next Generation ACO Model, Provides Flexibilities for Participants

On Friday, June 5, the Centers for Medicare and Medicaid Services (CMS) Innovation Center announced a series of updates to the Next Generation ACO model timeline and financial methodology. The model was initially set to conclude at the end of this ye...

CMS Updates QPP Resources

The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:

  • 2020 MIPS Exceptions Application Fact Sheet
This new resource details the automat...

CMS May Take Back CARES Funding if Nursing Home Inspection Rates Do Not Improve

In response to low inspection rates, the Centers for Medicare and Medicaid Services (CMS) has announced they are taking a series of steps to address inspection rate deficiencies and other challenges facing nursing homes in their response to COVID-19....

COVID-19 Activities and Actions Update

As part of the ongoing White House Coronavirus Task Force efforts, the Centers for Medicare and Medicaid Services (CMS) and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting o...

CMS Updates QPP Resources

The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:

  • 2020 Qualified Clinical Data Registries (QCDRs) Qualified Posting
This resource l...

GAO Releases 50 State Report on Medicaid Administrative Challenges

On June 1, 2020, the Government Accountability Office (GAO) published a report identifying current federal policies that create program administrative challenges for state Medicaid officials. This report details the responses from Medicaid program le...

CMMI Announces Model Extensions, Delays, and Adjustments in Response to the COVID-19 Pandemic

Today, June 3, the Center for Medicare and Medicaid Innovation (CMMI) released new flexibilities and adjustments for payment models to help protect physicians during the COVID-19 pandemic. CMMI released a comprehensive table detailing the announced f...

HHS Distributes Targeted Provider Relief Funds to SNFs and the IHS

The Department of Health and Human Services (HHS) recently distributed $4.9 billion to skilled nursing facilities (SNFs) and $500 million to the Indian Health Service (IHS) from the Provider Relief Fund. The $4.9 billion in funding for SNFs is the m...

COVID-19 Activities and Actions Update

As part of the ongoing White House Coronavirus Task Force efforts, the Centers for Medicare and Medicaid Services (CMS) and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting o...

CMS Releases 2021 RFA for Maryland Total Cost of Care Model

On May 20, 2020, the Centers for Medicare and Medicaid Services (CMS) released the 2021 Request for Applications for the Maryland Total Cost of Care (TCOC) model. The model—which launched on January 1, 2019—builds on the CMS Innovation Center’s...

Over 1,750 Plans Apply for CMS Insulin Model

The Centers for Medicare and Medicaid Services (CMS) announced that more than 1,750 standalone Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage have applied to join the Part D Senior Savings Model f...

CMS Updates QPP Resources

The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:

  • 2020 APM Quality Scoring Resources
This updated resource outlines the APM Scoring...

Final Rule Implements CURES Provisions Allowing ESRD Beneficiaries to Enroll in MA Plans

On Friday, the Centers for Medicare and Medicaid Services (CMS) released a final rule making policy and technical changes to the Medicare Advantage (MA) program. The rule expands policies to support telehealth services, provides some additional...

CMS announces MAC pricing for COVID-19 serology testing

CMS has announced pricing for the two new serology CPT codes (86769 and 86328) created last month. MAC pricing is as follows:

  • $42.13 for 86769
  • $45.23 for 86328
These prices will remain until a national Medicare paymen...

COVID-19 Activities and Actions Update

As part of the ongoing White House Coronavirus Task Force efforts, the Centers for Medicare and Medicaid Services (CMS) and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting o...

CMS Shares Early Insights from the Accountable Health Communities Model

The Centers for Medicare & Medicaid Services (CMS) released a summary document of key takeaways from a meeting on the Accountable Health Communities (AHC) model. The AHC model is designed to assess whether bridging the gap between clinical care a...

CMS Releases Webinar Discussing Changes Made to the CJR Model

On May 13, the Centers for Medicare and Medicaid Services (CMS) hosted a webinar covering changes made to the Comprehensive Care for Joint Replacement (CJR) model. This model tests whether bundled payments and quality measures can improve quality and...

CMS Updates QPP Resources

The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:

  • 2019 QPP Data Submission User Guide
This resource lists additional information fo...

CMS Requires Nursing Homes to Report COVID-19 Cases and Deaths

The Centers for Medicare and Medicaid Services (CMS) published an interim final rule with comment period (IFC) requiring nursing homes to report COVID-19 cases and deaths at least weekly to the Centers for Disease Control and Prevention (CDC). This i...

Agencies Release Data Detailing the Distribution of COVID-19 Support Funds

The Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) have released new data providing additional details in how federal financial supports have been distributed to providers throughout the country...

COVID-19 Activities and Actions Update

As part of the ongoing White House Coronavirus Task Force efforts, the Centers for Medicare and Medicaid Services (CMS) and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting o...

FY 2021 IPPS Proposed Rule: CMS Defers Discussion on Hospital Star Ratings but Provides Updates on Other Hospital Quality Programs

The Centers for Medicare and Medicaid Services (CMS) released proposed updates to the Inpatient Prospective Payment System (IPPS) for fiscal year (FY) 2021, including updates to the various hospital quality programs. CMS is not providing an update t...

CMS Updates QPP Resources

The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:

  • 2019 CMS Web Interface User Guide
This resource outlines how to access the CMS We...

CMS Releases FY 2021 IPPS Proposed Rule

On May 11, 2020 the Centers for Medicare and Medicaid Services (CMS) published the FY 2021 Proposed Rules for the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System. The proposed rule would ...

CMS Issues New Waivers and Flexibilities for Providers

On April 30, 2020, the Centers for Medicare and Medicaid Services (CMS) released a second Interim Final Rule and additional waivers that provide increased regulatory relief and flexibility for healthcare providers during the public health emergency. ...

Payment Increases for Audio-only Visit Codes (99441-99443)

Through an interim final rule released on April 30, 2020, the Centers for Medicare and Medicaid Services (CMS) increased payment for telephone evaluation and management codes (99441-99443) to match payments for similar outpatient visit codes. This ch...

COVID-19 Activities and Actions Update

As part of the ongoing White House Coronavirus Task Force efforts, the Centers for Medicare and Medicaid Services (CMS) and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting o...

CMS Issues MSSP ACO Policy Changes in New Interim Final Rule

On April 30, the Centers for Medicare and Medicaid Services (CMS) released a second Interim Final Rule and additional waivers related to Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP). For ACOs in two-sided ri...

CMS Delays QCDR Measure Testing and Data Collection

On April 30, the Centers for Medicare and Medicaid Services (CMS) released a second Interim Final Rule and additional waivers that provide increased regulatory relief and flexibility for healthcare providers during the public health emergency....

CMS Updates QPP Resources

The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:

  • 2020 MIPS Data Validation Criteria
This document lists the 2020 criteria used to ...

CMS Creates Telehealth Toolkit for Medicaid and CHIP Providers

The Centers for Medicare and Medicaid Services (CMS) released a toolkit to help states evaluate their Medicaid program’s capacity to expand telehealth capabilities and coverage policies. The toolkit CMS developed helps state officials consider vari...

CMS Suspends the Advance Payment Program for Part B Suppliers

On April 26, the Centers for Medicare and Medicaid Services (CMS) announced that it is suspending its Advance Payment Program to Part B suppliers effective immediately. CMS will not be accepting any new applications for the Advance Payment Program an...

COVID-19 Activities and Actions Update

As part of the ongoing White House Coronavirus Task Force efforts, the Centers for Medicare and Medicaid Services (CMS) and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting o...

CMS Offers Additional Flexibilities and Supports to CPC+ Participants during the PHE

The Centers for Medicare and Medicaid Services (CMS) has implemented changes to the Comprehensive Primary Care Plus (CPC+) payment model to ensure participating providers have the supports and the flexibility necessary to provide care during the curr...

CJR Proposed Rule Comment Period Extended to June 23

The Centers for Medicare and Medicaid Services (CMS) has extended the comment period deadline to June 23, 2020, for stakeholders to submit comments on the Comprehensive Care for Joint Replacement (CJR) Model Three-Year Extension and Changes to Episod...

CMS Promotes COVID-19 Clinical Trials Improvement Activity in Letter to Clinicians

In a letter to clinicians, the Centers for Medicare & Medicaid Services (CMS) encouraged clinicians who participate in the Quality Payment Program (QPP) to contribute to scientific research and evidence through clinical trials to help fight the C...

CMS Updates QPP Resources

The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:

  • Quality Payment Program COVID-19 Response
This resource detailing the current fle...

Update on HHS Emergency Fund Distribution

On April 22, 2020, the Department of Health and Human Services (HHS) announced the release of an additional $40.4 billion from the $100 billion from the Public Health and Social Services Emergency Fund (the Fund) in four targeted areas to be distribu...

HHS Delays Implementation of Interoperability Rules in Response to COVID-19

On April 21, 2020, the Department of Health and Human Services announced delays to the implementation of certain provisions of the interoperability final rules released on March 9, 2020, in response to COVID-19. A series of announcements were release...

Telehealth Roundup: Resources, Flexibilities and Funding Opportunities

Leveraging the use of telehealth technologies has become a critical component of ensuring beneficiaries receive necessary care while protecting both healthcare workers and patients from COVID-19. This past week there have been a number of telehealth-...

CMS Issues Guidance for States as They Emerge from Public Health Emergency Restrictions

On April 19, 2020, the Centers for Medicare and Medicaid Services (CMS) released guidelines and recommendations for providers and facilities as they emerge from public health emergency restrictions. These guidelines were released in response to the A...

COVID-19 Activities and Actions Update

As part of the ongoing White House Coronavirus Task Force efforts, the Centers for Medicare and Medicaid Services (CMS) and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting o...

CMS Releases Final Ratebook and Actuarial Methodology for VBID Hospice Benefit

On Wednesday, April 15, 2020, the Centers for Medicare and Medicaid Services (CMS) released the final 2021 Hospice Capitation Ratebook and Actuarial Methodology. The Actuarial Methodology finalizes the 2021 capitation rate for the hospice benefit com...

CMS Updates QPP Resources

The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:

  • 2020 MIPS Data Validation Criteria
This resources lists the criteria used during ...

CMS Announces Plan to Reprocess IPPS and LTCH Claims for 20% Increase for COVID Discharges

On April 15, 2020, the Centers for Medicare and Medicaid Services (CMS) announced plans for reprocessing Inpatient Prospective Payment System (IPPS) hospitals and Long-Term Care Hospitals (LTCHs) claims to account for payment increases for COVID-19 d...

COVID-19 Activities and Actions Update

As part of the ongoing White House Coronavirus Task Force efforts, the Centers for Medicare and Medicaid Services (CMS) and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting o...

CMS announces higher pricing for certain COVID-19 tests

CMS has increased pricing for COVID-19 lab tests that use high-throughput technologies to rapidly diagnose large numbers of potential COVID-19 cases. Effective April 14, 2020, CMS will pay $100 (nearly double the current price) for COVID-19 clinical ...

CMS Increases Payment for High Throughput COVID-19 Lab Tests

On April 15, 2020, the Centers for Medicare and Medicaid Services (CMS) announced that they will pay $100, nearly doubling payment, for certain lab tests that use high-throughput technologies to rapidly diagnose COVID-19 cases. Medicare will pay lab...

CMS Approves $51 Billion in Accelerated and Advance Payments

Last week, the Centers for Medicare and Medicaid Services (CMS) announced they had distributed more than $51 billion in advanced payments to healthcare providers. This is an increase from the first week of the expanded program when it was announced t...

Ventilator Exchange Program Announced

On April 14, 2020, the Administration announced a national ventilator exchange program led by Adam Boehler, former Director of the Center for Medicare and Medicaid Innovation. Under this voluntary program, hospitals will be able to lend unused ventil...

ET3 Model Delayed Until Fall 2020

The Centers for Medicare and Medicaid Services (CMS) announced that it is delaying the start of the Emergency Triage, Treat, and Transport (ET3) Model from May 1, 2020, until an unspecified date this fall. The agency stated this decision is in respon...

CMMI Posts Additional Resources for VBID and the Part D Payment Modernization Model

The Center for Medicare and Medicaid Innovation (CMMI) has posted additional resources for two of the current payment models. On April 2, the Centers for Medicare and Medicaid Services (CMS) held a webinar providing an overview of both the Value-Base...

CMS Updates QPP Resources

The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:

  • 2020 and 2019 Comprehensive List of APMs
This fact sheet provides a comprehensive...

CMS Releases FY 2021 IPF, SNF, and Hospice Payment and Policy Changes

On April 10, 2020, the Centers for Medicare and Medicaid Services (CMS) issued three different proposed rules updating payment and policy changes for FY 2021 for the Inpatient Psychiatric Facility (IPF), Skilled Nursing Facility, and Hospice Prospect...

Pre-Rulemaking Measure Specification Deadline Extended to June 30, 2020

The Centers for Medicare and Medicaid Services (CMS) has extended the deadline for the submission of measure specifications and supporting documentation until June 30, 2020. The agency took this action to extend the deadline in light of the current g...

New guidance issued on coverage for essential diagnostic services during the public health emergency

CMS together with the Department of Labor and Department of Treasury issued guidance today to ensure coverage for COVID-19 testing and select other services (e.g., antibody testing) at no cost. This guidance implements specific provisions in Familie...

New Jersey Section 1115 Waiver Amendment

On February 27, 2020, New Jersey submitted to the Centers for Medicare and Medicaid Services a request to amend the state’s existing Section 1115 demonstration program. This amendment would make two modifications. First, it seeks to expand Medicaid...

CMS Issues Recommendations to Nursing Homes, State and Local Governments

On April 2, 2020, the Centers for Medicare and Medicaid Services (CMS) issued recommendations to state and local governments, as well as nursing homes, to help mitigate the spread of the 2019 Novel Coronavirus (COVID-19) in nursing homes. The recomme...

COVID-19 Activities and Actions Update

As part of the ongoing White House Coronavirus Task Force efforts, the Centers for Medicare and Medicaid Services (CMS) and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting o...

CMS Updates QPP Resources

The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:

  • 2020 Registration Guide for the CMS Web Interface and CAHPS for MIPS Survey
The r...

CMS Announces CY 2021 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies

On April 6, 2020, the Centers for Medicare and Medicaid Services released the annual capitation rates for calendar year 2021 for Medicare Advantage (MA) and Part D. The agency states these adjustments and new policies will continue to advance, modern...

New Hampshire Draft 1332 Waiver Application

On March 25, 2020, New Hampshire released a draft Section 1332 waiver application that the state plans to submit to the Centers for Medicare and Medicaid Services (CMS) for the purpose of creating a state-based reinsurance program. The state acce...

CMS Approves Sweeping Changes to Expand Care During the National Emergency

On March 30, the Centers for Medicare and Medicaid Services (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. Section 1135 of the ...

Trump Administration Calls on Hospitals to Report COVID-19 Data

On March 29, 2020, the Trump Administration and the Centers for Medicare and Medicaid Services (CMS) sent a letter to hospitals across the country requesting immediate and daily reporting of COVID-19 testing data from in-house laboratories. In the le...

CMS Expands Accelerated Payment Program

On March 28, 2020, the Centers for Medicare & Medicaid Services (CMS) announced an expansion of its accelerated payment program to help provide financial relief to Medicare providers and suppliers affected by COVID-19. This announcement was relea...

COVID-19 Activities and Actions Update

As part of the ongoing White House Coronavirus Task Force efforts, the Centers for Medicare and Medicaid Services (CMS) and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting o...

Pharmaceutical Manufacturers Announced for the Part D Senior Savings Model

On March 23, the Centers for Medicare and Medicaid Services (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 an...

CMS Updates QPP Resources

The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:

  • Quality Payment Program COVID-19 Response
This resource provides additional infor...

CMS Issues Guidance on Open Payment Data Submission

The Centers for Medicare and Medicaid Services (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 d...

Oklahoma Draft Block Grant Waiver Application

Background 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. ...

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

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. CMS has developed provider specific fact sheets on the flexibilities during this PHE. Laboratories...

COVID-19 Activities and Actions Update

As part of the ongoing White House Coronavirus Task Force efforts, the Centers for Medicare and Medicaid Services (CMS) and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting o...

CMS Approves 11 Additional Medicaid Section 1135 Waivers

This announcement from the Centers for Medicare and Medicaid Services (CMS) brings the total number of approved Section 1135 waivers for states to 13. On March 13, 2020, President Trump declared the COVID-19 situation a national emergency which enabl...

Primary Care First Deadline Extended

In light of the recent COVID-19 outbreak and its impact on the healthcare industry, the Centers for Medicare and Medicaid Services (CMS) extended the payer solicitation period for the Primary Care First (PCF) Model until May 20, 2020. The PCF Model ...

MIPS 2019 Performance Year Submission Deadline Extended

On March 23, 2020, the Centers for Medicare and Medicaid Services (CMS) extended the deadline for clinicians to submit data for the 2019 performance year of the Merit-based Incentive Payment System (MIPS). The deadline has been extended from March 31...

CMS Updates QPP Resources

The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:

  • 2019 CMS Web Interface User Guide
This guide provides additional information on a...

Trump Administration Expands Medicare Telehealth Benefits

On March 17, 2020, the Centers for Medicare and Medicaid Services (CMS) and other agencies released further guidance on the use of telehealth during the coronavirus (COVID-19) national emergency. The guidance implements provisions of the Coronavirus ...

CMS Approves First State Request for 1135 Medicaid Waiver in Florida

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

COVID-19 Activities and Actions

As part of ongoing White House Coronavirus Task Force efforts, the Centers for Medicare and Medicaid Services (CMS) and other agencies have issued several resource documents, refocused activities related to state survey agencies and accrediting organ...

CMS Announced New Insulin Payment Model

The Centers for Medicare and Medicaid Services (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 benefi...

CMS Schedules Office Hours for MA VBID Model

On Thursday, March 19, the Centers for Medicare and Medicaid Services will host office hours on the Medicare Advantage (MA) Value-Based Insurance Design (VBID) Model. During this office hour, presenters will provide a review of the payment design rel...

CMS Updates QPP Resources

The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:

  • 2020 MIPS Data Validation Criteria
This resource lists the 2020 data validation c...

Pricing Announced for the Two New HCPCS Codes for Coronavirus Testing

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. Prices will be as ...

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

The Centers for Medicare and Medicaid Services (CMS) published a calendar highlighting key dates for stakeholders interested in the Direct Contracting Model. The calendar highlights key deadlines and provides additional information about when the age...

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

On Monday, March 9, the Office of the National Coordinator for Health Information Technology (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 cer...

CMS COVID-19 Activities and Actions

As part of ongoing White House Coronavirus Task Force efforts, the Centers for Medicare and Medicaid Services (CMS) has issued a number of resource documents, refocused activities related to state survey agencies and accrediting organizations; and ta...

CMS Promoting Interoperability Webinar Scheduled for March 19

The Centers for Medicare and Medicaid Services (CMS) has scheduled a webinar on Thursday, March 19, to discuss the Annual Call for Measures for consideration in the Medicare Promoting Interoperability Program. CMS will provide an overview of the Annu...

CMS Develops a Second HCPCS Code for Coronavirus Testing

On March 5, 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. The new test is for non-CDC laboratory ...

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

On February 27, 2020, the Centers for Medicare and Medicaid Services (CMS) released the second annual report and a summary of the findings at a glance for the Medicare Care Choices Model (MCCM).  The report found that 85 of the original 141 particip...

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

On March 2, 2020, CMS released the final evaluation report and a summary of the findings for the Maryland All-Payer Model (MDAPM). The report found that the model helped reduce hospital utilization and lower expenditures for dual-eligible beneficiari...

Independence at Home Demonstration: Year Five Evaluation Report Posted

On March 2, 2020, CMS posted the evaluation report and a summary of the findings for Year Five of the Independence at Home (IAH) Demonstration. This model tests whether comprehensive primary care services delivered at home can reduce costs and improv...

Ambulance Model Applicants Announced

The Center for Medicare and Medicaid Innovation (CMMI) has selected 205 applicants across 36 states and the District of Columbia to participate in the Emergency Triage, Treat and Transport (ET3) Model. This spring, CMS will share the final list of ET...

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

Revised “Medical Neighborhood” Payment Model Open for Comment Through March 20 The Physician Model Technical Advisory Committee (PTAC) is soliciting comments through March 20, 2020, on a revised payment model: “The ‘Medical Neighborho...

Top 5 Takeaways from the 2020 CMS Quality Conference

The Centers for Medicare and Medicaid Services (CMS) hosted the 2020 Quality Conference from February 25-27, 2019. During this annual quality-palooza, over 3,000 stakeholders met in Baltimore, Maryland, to discuss health care quality improvement init...

CMS Updates QPP Resources

The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:

  • 2019 Group Participation Guide
This guide details group participation requirement...

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

On Wednesday, February 26, 2020 the Centers for Medicare and Medicaid Services (CMS) will host a webinar to discuss the CY 2021 Hospice Capitation Payment Rate Actuarial Methodology for the Hospice Benefit Component of the Value-Based Insurance Desig...

Top 5 Takeaways: CMS Proposes to Extend and Expand CJR

On February 20, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would make modifications to the Comprehensive Care for Joint Replacement (CJR) Model. CJR, the first mandatory model established by CMS, is an in...

PTAC Update: March 16 Agenda Update

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) has updated the agenda for the scheduled March 16 public meeting. In addition to reviewing three proposed physician payment models, the Committee will also discuss previous propo...

CMS Updates QPP Resources

The Centers for Medicare and Medicaid Services (CMS) uploaded new materials to the Quality Payment Program (QPP) Resource Library:

  • 2020 MIPS Quick Start Guide
This guide highlights key program requirements for providers to p...

March 31 Deadline for MIPS Data Submission

The deadline for eligible clinicians to submit 2019 performance year data for the Merit-based Incentive Payment System (MIPS) is March 31 at 8:00 PM (EDT). All MIPS data must be submitted through the Quality Payment Program (QPP) website using a clin...

CMS Releases RFI on Rural Maternal and Infant Health

On February 12, 2020, Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS), released a Request for Information (RFI) to seek public comments regarding rural maternal and infant health care. The CMS Office of Minority Hea...

CMS Issues Revised Guidance on AUC Reporting

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. This guidance applies to the AUC program’s voluntary educ...

CMS Develops New HCPCS Code for Coronavirus Testing

Today, CMS created a new HCPCS code that providers and laboratories may use to report Coronavirus lab testing. This code (U0001) allows labs to bill for the specific CDC 2019 Novel Coronavirus Real-Time RT-PCR Diagnostic Test Panel rather than using ...

CMS Posts Slides from Recent VBID Model Webinar

CMS Posts Slides from Recent VBID Model Webinar On January 30, the Medicare Advantage Value-Based Insurance Design (VBID) Model team hosted a webinar to provide information and answer questions about the hospice benefit compo...

CMS Posts Office Hours Slides for Direct Contracting Model

On February 4, the Centers for Medicare and Medicaid Services (CMS) hosted office hours on the Direct Contracting Model. During the session, the Direct Contracting Model Options team provided a brief review of key aspects of the Direct Contracting f...

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

Public Meeting The Physician-Focused Payment Model Technical Advisory Committee (PTAC) posted the agenda and opened registration for the March 16 public meeting. During this meeting, the Committee will consider and vote on three previously su...

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

On February 5, 2020, the Centers for Medicare and Medicaid Services (CMS) issued two documents affecting the Medicare Advantage (MA) program: