Tag: Medicaid

MACPAC Releases June 2020 Annual Report to Congress

The Medicare and CHIP Payment and Access Commission (MACPAC) released its annual June 2020 Report to Congress on Medicaid and CHIP. This six-chapter report outlines improvements in the integration of care for dually eligible Medicaid and Medicare ben...

HHS Announces Distribution from PRF to Medicaid Providers

Today, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced the distribution of additional relief funds from the Provider Relief Fund to eligible Medicaid and Children’s ...

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...

CMS Seeking Feedback on Value in Opioid Use Disorder Treatment Demonstration

The Center for Medicare and Medicaid Innovation (CMMI) is soliciting stakeholder feedback on the Value in Opioid Use Disorder Treatment Demonstration Program. The Value in Treatment initiative is a 4-year demonstration that was created through the Su...

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 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 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...

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...

House Approves HEROES Act

The US House of Representatives on May 15, 2020, approved the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act a massive new relief and stimulus measure assembled by House Democrats and advanced on party lines, with only one Repu...

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...

MACPAC Urges HHS to Provide Relief to Medicaid Providers

On April 30, the Medicare and CHIP Payment and Access Commission (MACPAC) sent a letter to the Secretary of Health and Human Services (HHS) urging the Administrator to speed relief to Medicaid providers across the nation. This is the second letter th...

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 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...

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...

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...

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 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 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 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 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...

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...

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...

MACPAC Publishes Agenda and Moves April Public Meeting Online

The Medicaid and CHIP Payment and Access Commission (MACPAC) posted the agenda for their April 2 public meeting which will be hosted online. Registration for the online meeting can be accessed here. MACPAC staff is scheduled to present several prese...

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. ...

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...

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 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...

MACPAC Publishes March 2020 Report to Congress

The Medicare and CHIP Payment and Access Commission (MACPAC) released its March 2020 Report to Congress on Friday, March 13, 2020. MACPAC provides expert analyses of the Medicaid program related to payment, eligibility, coverage, access to care, and ...

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...

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...

MACPAC Commissioners Support VBP State Comparison Report

The Medicaid and CHIP Payment and Access Commission (MACPAC) held a public meeting on February 27-28, 2020. MACPAC staff presented results from MACPAC contracted research on five state strategies to promote the use of value-based payments (VBP) in Me...

MACPAC Releases Agenda for February 2020 Public Meeting

The Medicaid and CHIP Payment and Access Commission (MACPAC) posted the agenda for their next public meeting scheduled for February 27, 2020. MACPAC staff is scheduled to present results from MACPAC contracted research on state strategies to promote...

House Introduces Legislation to Increase Oversight of CMMI

On February 3, 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 Center for Medicare and Medicaid Innovation (CMMI...

Trump Administration Announces Medicaid Block Grant Proposal

The initiative, called the Healthy Adult Opportunity (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 flexibil...

Direct Contracting Office Hours on Feb 4

On February 4, the Center for Medicare and Medicaid Innovation (Innovation Center) will host office hours on the Direct Contracting model’s payment methodology. During the session—the first of two—the Direct Contracting model team will prov...

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

The 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. The Centers for Medicare & Medicaid Innovation announced...

Idaho 1115 Waiver Summary – Institutions for Mental Diseases

On January 3, 2020, Idaho submitted a new section 1115 waiver application to the Centers for Medicare and Medicaid Services (CMS).  Specifically, Idaho is requesting a 5-year section 1115 demonstration that authorizes the state to receive federa...

Georgia 1115 Waiver Application

On March 27, 2019, 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 ...

Hospital Quality Star Rating Program: Summary from Listening Session Posted

The Centers for Medicare and Medicaid Services (CMS) published the final summary report of the September 19, 2019 public listening session on the Hospital Quality Star Rating program. Under the Hospital Quality Star Rating Program, CMS uses data fro...

CMS Updates QPP Resources

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

  • 2019 CMS Web Interface User Guide
This document provides information on accessing the CMS Web...

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

The Center for Medicare and Medicaid Innovation (CMMI) posted the final evaluation report for the Maryland All-Payer Model. The model reduced total expenditures across payers and total hospital expenditures for Medicare beneficiaries without shifting...

CMMI Hosts Primary Care First Office Hours on Dec. 5

The Centers for Medicare and Medicaid Innovation (CMMI) will host office hours on the recently announced Primary Care First Model. Representatives from CMMI team will provide an overview of the model and answer questions from the audience on the mode...

Call for Nominations: MIPS Improvement Activities Validation TEP

The Centers for Medicare and Medicaid Services (CMS) is currently accepting nominations for a technical expert panel (TEP) on the validation criteria for the Improvement Activities for the 2020 performance year of the Merit-based Incentive Payment Sy...

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

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 hospi...

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

The Centers for Medicare and Medicaid Services (CMS) Center for Medicare & Medicaid Innovation posted the final report to Congress providing the results of the Medicaid Emergency Psychiatric Demonstration (MEPD). The 21st Century Cures...

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

On October 24, 2019, the Health Care Payment Learning and Action Network (LAN) hosted its annual Summit. The LAN set a new timeline for transitioning to payments tied to shared accountability alternative payment models (APMs) throughout the healthcar...

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

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

LAN Hosts Annual Summit on October 24

The Health Care Payment Learning and Action Network (LAN) is hosting its annual Summit on October 24th. Registration for the event can be found here and the agenda can be found here. The Summit provides a space for all stakeholders to engage in a di...

Part D Enhanced MTM Model: Year Two Results Fact Sheet

The Centers for Medicare and Medicaid Services (CMS) has posted a fact sheet summarizing the results of the second year of the Part D Enhanced Medication Therapy Management (MTM) Model. This model provides financial incentives for participating Medic...

CMS Updates QPP Resources

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

  • 2019 Clinical Quality Measure Specifications and Supporting Documents

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

On Thursday, September 19, 2019, the Government Accountability Office released a report on quality measurement activities of the Centers for Medicare and Medicaid Services (CMS) titled, “CMS Could More Effectively Ensure Its Quality Measurement Act...

Tennessee 1115 Waiver Application

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...

Montana 1115 Waiver Application Summary

On August 30, 2019, Montana submitted a new 1115 waiver application to the Centers for Medicare and Medicaid Services (CMS).  The waiver includes a work requirement and premium increases based on coverage duration.  The waiver is pending CMS ap...

GAO Releases Report on Managing High Cost Medicaid Beneficiaries

The Government Accountability Office (GAO) released a report on identifying, predicting, and managing high-cost beneficiaries in Medicaid. The GAO interviewed seven states that were able to successfully predict beneficiary healthcare expenditures. So...

Recent State Action Relating to Medicaid Expansion

To date, 37 states (including DC) have adopted Medicaid expansion. Of the remaining 14 states, some are considering expanding Medicaid. States with recent activity relating to Medicaid expansion include Idaho, Montana, Nebraska, North Carolina an...

Utah Medicaid Waivers

Throughout the course of 2019, Utah has proposed and submitted a series of Section 1115 Medicaid Demonstration waivers to the Centers for Medicare and Medicaid Services (CMS). On March 29, 2019, CMS approved a Utah 1115 waiver, which implemented ...

New York 1115 Waiver Application Summary

On August 9, 2019, New York announced it will be submitting a Section 1115 Medicaid Demonstration waiver application to the Centers for Medicare and Medicaid Services (CMS) to provide Medicaid services to certain incarcerated individuals about to...

Summary of Senate Finance Prescription Drug Package

Senate Finance Committee posts description of the Chairman’s mark of its legislation addressing prescription drug pricing. Today, July 23, 2019, the Senate Finance Committee posted a description of the Chairman’s mark of its legislation addres...

CMS Updates Medicaid and CHIP Scorecard

On July 18, 2019, the Centers for Medicare and Medicaid (CMS) updated the data within the Medicaid and the Children’s Health Insurance Program (CHIP) Scorecard. The Scorecard, released for the first time last year, is a component of the Trump Admin...

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

The Centers for Medicare and Medicaid (CMS) updates the Child and Adult Core Sets of quality measures annually. The Core Sets are important sources of information for CMS to assess the quality of services beneficiaries receive and improve Medicaid an...

Administration Withdraws Rebate Overhaul Proposal

The Administration has announced it is no longer pursuing its drug pricing proposal that would have required pharmacy benefit managers to pass rebates directly on to the patient. The Administration has announced it is no longer pursuing its drug p...

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

On June 25, 2019, the Centers for Medicare and Medicaid Services (CMS) released a Notice of Funding Opportunity for state Medicaid agencies to apply for planning grants to address the opioid crisis. The funding was authorized by the Substance Use Dis...

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

On June 24, President Trump signed the executive order “Improving Price and Quality Transparency in American Health Care to Put Patients First.” The executive order, which is consistent with previous Administration policies and priorities, focuse...

South Carolina 1115 Waiver Application Summary

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...

CMS Issues RFI on Patients over Paperwork Initiative

On June 6, the Centers for Medicare and Medicaid Services (CMS) issued a Request for Information (RFI) seeking new ideas from the public on how to continue the progress of the Patients over Paperwork initiative. Launched in 2017, the Patients over Pa...

Utah Per Capita Cap 1115 Waiver Summary

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 sessio...

Recent Updates from the Innovation Center

The Centers for Medicare and Medicaid Innovation recently posted several documents to their website. Financial Alignment Initiative for Medicare-Medicaid Enrollees The Financial Alignment Initiative is designed to provide individuals dually ...

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

The Centers for Medicare and Medicaid Innovation has released updated FAQs to assist applicants in preparing submissions for the Integrated Care for Kids (InCK) Notice of Funding Opportunity (NOFO). To view and download the new content, visit the “...

Updated eCQM Specifications and Materials for 2020 Reporting Now Available

The Centers for Medicare and Medicaid Services (CMS) has posted the electronic clinical quality measure (eCQM) specifications for the 2020 reporting period for Eligible Hospitals and Critical Access Hospitals, and the 2020 performance period for Elig...

CMS Presents All-Payer Combination Option Overview Webinar

The Centers for Medicare and Medicaid Services (CMS) is hosting a webinar on May 21, 2019, from 3 to 4 pm ET, to provide an overview of the All-Payer Combination Option. The All-Payer Combination Option allows clinicians to become a ...

GAO Recommends CMS Improve Transparency Policy for Section 1115 Waivers

On May 17, the Government Accountability Office (GAO) publicly released its report Medicaid Demonstrations: Approvals of Major Changes Need Increased Transparency. Medicaid demonstrations, established through the Section 1115 waiver...

Innovation Center Hosts Webinar on InCK Model on May 15

The Center for Medicare and Medicaid Innovation (the Innovation Center) will host a webinar on the Integrated Care for Kids (InCK) Model on Wednesday, May 15 from 2 to 3 pm ET. Innovation Center representatives will respond to inquiries about InCK...

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

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Senate Dems Introduce Choose Medicare Act, Public Option

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CMS Issues Letter to State Medicaid Directors

On April 24, 2019, the Centers for Medicare and Medicaid Services (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 Medicai...

Innovation Center Holds Second Webinar on InCK Funding Opportunity

The Center for Medicare and Medicaid Innovation is holding its second webinar on the Integrated Care for Kids (InCK) Model Notice of Funding Opportunity (NOFO) on April 18, 2019, at 2:30 pm ET. This webinar will include an overview of the model, its ...

Utah Medicaid 1115 Waiver Summary

On June 22, 2018, Utah submitted an 1115 waiver amendment to the Centers for Medicare and Medicaid Services (CMS) seeking to implement a partial and capped Medicaid expansion, as well as Medicaid work requirements for certain populations. Followi...

Innovation Center Hosts Webinar on MOM Model Application Process

The Center for Medicare and Medicaid Innovation is holding a webinar on April 4, from 2:45 to 4 pm ET, to review the Maternal Opioid Misuse (MOM) model Notice of Funding Opportunity and Grants.gov application process. The same material from the webi...

Ohio Section 1115 Waiver Approval

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

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CMS Updates Drug Spending Dashboards

CMS updated its drug spending dashboards with data for 2017. The dashboards show average spending per dosage unit for prescription drugs in CMS programs and track the change in average spending per dosage unit over time. According to CMS, from 2013 t...

CMS Publishes Guidance on 1115 Waiver Evaluations

On March 14, the Centers for Medicare and Medicaid Services (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, w...

President’s FY 2020 Budget Includes Drug Proposals

The White House FY 2020 budget proposal The Administration has been active in outlining its agenda to lower prescription drug costs. In May 2018, the Administration published its American Patients First Blueprint, which outlined the Administration...

State Innovation Waivers for ACA

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Actuaries Weigh in on Expanding Public Insurance

An American Academy of Actuaries report out today breaks down criteria and implications for “Medicare for All” and less sweeping ...

CMS Approves Drug Price Negotiations for Colorado Medicaid

Following in the footsteps of Oklahoma and Michigan, Colorado has become the latest state to receive approval from the Centers for Medicare and Medicaid Services (CMS) for negotiating drug prices for Medicaid recipients using value-based contracting ...

Innovation Center Hosts Webinar on MOM Model Application Process

The Center for Medicare and Medicaid Innovation is holding a webinar on February 21 from 2:00 to 3:15 pm ET to review the Maternal Opioid Misuse (MOM) model Notice of Funding Opportunity and Grants.gov application process. State Medicaid agencies an...

Medicaid Expansion Bill Introduced

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Maternal Opioid Misuse Model Funding Opportunity Announced

The Centers for Medicare and Medicaid Services Center for Medicare and Medicaid Innovation (Innovation Center) will execute up to 12 cooperative agreements with states whose Medicaid agencies will implement the Maternal Opioid Misuse (MOM) model with...

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

The Centers for Medicare and Medicaid Services Center for Medicare and Medicaid Innovation (Innovation Center) announced a funding opportunity for the Integrated Care for Kids (InCK) model. The model is a child-centered local service delivery and sta...

HHS and OIG Releases Proposal Targeting PBMs

The US Department of Health and Human Services and its Office of the Inspector General released a proposed rule building on the Administration’s efforts to lower prescription drug prices. The proposal would update the discount safe harbor in the An...

McDermottPlus Launches 2019 CMS/CMMI Payment Model Tracker

The Centers for Medicare and Medicaid Services (CMS) and its Innovation Center support the development and testing of innovative health care payment and delivery models. The Innovation Center is expected to announce several new models in 2019 – at ...

Medicaid Extenders Act of 2019

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

The Centers for Medicare and Medicaid Services (CMS) made a number of announcements on various payment innovation-related topics this past week.