Tag: Medicare
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...
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...
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...
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...
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, ...
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...
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....
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...
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...
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...
The Department of Health and Human Services (HHS) has again extended the deadline for providers to accept the Terms and Conditions for Provider Relief Fund payments. Eligible providers now have 90 days from the date they received the payment to accep...
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...
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...
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...
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...
The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:
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...
On May 21, 2020, the Government Accountability Office (GAO) appointed three new Commissioners and reappointed two Commissioners to the Medicare Payment Advisory Commission (MedPAC). The new MedPAC Commissioners are Michael Chernew, PhD, Betty Rambur,...
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...
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...
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...
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...
The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:
On May 12, 2020, the House Democrats released a fifth emergency funding bill in response to the Coronavirus (COVID-19) pandemic, the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act. This $3 trillion bill funds a wide range of in...
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 ...
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...
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....
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...
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...
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...
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...
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...
The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:
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...
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...
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...
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...
On April 22, 2020, the Medicare Board of Trustees released their annual report for Medicare’s two separate trust funds — the Hospital Insurance (HI) Trust Fund, which funds Medicare Part A, and the Supplementary Medical Insurance (SMI) Trust Fund...
On April 10, 2020, the US Department of Health and Human Services (HHS) began distributing $30 billion from the $100 billion Public Health and Social Services Emergency Fund to Medicare fee-for-service (FFS) providers. The Coronavirus Aid, Relief, an...
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...
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...
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...
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...
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...
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...
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...
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...
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...
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...
The Secretary of Health and Human Services (HHS) announced on Friday, April 3, 2020, during the daily briefing of the White House Coronavirus Task Force that Administration’s current plan is to use a portion of the $100 billion CARES Act funding to...
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...
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...
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...
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...
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...
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...
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...
The Medicare Payment Advisory Commission (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 tr...
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. ...
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...
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...
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 ...
The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:
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 ...
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...
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...
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...
The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:
The Medicare Payment Advisory Commission (MedPAC) published the March 2020 Report to Congress on Friday, March 13, 2020. As required by law, the Commission made recommendations for nine provider sectors in fee-for-service Medicare and reviewed the st...
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 ...
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...
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...
The Medicare Payment Advisory Commission (MedPAC) met on March 5-6 to consider presentations and recommendations from MedPAC staff related to quality improvement, risk adjustment and payment innovation. Addressing Medicare Shared Savings ...
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...
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...
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...
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...
The Centers for Medicare and Medicaid Services (CMS) uploaded new and updated materials to the Quality Payment Program (QPP) Resource Library:
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...
The Centers for Medicare and Medicaid Services (CMS) uploaded new materials to the Quality Payment Program (QPP) Resource Library:
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 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...
On February 11, 2020, the Center for Medicare and Medicaid Innovation (Innovation Center) will host office hours on the Direct Contracting model’s payment methodology. During this second session—the second in a two-part series—the Direct Contra...
The Centers for Medicare and Medicaid Services’ (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) released a report in which seven episode-based payment models were evaluated to identify common themes and best practices from eac...
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...
The Centers for Medicare and Medicaid Services (CMS) published the dataset listing the hospitals that will receive a one percent reduction in payments in FY 2020 under the Hospital Acquired Conditions (HAC) Reduction Program. An analysis by Kaiser He...
The Centers for Medicare and Medicaid Services (CMS) uploaded new materials to the Quality Payment Program (QPP) Resource Library:
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...
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...
Many federal programs, including Medicare and Social Security are funded through trust funds and other dedicated funds. Medicare is funded through the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund. T...
CMS began collecting data on social determinants of health (SDOH) through the use of z-codes in 2016. The agency reported that among 33.7 million total Medicare FFS beneficiaries in 2017, approximately 1.4% had claims with Z codes. SDOH indicators ar...
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. This expansion of coverage builds on the origina...
On Thursday, January 16, 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. Previously, Sa...
On January 22, 2020, the Centers for Medicare and Medicaid Services (CMS) will host a webinar to discuss the payment methodologies for the Direct Contracting Model Options. This webinar follows a previous presentation delivered on January 15, which p...
The Medicare Payment Advisory Commission (MedPAC) met on January 16 and 17 to vote on payment update recommendations and to discuss other recommendations to update the Medicare program. The Commission will include payment updates and other recommenda...
On January 14, 2020, the Government Accountability Office (GAO) published a request for nominations for the Medicare Payment Advisory Commission (MedPAC). Nominations and resumes are due February 14, 2020, and can be sent to MedPACappointments@gao.go...
The Medicare Payment Advisory Commission (MedPAC) has posted the agenda for the next public meeting scheduled for January 16-17, 2020. MedPAC staff is scheduled to present on the Medicare Advantage quality bonus program and beneficiary alignment with...
In a blog post, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma touted the uptick in participation in two-sided risk arrangements in the redesigned Medicare Shared Savings Program for Accountable Care Organizations (ACOs),...
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. This guidance gives additional clarity as stak...
The Centers for Medicare and Medicaid Services (CMS) is requesting feedback on eliminating Medicare specific regulations requiring supervision that exceeds other federal or state laws. CMS states that certain Medicare scope of practice limitations ar...
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. CMS had most recently adopted changes to the laboratory Date of Service (DOS) ex...
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...
The Centers for Medicare and Medicaid Services (CMS) uploaded new materials to the Quality Payment Program (QPP) Resource Library:
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). Clinicians can enter their National Provider Identifier in th...
The Centers for Medicare and Medicaid Services (CMS) uploaded new materials to the Quality Payment Program (QPP) Resource Library:
The Medicare Payment Advisory Commission (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 Medicare Advantage (MA) as they prepare their...
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. The transmittal includes the G codes...
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...
The Medicare Payment Advisory Commission (MedPAC) is scheduled to meet December 5 to 6, 2019. The Commission will review data in preparation for their annual March report in which they will recommend annual adjustments for Medicare’s various paymen...
The Centers for Medicare & Medicaid Services (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...
CMS releases CY 2020 final payment determinations for the 90 codes reviewed during the summer 2019 CLFS Annual Public Meeting. For each code, CMS announces whether the Agency is using crosswalk or gapfill to establish the payment rate, along with it...
As part of a larger campaign to inform the public about accountable care organizations (ACOs), the Centers for Medicare and Medicaid Services (CMS) launched a new toolkit highlighting how ACOs and end-stage renal disease (ESRD) seamless care organiza...
The Centers for Medicare and Medicaid Services (CMS) announced another Open Door Forum. On Wednesday, December 4, CMS will host a webinar to discuss updates on the Hospice Outcomes and Patient Evaluation (HOPE) tool. What: CMS: Hos...
Public Meeting The Physician-Focused Payment Model Technical Advisory Committee (PTAC) recently opened registration for the Monday, December 9, 2019, public meeting. Registration for the event is open here. Preliminary Review Team Report<...
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...
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...
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...
CMS publishes the annual National Correct Coding Initiative (NCCI) policy manual for CY 2020. Stakeholders remain concerned regarding the NCCI manual language in Chapter 10 about multiplex testing. National Correct Coding Initiative Edits...
The Medicare Payment Advisory Commission (MedPAC) met in Washington, DC on November 6-7, 2019. The Commission continued a discussion on redesigning the Medicare Advantage (MA) quality bonus program (QBP).
The Medicare Payment Advisory Commission (MedPAC) met in Washington, DC on November 6-7, 2019. The Commission continued a discussion on redesigning the Medicare Advantage (MA) quality bonus program (QBP).
Redesigning the Medicare Advantage (MA) q...
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...
The Medicare Payment Advisory Commission (MedPAC) is discussing several innovation and quality topics at their next public meeting scheduled for November 7-8, 2019. Topics include:
MedPAC Discusses MA Quality Program, MA Benchmarks and MSSP Post-Acute Care Spending at November Public Meeting
Report to Congress: Response to 21st Century Cure Act MEPD Demonstration
MedPAC to Discuss Quality at November Public Meeting
On October 24, 2019, the Center for Medicare and Medicaid Innovation (CMMI) posted request for applications (RFAs) for the Primary Care First (PCF) and Kidney Care Choices (KCC) Models. The models were announced earlier in 2019. The applications are ...
The Centers for Medicare and Medicaid Services (CMS) released the year five report for the Independence at Home (IAH) Demonstration. The report indicates that of the 14 participating practices, 13 reduced per-beneficiary-per-month spending relative t...
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...
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. The proposed decision memo would revis...
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...
As a follow-up to the recently released Presidential Executive Order on Medicare, the Centers for Medicare and Medicaid Services (CMS) released two requests for information (RFIs) on the future of Medicare program integrity. For CMS, the focus of Med...
The Centers for Medicare and Medicaid Services (CMS) is currently seeking nominations for members of the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC). The notice for nominations can be found here. Nominations and supportin...
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...
The Centers for Medicare and Medicaid Services (CMS) uploaded new materials to the Quality Payment Program (QPP) Resource Library:
The Centers for Medicare and Medicaid Services (CMS) released their annual update of Medicare Part C and D Star Ratings. These ratings measure the quality of health and drug services received by beneficiaries enrolled in Medicare Advantage (MA) and P...
The Medicare Payment Advisory Commission (MedPAC) met in Washington, DC on October 3-4, 2019. The Commission continued the discussion on a variety of innovation topics including restructuring Part D, the development of a unified post-acute care (PAC)...
The Medicare Payment Advisory Commission (MedPAC) is discussing several innovation and quality topics at their next public meeting scheduled for October 3 to 4, 2019. Topics include:
CMS releases CY 2020 preliminary payment determinations for 90 codes reviewed during the summer 2019 CLFS Annual Public Meeting. For each code, the CMS announces whether the Agency intends to crosswalk or gapfill to establish the payment rate, along...
The Centers for Medicare and Medicaid Services (CMS) uploaded new materials to the Quality Payment Program (QPP) Resource Library:
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...
The U.S. Government Accountability Office (GAO) recently released a report on Medicare physician spending on longitudinal comprehensive care planning (LCCP) services. This report, which was required by a provision of the Bipartisan Budget Act of 2018...
On July 29, 2019, the Centers for Medicare and Medicaid Services (CMS) released the CY 2020 Revisions to Payment Policies under the Physician Fee Schedule (PFS) and Other Changes to Part B Payment Policies (CMS-1715-P), which includes proposals relat...
The Centers for Medicare and Medicaid (CMS) Innovation Center released an infographic describing the new payment model for ambulance care teams. The new Emergency Triage, Treat and Transport (ET3) Model is a voluntary model allowing flexibility for e...
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...
On Friday, July 19, 2019, the Medicare Payment and Advisory Commission (MedPAC) released their 2019 Health Care Spending and the Medicare Program data book. The MedPAC Data Book provides information on national health care and Medicare spend...
The Centers for Medicare and Medicaid Services (CMS) is proposing coverage of acupuncture for Medicare patients with chronic low back pain who are enrolled participants either in clinical trials sponsored by the National Institutes of Health or in CM...
The US Department of Health and Human Services Office of Inspector General (OIG) published two reports identifying significant vulnerabilities in the Medicare hospice benefit that are harming beneficiaries. The report analyzed auditing data from 201...
The Centers for Medicare and Medicaid (CMS) proposed changes to the Home Health Quality Reporting Program (QRP) for CY 2020. The program currently has 19 reporting requirements. The proposed rule adds an additional reporting requirement to the Home ...
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...
The Center for Medicare and Medicaid Innovation recently released the Second Annual Evaluation Report for the Comprehensive Care for Joint Replacement (CJR) model. After two performance years, average episode payments decreased by 3.7 percent or $1...
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...
On June 14, 2019, the Medicare Payment Advisory Commission (MedPAC) released its June 2019 Report to the Congress: Medicare and the Health Care Delivery System. Each June, as part of its mandate from the Congress, MedPAC reports on issues affecting t...
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...
The Center for Medicare and Medicaid Innovation will host a webinar on June 11, 2019, from 2 to 3 pm EDT, to provide an overview of the Emergency Triage, Treat and Transport (ET3) Model Request for Applications. The ET3 Model is a voluntary five-yea...
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 ...
On May 23, 2019, the Government Accountability Office appointed two new members to the Medicare Payment Advisory Commission (MedPAC) and reappointed four current members. The new members are Lawrence Casalino, MD, PhD, and Amol Navathe, MD, PhD. The ...
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...
The Centers for Medicare and Medicaid Services (CMS) released the first annual report of the Comprehensive Primary Care Plus (CPC+) payment model. CPC+ is the largest primary care payment and delivery reform ever tested in the US. In January 2017 it ...
The Centers for Medicare and Medicaid Services (CMS) requires that all eligible hospitals and critical access hospitals (CAHs) use 2015 edition certified electronic health record technology (CEHRT) to meet the requirements of the Promoting Interopera...
On Wednesday, May 8, 2019 at 9:30 am ET, the Senate Finance Committee is hosting a hearing titled, “Medicare Physician Payment Reform After Two Years: Examining MACRA Implementation and the Road Ahead.” The hearing intends to assess how well the ...
The Center for Medicare and Medicaid Innovation (the Innovation Center) will host a webinar on the billing and claims process for the Medicare Diabetes Prevention Program (MDPP) Expanded Model on Wednesday, May 29 from 1 to 2 pm ET. Registration inf...
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The Centers for Medicare and Medicaid Services released a report regarding disparities in quality of care received by Medicare Advantage (MA) beneficiaries. The report discusses the distribution of race, ethnicity and gender among MA beneficiaries....
On April 22, 2019, the Medicare Board of Trustees released their annual report on the state of the Medicare Trust Fund. The Trustees project that Medicare costs will grow from approximately 3.7 percent of GDP in 2018 to 5.9 percent of GDP by 2038, a...
The Medicare Payment Advisory Commission (MedPAC) met on April 4 to 5, 2019, in Washington, DC. MedPAC discussed a number of innovation and quality topics at this meeting.
Senators Michael Bennet (D-CO) and Tim Kaine (D-VA) introduced a bill that would allow anyone to buy Medicare plans, an option they say is more realistic than Medicare for All. It also includes some ACA stabilization provisions, including increas...
The Centers for Medicare and Medicaid Services (CMS) will open the application period for Model Year 3 of the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model in April 2019. This second cohort will start on January 1, 2020. Curren...
The Centers for Medicare and Medicaid Services (CMS) Annual Call for Measures for eligible hospitals and critical access hospitals participating in the Medicare Promoting Interoperability Program is now open. The deadline to submit a measure proposal...
On Friday, March 15, 2019, the Medicare Payment Advisory Commission (MedPAC) released their March 2019 Report to Congress. The principal focus of the March report is MedPAC’s recommendations for annual payment rate adjustments (or ...
The Centers for Medicare and Medicaid Services (CMS) Annual Call for Measures for eligible hospitals and critical access hospitals participating in the Medicare Promoting Interoperability Program is now open. Submit a measure proposal by June 28, 201...
CMS updated its drug spending dashboards with data for 2017. The Centers for Medicare and Medicaid Services (CMS) updated its drug spending dashboards with data for 2017. The dashboards show average spending per dosage unit for prescription drugs...
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 protect...
At their public meeting on March 7 and 8, the Medicare Payment Advisory Commission (MedPAC) considered a range of Medicare payment issues. Five takeaways from the meeting are as follows:...
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An American Academy of Actuaries report out today breaks down criteria and implications for “Medicare for All” and less sweeping ...
Clinicians can now check the Quality Payment Program (QPP) Participation Status Tool to view their 2019 Merit-based Incentive Payment System (MIPS) eligibility status for the 2019 performance period. 2019 MIPS eligibility status is determined by rev...
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On February 7, 2019, Representative Lloyd Doggett (D-TX) introduced legislation (H.R. 1046) allowing Medicare to negotiate lower drug prices in the Part D program. Read the full article here....
On February 7, 2019, Senator Sherrod Brown (D-OH) introduced legislation (S. 377) allowing Medicare to negotiate lower drug prices in the Part D program. Read the full article here....
On February 4, 2019 the Centers for Medicare and Medicaid Services issued proposed rule that would, if finalized, make changes to certain proficiency testing requirements under the CLIA program. Comments are due April 5, 2019....
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 ...
The Centers for Medicare and Medicaid Services (CMS) launched a new app called “What’s Covered” that tells users whether Medicare covers a specific medical item or service. The app is available for download in Google Play or at the Apple App St...
On January 10, 2019, Representative Elijah Cummings (D-MD) introduced legislation (H.R. 448) allowing Medicare to negotiate lower drug prices in the Part D program. Read the full article here....
On January 10, 2019, Senator Bernie Sanders (I-VT) introduced legislation (S. 99) allowing Medicare to negotiate lower drug prices in the Part D program. Read the full article here....
The Centers for Medicare and Medicaid Services published a final rule on December 31, 2018, that overhauls the Medicare Shared Savings Program and takes a new approach to transitioning providers to performance-based risk arrangements in traditional M...
On January 9, 2019, Senator Amy Klobuchar (D-MN) introduced legislation (S. 62) allowing Medicare to negotiate lower drug prices in the Part D program. Read the full article here....
Today the Centers for Medicare and Medicaid Services released the Medicare Shared Savings Program; Accountable Care Organizations Pathways to Success and Extreme and Uncontrollable Circumstances Policies for Performance Year 2017 (CMS-1701-F2 and CM...
At their December 6, 2018, public meeting the Medicare Payment Advisory Commission (MedPAC) considered a draft recommendation to revamp the Hospital Value Based Purchasing Program (HVBP). Under the Hospital Value Incentive Program (HVIP), MedPAC pr...
Eligible clinicians can check the Quality Payment Program (QPP) Participation Status Tool to view their final 2018 eligibility status for the Merit-based Incentive Payment System (MIPS). The initial 2018 MIPS eligibility status was based on CMS revie...
On December 3, 2018, the Centers for Medicare and Medicaid Services (CMS) released fiscal year (FY) 2019 results from the Hospital Value Based Purchasing Program (HVBP). Under the HVBP CMS adjusts hospital payment for Inpatient Prospective Payment Sy...
The Centers for Medicare & Medicaid Services launched a new online tool that allows consumers to compare Medicare payments and copayments for certain procedures that are performed in both hospital outpatient departments and ambulatory surgical ce...
On November 26, 2018, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would allow for changes in 2020 to coverage of protected class drugs, establish new requirements for when MA plans may apply step therapy as a ut...
The Centers for Medicare and Medicaid Services (CMS) made a number of announcements on various payment innovation-related topics this past week.
Under current law, clinicians in Advanced Alternative Payment Models (APMs) receive an incentive payment on their Medicare professional services revenue if they meet a specified participation threshold each year between 2019 and 2024. Meeting this th...
The Assistant Secretary for Planning and Evaluation (ASPE) released a request for information (RFI) regarding provider and plan approaches to improve care for Medicare beneficiaries with social risk factors. The Improving Medicare Post-Acute Care T...
The Health Care Payment Learning and Action Network (LAN) released a new report on alternative payment model (APM) adoption. The LAN collaborated with America’s Health Insurance Plans and the Blue Cross Blue Shield Association to gather represent...
The Centers for Medicare and Medicaid Services (CMS) released Part C and Part D Star Ratings that provide information about the quality of plan choices. Medicare Advantage plans with prescription drug coverage (MA-PD) are rated on up to 46 quality ...
The Centers for Medicare and Medicaid Services (CMS) announced a number of changes to the oversight of Medicare Accrediting Organizations (AOs). CMS believes these changes will improve quality and safety in healthcare facilities and empower patients ...
The Centers for Medicare & Medicaid Services (CMS) announced a new, multi-year initiative intended to modernize the ways beneficiaries receive information about Medicare and create new ways to assist health care decision-making. The tools that ...
Representative Suzan DelBene (D-WA) is requesting support for a letter that will ask the Centers for Medicare and Medicaid Services (CMS) to adjust the Merit-based Incentive Payment System (MIPS) low-volume threshold in order to include more provider...
On September 20, the Office of the Inspector General (OIG) released the fourth in a series of data briefs looking at Medicare spending under the Clinical Laboratory Fee Schedule. This report evaluates Medicare spending in 2017, the final year befor...
On September 13, 2018 at 1:15 pm, the Energy and Commerce Health Subcommittee will hold a hearing entitled “Examining Barriers to Expanding Innovative, Value-Based Care in Medicare.” The hearing will look at ways to meaningfully evaluate and in...
The Centers for Medicare & Medicare Services (CMS) released a data set showing how Medicare Accountable Care Organizations (ACOs) performed in 2017. Analysis of the data showed that ACOs saved $314 million for Medicare. The results come as CM...
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires the Medicare Payment Advisory Commission (MedPAC) to conduct a mandated report on clinician payment examining the relationship between Medicare’s payments to clinicians and t...
The Centers for Medicare & Medicaid Services (CMS) is hosting a webinar to provide an overview of the All-Payer Combination Option, which allows clinicians to qualify for the Advanced Alternative Payment Model (APM) five percent incentive payment...
The Centers for Medicare & Medicaid Services (CMS) updated the Quality Payment Program Participation Status Tool to include 2018 Advanced Alternative Payment Model (APM) Qualifying Participant (QP) and Merit-based Incentive Payment System (MIPS) ...
The Centers for Medicare & Medicaid Services (CMS) will host two 60-minute Physician Compare webinars about public reporting and information in the pipeline for potential inclusion on Physician Compare in late 2018, including year one Quality P...
The Republican House Budget Committee released a FY 2019 budget roadmap, The Budget for A Brighter American Future, on June 19. The budget proposes to reduce the deficit by $302 billion in the next decade, in large part by cutting spending on man...
On Wednesday, June 20, 2018, the Centers for Medicare & Medicaid Services (CMS), will host a call to present information about the Medicare Diabetes Prevention Program (MDPP) supplier enrollment requirements and process. The call will include a...
On June 5, 2018, the Board of Trustees released the 2018 annual report on solvency of the Medicare trust funds (the Hospital Insurance Trust Fund and the Supplementary Medical Insurance Trust Fund).
The Centers for Medicare & Medicaid Services (CMS) announced that it is opening the advanced alternative payment model (APM) module for Medicare Advantage (MA) plans. The module will allow Medicare plans to request that their payment arrangemen...
The Urban Institute unveiled a plan to provide near-universal health insurance coverage, adopting elements of the Medicare program and the Affordable Care Act (ACA). The Healthy America plan would be open to all legal US residents under age 65, o...
The Centers for Medicare and Medicaid Services (CMS) added new resources to the resource library for the Medicare Diabetes Prevention Program (MDPP). The MDPP is an expanded Innovation Center model with the goal of preventing type two diabetes for ...
On April 23, 2018, the Innovation Center released a Request for Information (RFI) on direct provider contracting (DPC) between payers and primary care or multi-specialty groups to inform potential testing of a DPC model within the Med...
As part of its Patients Over Paperwork initiative, the Centers for Medicare and Medicaid Services (CMS) released an analysis of comments submitted in response to nine Requests for Information (RFIs) included in the Medicare FFS payment rules. CMS r...
On Monday December 11, the American Clinical Laboratory Association (ACLA) filed a legal challenge to CMS’s implementation of the revised Clinical Laboratory Fee Schedule (CLFS) required under Section 216 of the Protecting Access to Medicare Act ...
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