Tag: Medicare

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 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 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 Extends Deadline to Accept Terms and Conditions for Provider Relief Fund Payments

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...

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...

GAO Announces New MedPAC Commissioners and Chair

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,...

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...

House Introduces $3 Trillion Funding Bill

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...

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 ...

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...

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...

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...

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...

2020 Medicare Trustees Report Released

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...

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...

HHS Distributes $30 Billion to FFS Medicare Providers

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...

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...

HHS Announces Plan to Use $1 billion from CARES Act Funding to Treat Uninsured COVID-19 Patients

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...

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 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 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...

MedPAC Releases Agenda for Closed-door April Meeting

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...

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...

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 ...

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 ...

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...

MedPAC Publishes March 2020 Report to Congress

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...

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 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...

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...

MedPAC Discusses Innovation Improvements and Mandated Report to Congress

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 ...

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...

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...

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...

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...

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 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...

Direct Contracting Office Hours on Feb 11

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...

CMS Evaluates Episode-Based Payment Models

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...

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...

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

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...

CMS Updates QPP Resources

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

  • 2020 CAHPS for MIPS Minimum Business Requirements
This documents lists the requirements inter...

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...

GAO Identifies Fiscal Sustainability Concerns with Medicare and Other Trust Funds

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

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

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...

CMMI Hires New Chief Technology Officer

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...

CMS Schedules Direct Contracting Model Webinar

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...

MedPAC Discusses Restructuring Medicare Benefits and Votes on Payment Update Recommendations

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...

GAO Requests Nominations for MedPAC Commissioners

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...

MedPAC Releases Agenda for January 2020 Public Meeting

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...

CMS Announces New ACO Participation and Savings Numbers

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 Additional Guidance on AUC Reporting

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...

Request for Feedback on Medicare Scope of Practice

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...

Enforcement Discretion Period Ends for Laboratory Date of Service Exception Policy

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...

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...

MIPS Eligibility Status Final 2019 Update Now Available

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...

CMS Updates QPP Resources

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

  • Quality Payment Program Access User Guide
This resource guides new users through the process ...

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

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...

Appropriate Use Criteria Claims Processing Requirements Issued

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...

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...

MedPAC Releases Agenda for December 2019 Public Meeting

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...

CMS Hosts Webinar on the 2020 Medicare Promoting Interoperability Program

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 2020 Final CLFS Payment Determinations

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...

CMS Publishes Beneficiary Engagement Toolkit for ACOs

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...

CMS Hosting Hospice Quality Reporting Program Forum on Dec. 4

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...

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

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<...

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...

CMS Publishes CY 2020 National Correct Coding Initiative Policy Manual

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...

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

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).  

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

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...

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...

MedPAC to Discuss Quality at November Public Meeting

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: