Archives: Other CMS Developments

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CMS Issues Guide on Avoiding Readmissions in Diverse Medicare Populations

The CMS Office of Minority Health has released a “Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries.”   The guide highlights data indicating that racial and ethnic minority populations have higher rates of potentially avoidable readmissions for certain chronic conditions, such as heart failure, heart attack, and pneumonia, and identifies social, cultural, and … Continue Reading

CMS Launches New “Accountable Health Communities” Innovation Model

CMS’s latest innovation model, the Accountable Health Communities model, will test whether screening for health-related social needs, providing community service referral and navigation, and encouraging partner alignment impacts total cost of care, emergency department visits, inpatient hospital admissions, and quality of care for high-risk Medicare and Medicaid beneficiaries. The five-year program will provide up to … Continue Reading

CMS Requests Comments on HIT Certification and Quality Measure Reporting to Reduce Provider/HIT Developer Burden

On December 31, 2015, CMS published a request for information (RFI) seeking public comments on certification requirements for health information technology (HIT), including electronic health records (EHR) products used for reporting under certain CMS quality reporting programs. The RFI also invites feedback on how often CMS should require recertification, the number of clinical quality measures … Continue Reading

CMS Seeks Comments on Draft Physician Fee Schedule Quality Measure Development Plan

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to develop quality measures that will apply to Medicare payments to physicians when new Merit-based Incentive Payment System (MIPS) and Medicare alternative payment model (APM) provisions go into effect (MIPS and APM payment adjustments begin in 2019).  Pursuant to this mandate, CMS has … Continue Reading

CMS Releases Draft 2017 Letter to QHP Issuers in Federally-facilitated Marketplaces

On December 23, 2015, CMS released its Draft 2017 Letter to Issuers in the Federally-facilitated Marketplaces, which provides operational and technical guidance to issuers seeking to offer qualified health plans (QHPs) in the Federally-facilitated Marketplaces or the Federally-facilitated Small Business Health Options Programs.  Comments will be accepted until January 17, 2016.… Continue Reading

CMS Call on Upcoming Home Health Value-Based Purchasing Model (Dec. 17)

On December 17, 2015, CMS is hosting an “Open Door Forum” on the Home Health Value-Based Purchasing Model (HHVBP), which begins January 1, 2016 in nine states. All Medicare-certified HHAs delivering services within these states will be required to compete for payment adjustments based on quality performance.… Continue Reading

CMS Releases 2016 Medicare DMEPOS Fee Schedule – Reflecting Steep Cuts Based on DMEPOS Competitive Bidding Rates

Today CMS released the Medicare durable medical equipment (DME), prosthetics, orthotics, and supplies (DMEPOS) fee schedule for the first half of 2016 – reflecting the agency’s first adjustments to nationwide rates based on DMEPOS competitive bidding program (CBP) pricing. As previously reported, the Affordable Care Act mandates that CMS use pricing information from competitive bidding … Continue Reading

CMS Invites Comments on MACRA Episode Groups

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to establish care episode groups and patient condition groups, which will be used to measure resource use under the new Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs). Care episode groups describe the patient’s clinical problems at the time items and … Continue Reading

CMS Update on Medicare-Medicaid Plan Quality Ratings Strategy

CMS has provided an update on vision for developing a star rating system for Medicare-Medicaid Plans (MMPs). While CMS does not expect to have the full star rating system in place during the testing of the previously-announced Financial Alignment Initiative, the rating system could potentially serve as a basis for quality-based payments for plans in … Continue Reading

Medicare FFS RACs Identified Almost $2.4 Billion in Overpayments in FY 2014

According to CMS, the Medicare Fee-For-Service (FFS) Recovery Auditor Program identified and corrected $2.57 billion in improper Medicare payments in FY 2014. The lion’s share of this amount — $2.39 billion — represented overpayments collected, compared to $173.1 million in underpayments repaid to providers. Considering all program costs (other than expenses incurred at the third … Continue Reading

CMS Releases Medicare DMEPOS Payment/Utilization Data

In a continuation of the Administration’s efforts to make Medicare spending data more transparent, CMS has released detailed payment information regarding physicians and other providers who order durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) for Medicare beneficiaries.  The new “Referring Provider DMEPOS Public Use File” includes provider-specific Medicare Part B DMEPOS utilization, payment, and … Continue Reading

CMS Announces Medicare Part D Medication Therapy Management Innovation Model

The latest CMS “innovation model” will test whether providing Medicare Part D prescription drug plan (PDP) sponsors with financial incentives and flexibility with regard to medication therapy management (MTM) program requirements can improve quality and reduce costs by “right-sizing” investment in MTM services.  Specifically, CMS will allow stand-alone PDP sponsors in 11 states to apply … Continue Reading

CMS Releases Preliminary 2016 Determinations for New Clinical Lab Tests, Announces October 19 Open Meeting on Clinical Lab Payments

CMS has announced its preliminary 2016 clinical laboratory fee schedule (CLFS) payment determinations for new and reconsidered test codes.  These preliminary determinations will be the subject of an October 19, 2015 meeting of the Advisory Panel on Clinical Diagnostic Laboratory Tests. The public may attend the meeting in-person (registration required), view via webcast, or listen … Continue Reading

CMS Equity Plan Tackles Health Disparities

On September 8, 2015, CMS released its first “CMS Equity Plan for Improving Quality in Medicare,” which seeks to reduce health disparities among Medicare populations that experience disproportionately high burdens of disease, lower quality of care, and barriers accessing care. Such populations identified by CMS include: racial and ethnic minorities, sexual and gender minorities, people … Continue Reading

CMS Launches New Medicare Advantage Innovation Model

The latest CMS “innovation model” focuses on options for redesigning Medicare Advantage (MA) to improve health outcomes while reducing expenditures. Specifically, the Medicare Advantage Value-Based Insurance Design (VBID) Model will allow MA plans in seven states to apply to offer supplemental benefits or reduced cost sharing to enrollees with specified chronic conditions. The five-year initiative will … Continue Reading

CMS Updates Inpatient Hospital “Two Midnight” Review Education/Enforcement Strategy

CMS recently provided an update on its education and enforcement strategies related to its “Two Midnight” policy, which addresses when surgical procedures, diagnostic tests and other treatments are generally considered appropriate for inpatient hospital admission under Medicare Part A. The Medicare Access and CHIP Reauthorization Act of 2015 generally bars recovery audit contractors (RACs) from … Continue Reading
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