The Centers for Medicare & Medicaid Services (CMS) has released a Request for Information (RFI) on how the Medicaid program can incorporate out-of-state providers in coordinating care for children with certain medically complex conditions under Medicaid. The RFI is intended to help CMS implement a provision of the Medicaid Services Investment and Accountability Act of
coordination of care
OMB Reviewing OIG Proposed Rule Amending Federal Anti-kickback and Beneficiary Inducement Policies to Promote Value-Based Care
The White House Office of Management and Budget (OMB) is reviewing a long-awaited Trump Administration proposed rule to amend the safe harbors to the Anti-Kickback Statute (AKS) and exceptions to the beneficiary inducement provisions of the Civil Monetary Penalty (CMP) statute to better support coordinated care. The proposed rule presumably builds on the related request…
CMS Invites Comments on Ways to Ease the Burden of Stark Physician Self-Referral Rules on Coordinated Care Arrangements
As part of its “Regulatory Sprint to Coordinated Care,” the Centers for Medicare & Medicaid Services (CMS) is seeking input on how it can address “unnecessary obstacles to coordinated care, real or perceived, caused by the physician self-referral law.” CMS Administrator Seema Verma acknowledged in a recent blog post that “[i]n its current form, the…
Proposed Revisions to Home Health Conditions of Participation
On October 9, 2014, CMS is publishing a proposed rule that would extensively revise the conditions of participation (CoPs) that home health agencies (HHAs) must meet to participate in the Medicare and Medicaid programs. The rule is intended to provide HHAs with enhanced flexibility while focusing provider efforts on the services delivered to the patient…
CMS Call to Focus on ACO Educational Opportunities (Aug. 27)
The CMS Center for Medicare and & Medicaid Innovation is holding an Open Door Forum on August 27, 2012 to receive input on designing educational opportunities for providers interested in participating in accountable care organizations (ACOs) or other coordinated care initiatives.
CMS Call: Medicare Shared Savings Program and Advance Payment Model Application Process (July 31)
On July 31, CMS is hosting a call on the Medicare Shared Savings Program application and Advance Payment Model application processes for the January 1, 2013 Shared Savings Program start date. These two initiatives are designed to help providers participate in Accountable Care Organizations (ACOs) to improve quality of care for Medicare patients. Registration is…
CMS Guidance on Medicaid Integrated Care Models
On July 10, 2012, CMS released two letters to state Medicaid agencies on “Developing and Implementing Integrated Care Models in Medicaid Programs.” The first letter describes the concept of “Integrated Care Models,” which could include medical/health homes, accountable care organizations (ACOs), ACO-like models, and other arrangements that emphasize person-centered, continuous, coordinated, and comprehensive…
CMS Call on Medicare Shared Savings Program and Advance Payment Model Application Process (July 16)
On July 16, 2012, CMS is hosting a National Provider Call on the Shared Savings Program application and Advance Payment Model application processes for the January 1, 2013 Shared Savings Program start date. These two initiatives are designed to help providers participate in Accountable Care Organizations (ACOs) to improve quality of care for Medicare patients.…
MedPAC Examines Medicare Benefit Redesign, Dual Eligible Policy Options
On June 15, 2012, MedPAC released its June 2012 Report to the Congress on “Medicare and the Health Care Delivery System.” Unlike most MedPAC reports that focus on provider payments, this report examines the role of beneficiaries and their impact on the Medicare program. In particular, MedPAC recommends reforms to Medicare’s benefit design/cost-sharing structure to…
CMS Announces Comprehensive Primary Care (CPC) Initiative Participants
On June 6, 2012, the CMS Innovation Center announced that 45 insurers in seven markets will participate in the CPC Initiative, under which CMS will offer bonus payments to primary care doctors who improve patient care coordination. CMS will select approximately 75 primary care practices in each designated market to participate. Interested primary care…
GAO Report on Impact of Fraud and Abuse Laws on Medicare Financial Incentive Programs
A recent GAO report focuses on how federal fraud and abuse laws affect the implementation of financial incentive programs intended to improve quality and efficiency, such as pay-for-performance programs that reward physicians for adherence to clinical protocols or shared savings programs that offer physicians a percentage of a hospital’s cost savings attributable to the physicians.
CMS Initiative Targets Avoidable Nursing Facility Resident Hospitalization
CMS has launched the “Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents,” through which the agency will partner with independent organizations to improve care for long-stay nursing facility residents enrolled in Medicare and Medicaid. CMS will support organizations (called “enhanced care & coordination providers”) that work with nursing facilities to implement evidence-based…
HHS Health IT Challenge Targets Post-Discharge Care
The HHS National Coordinator for Health Information Technology has announced a “Discharge Follow-Up Appointment” care transitions challenge for health IT software developers, the second “Investing in Innovation” (i2) Initiative. The challenge seeks to stimulate the use of simple, information technology-enabled processes to schedule follow-up appointments and post-discharge testing before a patient leaves the hospital,…
CMS Call on ACA Comprehensive Primary Care Initiative (Oct. 13)
On October 13, 2011, CMS is hosting a call to discuss its request for applications for the Comprehensive Primary Care (CPC) initiative, which is designed to help primary care practices deliver higher quality, better coordinated, and more patient-centered care. The call will begin at 1:00 p.m. ET; to participate, dial 1-800-837-1935 and reference Conference…
CMS Invites Applications for New Comprehensive Primary Care Initiative
On September 28, 2011, CMS announced a new “Comprehensive Primary Care” (CPC) initiative, designed to help primary care practices deliver higher quality, better coordinated, and more patient-centered care. The program is being established under section 3021 of the ACA, which authorized CMS to test innovative payment and service delivery models that reduce spending under Medicare,…
HHS Launches “Safe Transitions from Hospital to Home” Software Challenge
HHS has launched the “Ensuring Safe Transitions from Hospital to Home” challenge, which will award cash prizes of up to $25,000 to software developers who create technology solutions that help discharged patients take charge of their health care during transitions of places of care. According to an HHS notice, innovative applications will help patients and…