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The Government Accountability Office (GAO) has identified shortcomings in CMS’s implementation of accreditation requirements for suppliers of advanced diagnostic imaging (ADI) services under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). For instance, the GAO found significant differences among the accrediting organizations arising from the lack of minimum national standards, rendering it…

On September 1, 2011, CMS published a final rule implementing certain provisions of the Medicare Improvements to Patients and Providers Act (MIPPA) of 2008 that revise Medicare Advantage (MA) and Medicare Part D prescription drug benefit regulations (note that these provisions were addressed previously through a series of interim final rules in 2008 and a …

The HHS Office of Inspector General (OIG) has issued a report entitled "Medicare Market Shares of Mail Order Diabetic Testing Strips," as mandated by the Medicare Improvements for Patients and Providers Act (MIPPA). The report is intended to assist in implementation of a requirement for future rounds of the Medicare durable medical equipment, prosthetics, …

On August 12, 2010, the Centers for Medicare & Medicaid Services (CMS) is publishing a final rule implementing a prospective payment system (PPS) for Medicare end-stage renal disease (ESRD) services, as mandated by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). The final ESRD PPS rule provides a single bundled payment…

CMS is seeking up to six “conveners” to apply to participate in the MIPPA Medicare Imaging Demonstration (MID). The MID will test whether the use of decision support systems (DSSs) can improve quality of care and reduce unnecessary radiation exposure and utilization by promoting appropriate ordering of advanced diagnostic imaging services. Conveners will recruit…

On January 30, CMS issued a Medicare Benefit Policy Manual transmittal entitled "Revision of Definition of Compendia as Authoritative Source for Use in the Determination of a Medically-Accepted Indication of Drugs/Biologicals Used Off-label in Anti-Cancer Chemotherapeutic Regimens." The transmittal makes changes to conform to the MIPPA compendia requirement that provides that effective January 1, …

On May 27, 2009, CMS is holding a Special Open Door Forum on the MIPPA Medicare Imaging Demonstration Project on Appropriate Use of Imaging Services.  CMS is seeking input regarding the design and development of the demonstration project.  Interested parties can attend the event in person or by phone.  CMS priority topics for the forum are listed after the jump. Continue Reading CMS Forum on Appropriate Use of Imaging Services (May 27, 2009)

On March 12-13, 2009, MedPAC is meeting to discuss a number of health policy issues, including: accountable care organizations; physician resource use measurement; MIPPA Medicare Advantage payment report; improving Medicare’s chronic care demonstration programs; the effects of secondary coverage on Medicare spending; medical education; and follow-on biologics.

On January 16, 2009, the Centers for Medicare & Medicaid Services (CMS) published an interim final rule with comment period to implement the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding provisions in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Among other things, the rule codifies MIPPA provisions: …

On January 16, 2009, CMS published an interim final rule with comment period to implement MIPPA provisions regarding protected classes of drugs under the Medicare Part D prescription drug benefit. For 2010, CMS is continuing to require Part D sponsors to include all or substantially all Part D drugs in the antidepressant, antipsychotic, anticonvulsant, immunosuppressant, antiretroviral, …

On December 3, 2008, CMS issued FY 2009 hospital wage index changes to implement Section 124 of the Medicare Improvement for Patients and Providers Act of 2008 (MIPPA). The notice contains revised final wage indices and hospital reclassifications for 27 hospitals and are applicable for discharges beginning October 1, 2008. 

CMS has released the 2009 Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) fee schedule. The update reflects payment changes mandated by the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. Specifically, MIPPA reduces the nationwide fee schedule amount of most items included in Round 1 of the DMEPOS competitive bidding program…

On November 21, 2008, CMS published a notice correcting technical and typographical errors identified in the September 18, 2008 interim final rule with comment period that revises the regulations governing the Medicare Advantage program, the Part D prescription drug benefit program, and section 1876 cost plans to conform with provisions of the Medicare Improvements for…

On December 16, 2008, the Agency for Healthcare Research and Quality (AHRQ) is hosting a “Stakeholders’ Meeting” to solicit feedback regarding a provision of MIPPA that provides Medicare coverage for kidney disease patient education services for individuals with Stage IV chronic kidney disease. The registration deadline is December 8, or when capacity is reached.

CMS is hosting a Special Open Door Forum November 19 on electronic prescribing under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). At the forum, CMS staff will present information on the following topics: Overview of Part D E-Prescribing Standards, E-Prescribing Resources, E-Prescribing Incentives and E-Prescribing Measures. The forum will take place…

On November 6, 2008, CMS will host a Special Open Door Forum to discuss a Medicare Improvements for Patients and Providers Act provision that provides coverage for Kidney Disease Patient Education Services for individuals with Stage IV chronic kidney disease (CKD).  Among other things, CMS is seeking comments on: specific competencies for referring clinicians and the …

On September 18, 2008, the Centers for Medicare & Medicaid Services (CMS) published two final rules modifying Medicare Advantage (MA) and Part D Prescription Drug Plan (PDP) marketing and other requirements.

  • The first rule implements certain MA and PDP marketing provisions and a requirement related to the disclosure and dissemination of Part D information included in a May 16, 2008 proposed rule and subsequently enacted into statute by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Specifically, the rule: prohibits plans from providing meals to prospective enrollees at promotional events; prohibits unsolicited contact with potential enrollees (e.g., door-to-door solicitation); prohibits plans from cross-selling non-health care related products during Medicare marketing activities; restricts marketing activities in provider offices (except in certain common areas); prohibits plans from conducting marking activities at educational events; requires that only state-licensed representatives conduct marketing activities; requires plans to disclose certain beneficiary information at the time of enrollment and 15 days before the annual coordinated election period; and defines certain terms related to marketing activities. The rule is effective September 18, 2008 and applies to the 2009 benefit year marketing campaign, beginning October 1, 2008.

Continue Reading Final Rules on MIPPA Medicare Part D Drug Plan/Medicare Advantage Plan Provisions