Tag Archives: MIPPA

GAO Highlights Gaps in Medicare Imaging Accreditation Framework

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 … Continue Reading

CMS Finalizes MIPPA Medicare Advantage/Part D Drug Plan Rule

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 … Continue Reading

IOM Issues Comparative Effectiveness Standards Reports

The Institute of Medicine has issued two reports mandated by the Medicare Improvement for Patients and Providers Act that are designed to enhance the quality and reliability of clinical practice guidelines and systematic reviews of the evidence base for health care services. In “Clinical Practice Guidelines We Can Trust,” the IOM recommends eight standards intended … Continue Reading

OIG Report on Mail Order Diabetic Testing Strips

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, orthotics, and … Continue Reading

CMS Issues Final Rule on Medicare ESRD Bundled Payment System, Proposed Rule on ESRD Quality Program

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 to dialysis … Continue Reading

CMS Solicits Proposals for Medicare Imaging Demonstration

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 participating … Continue Reading

Medicare Advantage Marketing Practices

The OIG recently issued a report entitled “Beneficiaries Remain Vulnerable to Sales Agents’ Marketing of Medicare Advantage Plans.” The report assesses MA plan sponsor compliance with CMS regulations implementing the marketing activity restrictions enacted in the Medicare Improvements for Patient and Providers Act of 2008. Each of six selected plan sponsors reviewed by the OIG did not … Continue Reading

CMS Manual Transmittal on Authorized Compendia for Off-Label Uses of Cancer Drugs

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, 2010, no … Continue Reading

ESRD Bundled Payment System

The Government Accountability Office (GAO) has issued a report entitled “End-Stage Renal Disease: CMS Should Monitor Effect of Bundled Payment on Home Dialysis Utilization Rates.” According to the GAO, the Medicare bundled payment system for ESRD services, which must be implemented by January 1, 2011 under the Medicare Improvements for Patients and Providers Act, could end up … Continue Reading

CMS Forum on Appropriate Use of Imaging Services (May 27, 2009)

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 … Continue Reading

MedPAC Meeting — March 12-13, 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.… Continue Reading

DMEPOS Competitive Bidding

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: delaying implementation of … Continue Reading

MIPPA Part D Drug Benefit Revisions

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, and … Continue Reading

Medicare Inpatient Hospital Payments/Wage Index Changes & Reclassifications

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. … Continue Reading

2009 Medicare DMEPOS Fee Schedule Released

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 by 9.5% … Continue Reading

Part D/MA Correction Notice

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 … Continue Reading

AHRQ Kidney Disease Education Meeting – Dec. 16, 2008

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.… Continue Reading

E-Prescribing Special Open Door Forum, Nov. 19, 2008

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 … Continue Reading

Medicare Coverage of Kidney Disease Patient Education Services

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 … Continue Reading

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

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 … Continue Reading

DMEPOS Supplier Accreditation

On October 14, 2008, CMS is hosting a conference at CMS headquarters in Baltimore for non-accredited suppliers of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)   At the event, CMS will provide technical guidance on how to comply with the DMEPOS quality standards.… Continue Reading

Medicare Advantage Special Needs Plan Chronic Condition Panel

CMS has announced it is convening a Special Needs Plan Chronic Condition Panel to determine the conditions that meet the definition of severe or disabling chronic conditions under MIPPA. CMS will accept comments until October 8, 2008 on the criteria the panel could use for selecting conditions. CMS held a special open door forum to discuss the … Continue Reading

MedPAC Meeting

The Medicare Payment Advisory Commission (MedPAC) met on October 8 and 9, 2009 to discuss a variety of Medicare payment and policy issues, including the in-office ancillary exception to the physician self-referral law, provider consolidation, physician fee schedule prices, and medical education.… Continue Reading
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