Centers for Medicare & Medicaid Services

CMS Reconsidering Medicare Payment Models

Five Medicare alternative payment models previously slated for implementation are being delayed, cancelled, or reconsidered. The five APMs whose futures are not clear are: The Community Health Access and Rural Transformation Model ACO Track Primary Care First Kidney Care Choices Geographic Direct Contracting Part D Payment Modernization Model Learn more about the Centers for Medicare & Medicaid Services’ latest actions on these models in the Becker’s Hospital Review article “5 CMS payment models that are under review, delayed.”  

2021-04-26T06:00:47-04:00April 26, 2021|ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy|
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Feds Rescind Texas Medicaid Waiver

A federal Medicaid waiver approved for the state of Texas in the waning days of the Trump administration has been rescinded by the Biden administration. The waiver called for spending as much as $100 billion for health care for low-income Texans over the next ten years. Officially, the Centers for Medicare & Medicaid Services revoked the waiver on technical grounds, maintaining that the agency “… erred in exempting the state from the normal public notice process – a critical priority for soliciting stakeholder feedback and ensuring public awareness.”  The Washington Post, however, reports that according to two unnamed federal health [...]

2021-04-22T06:00:32-04:00April 22, 2021|Affordable Care Act, Centers for Medicare & Medicaid Services, Medicaid|
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CMS Ponders Future of Medicare Payment Models

The new administration has delayed the planned launch of several new Medicare payment models and ultimately may choose not to move forward with some or to alter them. The models currently under review by the Centers for Medicare & Medicaid Services are: Primary Care First Kidney Care Choices Geographic Direct Contracting Part D Payment Modernization Model Learn more from the Becker’s Hospital Review article “CMS payment models that are under review, delayed.”

2021-03-30T06:00:20-04:00March 30, 2021|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicare reimbursement policy|
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CMS Provides Guidance on Medicaid DSH Calculations

State Medicaid program accounting for hospital uncompensated care when calculating hospital-specific Medicaid disproportionate share limits is the subject of new guidance from the Centers for Medicare & Medicaid Services. In the guidance, the Centers for Medicare & Medicaid Services explains that because of several court rulings, states can decide for themselves whether to offset third-party payer payments from costs in their Medicaid DSH calculations for periods prior to June 2, 2017 but that beginning with that date,  CMS will enforce its own interpretation of the policy. In new guidance, CMS presents two methodologies for accounting for its mid-year policy change [...]

2020-08-29T13:00:57-04:00August 29, 2020|Centers for Medicare & Medicaid Services, Medicaid disproportionate share, Medicaid DSH, Medicaid regulations|
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Feds Delay Stark Rule, Anti-Kickback Update

An update of regulations that limit the ability of doctors to refer patients for care to sources in which those doctors have a financial interest will wait as long as another year, according to the Centers for Medicare & Medicaid Services. CMS had previously proposed regulations updating current guidelines, essentially easing them, but provider comment was so great – often, saying that the easing of the guidelines did not go far enough – that the agency decided to step back and review the situation. In a public inspection version of a notice to be published in the Federal Register, CMS [...]

2020-08-29T06:00:59-04:00August 29, 2020|Centers for Medicare & Medicaid Services, Medicare, Medicare regulations|
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OIG Cites Medicare, Medicaid Among Top Unimplemented Recommendations

CMS has failed to implement many of the policy changes recommended to it by HHS’s Office of the Inspector General, according to a new OIG report. Every year the Department of Health and Human Services’ OIG offers recommendations for policy changes designed to reduce fraud, waste, and abuse in HHS programs.  This week, the OIG published “OIG’s Top Unimplemented Recommendations:  Solutions to Reduce Fraud, Waste, and Abuse in HHS Programs.” Among the top 25 unimplemented recommendations to the Centers for Medicare & Medicaid Services are 14 involving Medicare and Medicaid.  Its top 10 unimplemented Medicare recommendations are: CMS should take [...]

2020-08-11T10:33:28-04:00August 11, 2020|Centers for Medicare & Medicaid Services, Medicaid, Medicare, Medicare post-acute care, Medicare reimbursement policy|
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MedPAC Offers 2021 Medicare Rate Recommendations

MedPAC has recommended to Congress changes in Medicare payment rates in the coming year. In its annual report to Congress, the Medicare Payment Advisory Commission recommended the following rate changes: acute-care hospitals – a two percent rate increase and a suggestion that the difference between this two percent increase and the payment increase specified by law be used to increase the rewards hospitals may earn under Medicare’s hospital value incentive program.  As a result, the value incentive program would offer a possible 0.8 percent in bonus payments, and with the recommended elimination of the 0.5 percent penalty for which hospitals [...]

2020-03-26T11:48:02-04:00March 26, 2020|Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy, MedPAC|
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CMS Posts COVID-19 FAQ for State Medicaid and CHIP Agencies

State Medicaid agencies and CHIP programs have received new guidance on the federal resources available to them to fight the COVID-19 national health emergency through a new FAQ published by the Centers for Medicare & Medicaid Services last week. Among the issues addressed in the FAQ are eligibility, enrollment, benefits, cost sharing, workforce issues, telehealth, and more.  Health care providers may find this information useful when serving their patients. See CMS’s news release describing the FAQ here and the FAQ itself here.

2020-03-16T06:00:32-04:00March 16, 2020|Centers for Medicare & Medicaid Services, Medicaid|
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MedPAC Meets

Last week the Medicare Payment Advisory Commission met in Washington, D.C. to discuss a number of Medicare payment issues. The issues on MedPAC’s March agenda were: Addressing Medicare Shared Savings Program vulnerabilities The role of specialists in alternative payment models and accountable care organizations Realigning incentives in Medicare Part D Redesigning the Medicare Advantage quality bonus program Mandated report: Impact of changes in the 21st Century Cures Act to risk adjustment for Medicare Advantage enrollees Improving Medicare’s end-stage renal disease prospective payment system Separately payable drugs in the hospital outpatient prospective payment system MedPAC is an independent congressional agency that advises [...]

2020-03-09T09:40:54-04:00March 9, 2020|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Medicare, Medicare regulations, Medicare reimbursement policy, MedPAC|
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