Centers for Medicare & Medicaid Services

Administration Slows Movement Toward Medicare Quality Payments

The Trump administration is slowing Medicare’s movement toward making greater use of quality in its payment system. The Obama administration’s goal of having 50 percent of Medicare payments made through a quality or alternative payment model by the end of 2018 now appears to be out of sight. Instead, the Centers for Medicare & Medicaid Services has partially canceled two bundled payment programs – one for joint replacement and another for cardiac rehabilitation programs – and announced that before introducing new programs it wants to take a closer look at the successes and failures of the alternative payment model programs [...]

iqtsupport2018-02-20T10:26:50-05:00February 20, 2018|Centers for Medicare & Medicaid Services, Medicare|

Medicaid Changes: More Than Just Work Requirements Coming?

While the green light for state applications to impose work requirements on their Medicaid recipients is receiving all of the attention, the Trump administration has issued guidance that appears to pave the way for other major changes in the Medicaid program as well. Specifically, the Centers for Medicare & Medicaid Services has issued guidance that will enable states to pursue section 1115 waivers to test different ways of serving Medicaid patients that are otherwise not permitted under federal Medicaid law, including: establishing time limits on how many months or years individuals may be enrolled in Medicaid; locking out for a [...]

iqtsupport2018-02-09T06:00:25-05:00February 9, 2018|Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations|

Administration Lays Groundwork for Medicaid Work Requirements

The Centers for Medicare & Medicaid Services has issued guidelines for states interested in adding a work requirement component to their Medicaid programs. With nearly a dozen states applying to implement controversial Medicaid work requirements, CMS has issued a guidance letter to state Medicaid directors outlining the criteria it will use when considering such applications. The new policy does not mandate work requirements in state Medicaid programs; it only presents the parameters CMS will use when considering the applications of states wishing to impose such requirements. For more information about the new policy, see the following resources: CMS’s news release [...]

iqtsupport2018-01-16T06:00:52-05:00January 16, 2018|Centers for Medicare & Medicaid Services, Medicaid|

A New Use for Section 1115 Medicaid Waivers?

Historically, states have pursued section 1115 Medicaid waivers as a means of expanding Medicaid eligibility. But the Centers for Medicare & Medicaid Services now appears to be looking at granting 1115 waivers to help states reduce their Medicaid populations. According to a new report published by the Commonwealth Fund, CMS is encouraging states – both Medicaid expansion and non-expansion states – to launch demonstration programs designed to reduce enrollment in “means-tested public assistance” programs such as Medicaid. In their efforts to cut spending and reduce Medicaid enrollment, states are expected to seek section 1115 waivers to experiment with means of [...]

iqtsupport2018-01-16T06:00:16-05:00January 16, 2018|Centers for Medicare & Medicaid Services, Medicaid|

E&C Calls for Action on 340B

The section 340B prescription drug program has flaws and needs change, a report by the House Energy and Commerce Committee has concluded. The program, which requires pharmaceutical companies to provide discounts on prescription drugs to be dispensed on an outpatient basis to qualified providers that serve large numbers of low-income patients, has been controversial in recent years. As the number of providers eligible for the program has grown, pharmaceutical companies have claimed that the program is expensive, is being abused, and is responsible for driving up prescription drug costs while providers insist that 340B is a vital tool in helping [...]

iqtsupport2018-01-12T06:00:38-05:00January 12, 2018|Centers for Medicare & Medicaid Services, Medicare, Medicare regulations|

CMS Unveils New Bundled Payment Program

The Centers for Medicare & Medicaid Services has announced the launch of a new bundled payment model called “Bundled Payments for Care Improvement Advanced.” Under this new program – participation in which will be voluntary – participants can, as CMS explains …earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality. The following are a few highlights of BPCI Advanced. It encompasses 32 types of clinical episodes (29 inpatient and three outpatient). These episodes, of 90 days, may change in the future. Participating providers can waive the Medicare requirement [...]

iqtsupport2018-01-11T06:00:30-05:00January 11, 2018|Centers for Medicare & Medicaid Services, Medicare|

CMS Shares Vision for Medicaid

Medicaid is about to undergo major changes, CMS administrator Seema Verma outlined in a news release yesterday and in a speech to state Medicaid directors. According to the news release, those changes include: re-establishing a state-federal partnership that Verma believes has become too much federal and not enough state giving states greater freedom to innovate offering new guidelines for how states can align their individual programs with federal Medicaid objectives new guidance on section 1115 waivers longer section 1115 waivers with simpler review processes CMS willingness to consider proposals to impose work requirements on Medicaid beneficiaries Medicaid and CHIP “scorecards” [...]

iqtsupport2017-11-08T13:00:50-05:00November 8, 2017|Centers for Medicare & Medicaid Services, Medicaid, Medicaid regulations|

CMS Offers States New Medicaid Path for Opioid Treatment

The Centers for Medicare & Medicaid Services (CMS) has issued new guidance to states advising them on how they can use section 1115 Medicaid waivers to improve access to treatment for Medicaid recipients struggling with opioid abuse problems. According to the 14-page guidance letter from CMS to state Medicaid directors, CMS is now offering a more flexible, streamlined approach to accelerate states’ ability to respond to the national opioid crisis while enhancing states’ monitoring and reporting of the impact of any changes imsplemented through these demonstrations. As the opioid crisis continues to raise alarm and highlight the need for better [...]

iqtsupport2017-11-08T06:00:52-05:00November 8, 2017|Centers for Medicare & Medicaid Services, Medicaid|

CMS Announces Drive to Reduce Paperwork

The Centers for Medicare & Medicaid Services is launching a new “Meaningful Measures” initiative that will seek to reduce the regulatory burden on health care providers. According to a CMS news release, Meaningful Measures …will involve only assessing those core issues that are most vital to providing high-quality care and improving patient outcomes. The agency aims to focus on outcome-based measures going forward, as opposed to trying to micromanage processes.. In a speech at the Health Care Payment Learning and Action Network, CMS administrator Seema Verma explained that this project will include moving the Center for Medicare and Medicaid Innovation [...]

iqtsupport2017-11-02T06:00:16-04:00November 2, 2017|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services|

CMS Nursing Home Program Cuts Hospital Admissions

An experimental Medicare program has helped nursing homes reduce the frequency with which their residents are admitted to hospitals. The Centers for Medicare & Medicaid Services’ Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents has reduced avoidable hospitalizations among nursing facility residents 17 percent in the program’s three years. 143 nursing homes in seven states participated in the program, which employed third-party vendors, known as enhanced care and coordination providers, to provide education to nursing facility staff. Hospitals, too, can benefit from the program because it may help reduce avoidable hospital readmissions for which they are penalized financially by [...]

iqtsupport2017-11-01T06:00:28-04:00November 1, 2017|Centers for Medicare & Medicaid Services, Medicare post-acute care|