Centers for Medicare & Medicaid Services

MedPAC Issues Annual Report to Congress

The Medicare Payment Advisory Commission has sent its mandatory annual report to Congress. Included in the report are sections on: Beneficiary enrollment in Medicare: eligibility notification, enrollment process, and Part B late enrollment penalties. Restructuring Medicare Part D for the era of specialty drugs. Medicare payment strategies to improve price competition and value for Part B drugs. MedPAC’s mandated report to Congress on clinician payments. Issues in Medicare beneficiaries’ access to primary care. Assessment of the Medicare Shared Savings Program’s effect on Medicare spending. Ensuring the accuracy and completeness of Medicare Advantage encounter data. Redesigning the Medicare Advantage quality bonus [...]

iqtsupport2019-06-19T11:57:26-04:00June 19, 2019|Alternative payment models, Centers for Medicare & Medicaid Services, Medicare post-acute care, Medicare reimbursement policy, MedPAC|

CMS Seeks Help With Reducing Administrative and Regulatory Burdens

Reducing administrative and regulatory burdens is the subject of a new request for information issued last week by the Centers for Medicare & Medicaid Services. In the RFI, CMS explains that it is especially interested in “…innovative ideas that broaden perspectives on potential solutions to relieve burden and ways to improve” reporting and documentation requirements coding and documentation requirements for Medicare or Medicaid payment prior authorization procedures policies and requirements for rural providers, clinicians, and beneficiaries policies and requirements for dually enrolled (Medicare and Medicaid) beneficiaries beneficiary enrollment and eligibility determination CMS processes for issuing regulations and policies Comments are [...]

iqtsupport2019-06-12T06:00:42-04:00June 12, 2019|Centers for Medicare & Medicaid Services, Medicaid regulations, Medicare regulations|

PACE Regulation Updated

PACE programs will have new flexibility under a recent update of regulations governing Programs of All-Inclusive Care. As described by the National Association of Medicaid Directors, the new regulation Allows PACE team members to fulfill multiple roles on the care team; Allows certain non-physician providers to serve in the place of primary care physicians on the care team; Clarifies that PACE programs offering prescription drug benefits are subject to Medicare Part D regulations; Eliminates requirements for PACE organizations to seek waivers for several of the most commonly waived aspects of PACE regulation; and Updates CMS's enforcement actions to promote accountability [...]

iqtsupport2019-06-11T06:00:59-04:00June 11, 2019|Centers for Medicare & Medicaid Services, Medicaid regulations, Medicare regulations|

More Medicaid Matching Funds for Only Partial Medicaid Expansion?

The federal government is considering providing an unusual amount of federal Medicaid matching funding for only partial state Medicaid expansion. At least that’s what Centers for Medicare & Medicaid Services administrator Seema Verma told a health care conference in Georgia last week. The state of Georgia has proposes partially expanding its Medicaid population. Under the Affordable Care Act, states that fully expand their Medicaid programs under the terms established by the 2010 health care law receive nine dollars in federal matching funds for every one dollar they spend on their Medicaid expansion population. States that only partially expand their Medicaid [...]

iqtsupport2019-05-15T06:00:11-04:00May 15, 2019|Affordable Care Act, Centers for Medicare & Medicaid Services, Medicaid|

CMS Speeds Up Medicaid Review Process

The federal government has greatly increased the speed with which it is reviewing and approving state applications to modify their Medicaid programs. Most often, such applications involve Medicaid state plan amendments and section 1915 waiver requests. According to a recent post on the CMS blog (in CMS’s own words), Between calendar years 2016 and 2018, there was a 16 percent decrease in the median approval time for Medicaid SPAs [note: state plan amendments]. Seventy-eight percent of SPAs were approved within the first 90 day review period during calendar year 2018, a 14 percent increase over 2016. Between calendar year 2016 [...]

iqtsupport2019-05-14T06:00:36-04:00May 14, 2019|Centers for Medicare & Medicaid Services, Medicaid|

CMS Outlines Improvements in RAC Audit Processes

In the face of complaints from hospitals about backlogs, time-consuming procedures, and lengthy appeals processes involving Medicare Recovery Audit Contractor audits, the Centers for Medicare & Medicaid Services recently outlined changes it has implemented in the RAC audit process to address these and other concerns. They are (in CMS's own words): Better Oversight of RACs We are holding RACs accountable for performance by requiring them to maintain a 95% accuracy score. RACs that fail to maintain this rate will receive a progressive reduction in the number of claims they are allowed to review. We also require RACs to maintain an [...]

iqtsupport2019-05-09T06:00:15-04:00May 9, 2019|Centers for Medicare & Medicaid Services, Medicare|

CMS Solicits Waiver Input From Stakeholders

The Centers for Medicare & Medicaid Services is soliciting ideas from stakeholders about new approaches that might be employed in the development of state relief and empowerment waivers, also known as section 1332 waivers. Last year CMS loosened section 1332 waiver requirements and offered states four concepts for how to take advantage of both the waivers and the less stringent requirements. Section 1332 waivers permit states to seek exemption from selected requirements of the Affordable Care Act to pursue new approaches to enhancing access to quality, affordable health insurance. Through a new request for information, CMS now seeks …to build [...]

iqtsupport2019-05-06T06:00:32-04:00May 6, 2019|Affordable Care Act, Centers for Medicare & Medicaid Services, health care reform|

Mandatory Payment Models Coming to Medicare?

Even as CMS rolls out new, voluntary Medicare alternative payment models, it is contemplating making participation in future models mandatory rather than voluntary, as is currently the case. Or so Centers for Medicare & Medicaid Services administrator Seema Verma told a gathering in Baltimore last week. At the heart of the idea, Verma told her audience, is that while CMS is pleased with participation in voluntary accountable care organization models, organizations are choosing to participate in ACO models they think would benefit them most while posing little or no downside financial risk. The agency may need to move away from [...]

iqtsupport2019-05-02T06:00:59-04:00May 2, 2019|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Medicare, Medicare reimbursement policy|

CMS Posts Proposed FY 2020 Inpatient Regulation

Medicare would change its wage index system, raise inpatient fees, increase funding for Medicare disproportionate share hospital payments (Medicare DSH), enhance payments for new technologies, and make minor modifications in its hospital readmissions reduction, value-based purchasing, and hospital-acquired condition program if a proposed regulation published this week is ultimately adopted. The Centers for Medicare & Medicaid Services has published its proposed FY 2020 Medicare inpatient prospective payment system regulation: its plan for paying acute-care hospitals for Medicare-covered inpatient services in FY 2020. The 1800-page regulation calls for major changes in Medicare’s wage index system – changes CMS says would “…address [...]

iqtsupport2019-04-25T06:00:11-04:00April 25, 2019|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare disproportionate share, Medicare DSH, Medicare regulations, Medicare reimbursement policy|

Feds Seek Input on Selling Health Insurance Across State Lines

Working to achieve an objective of reducing the cost of health insurance by encouraging the sale of health insurance policies across state lines, the Centers for Medicare & Medicaid Services has published a request for information seeking input from stakeholders and the public on how this might best be done. According to a CMS news release, the agency seeks … feedback on how states can take advantage of Section 1333 of the Patient Protection and Affordable Care Act, which provides for the establishment of a regulatory framework that allows two or more states to enter into a Health Care Choice [...]

iqtsupport2019-03-11T06:00:41-04:00March 11, 2019|Affordable Care Act, Centers for Medicare & Medicaid Services|