Centers for Medicare & Medicaid Services

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|

Stark Changes Coming to Facilitate Value Care?

At a Washington, D.C. conference, Centers for Medicare & Medicaid Services Administrator Seema Verma announced that changes coming in Stark law requirements will enable Medicare to make better use of value-based purchasing in its reimbursement system. In addition to addressing cybersecurity and electronic health record system issues, changes in the anti-self-referral law will seek to facilitate better coordination of care for Medicare patients. Verma explained the underlying rationale for the anticipated changes, noting that …in a system where we’re transitioning and trying to pay for value, where the provider is ideally taking on some risk for outcomes and cost overruns, [...]

iqtsupport2019-03-07T06:00:54-05:00March 7, 2019|Centers for Medicare & Medicaid Services, Medicare, Medicare regulations, Medicare reimbursement policy|

Protections Overlooked as Medicaid Reforms are Implemented

In its eagerness to help states introduce changes in their Medicaid programs and reduce administrative burdens, the Centers for Medicare & Medicaid Services is ignoring regulatory requirements designed to understand and measure the impact of those changes on beneficiaries. According to an analysis by the Los Angeles Times, many states seeking to implement Medicaid work requirements have not projected how many of their beneficiaries would be affected by those requirements nor have they projected how many beneficiaries who are removed from the Medicaid rolls will gain employment after losing their Medicaid benefits. Both projections are required under Medicaid regulations adopted [...]

iqtsupport2019-02-15T06:00:51-05:00February 15, 2019|Centers for Medicare & Medicaid Services, MACPAC, Medicaid, Medicaid regulations|

Hospitals Sue Over Site-Neutral Outpatient Payment Policy

Nearly 40 hospitals have filed a joint lawsuit in opposition to the Centers for Medicare & Medicaid Services’ site-neutral payment policy for Medicare-covered outpatient services. In the suit, the hospitals charge the federal government with overstepping its authority in implementing such a change through regulation in the face of past congressional action to limit the use of site-neutral payments. Under its site-neutral payment policy, Medicare pays the same for some outpatient services regardless of where those services are provided. Under Medicare’s previous policy, Medicare paid more for services provided in hospital-run outpatient facilities. Hospitals argue that their outpatient facilities are [...]

iqtsupport2019-01-30T06:00:38-05:00January 30, 2019|Centers for Medicare & Medicaid Services, hospitals, Medicare, Medicare regulations, Medicare reimbursement policy|

End Run Around Congress for Medicaid Block Grants?

The Trump administration reportedly is considering introducing Medicaid block grants through regulations rather than legislation, according to published reports. Those reports explain that the administration may seek to offer states an opportunity to apply to the federal government to use Medicaid block grants by obtaining section 1115 Medicaid waivers, a commonly used tool for states seeking exemptions from federal legislative or regulatory requirements. As reported by the online publication The Hill, …the Trump administration is now considering issuing guidance to states encouraging them to apply for caps on federal Medicaid spending in exchange for additional flexibility on how they run [...]

iqtsupport2019-01-16T06:00:01-05:00January 16, 2019|Centers for Medicare & Medicaid Services, Medicaid|

CMS Revamps Medicare ACO Program

The federal government seeks to pursue greater savings and an accelerated approach to value-based care through an overhaul of its programs for Medicare accountable care organizations. The Centers for Medicare & Medicaid Services’ new “Pathways to Success” program seeks to speed up the process of providers assuming risk for costs and outcomes through the following changes from the agency’s current approach. A reduction in how long participating ACOs can remain in the program without assuming some responsibility for their spending. Modifications that CMS hopes will encourage physician groups to remain independent of hospitals and health systems. Greater flexibility to innovate [...]

iqtsupport2018-12-31T06:00:14-05:00December 31, 2018|Accountable Care Organization, ACO, Alternative payment models, Centers for Medicare & Medicaid Services, Medicare regulations, Medicare reimbursement policy|

CMS to Create New Office for Regulatory Reform

In 2019 the Centers for Medicare & Medicaid Services intends to create a new office to address regulatory reform. CMS administrator Seema Verma recently announced her intention to create this office, but other than saying its priority would be to reduce regulatory burden, offered no details. See a brief notice about the new office here.

iqtsupport2018-12-26T09:51:55-05:00December 26, 2018|Centers for Medicare & Medicaid Services, Medicaid regulations, Medicare regulations|