Centers for Medicare & Medicaid Services

CMS Tinkers With ACO REACH Model

Medicare’s ACO REACH Model will undergo some changes when it heads into its 2025 performance year. To help ensure that the program controls costs and saves money, the Centers for Medicare & Medicaid Services will implement a series of changes in its voluntary Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. According to the agency, it is: adjusting the financial methodology to improve model sustainability based on the findings in the PY [performance year] 2022 Evaluation Report; responding to feedback from interested parties on improvements to the accuracy of benchmarks; and strengthening operational flexibility and [...]

joe2024-08-13T15:57:16-04:00August 14, 2024|Accountable Care Organization, ACO, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Medicare, Medicare reimbursement policy|

Feds Tackling Prior Authorization

The Centers for Medicare & Medicaid Services has ambitious plans to improve the prior authorization process between providers and payers – and to save $15 billion over 10 years in the process. The tools it envisions using in its efforts include digitization, better data exchange, and streamlined prior authorization processes. It also will seek to foster greater transparency, requiring payers to be clearer about their policies and guidelines and to provide better explanations when they deny requests for care. Doing so, CMS believes, will reduce health care costs by $15 billion over ten years. Learn more about CMS’s prior authorization [...]

joe2024-03-21T21:31:16-04:00March 25, 2024|Centers for Medicare & Medicaid Services|

Federal Health Policy Update for March 30

The following is the latest health policy news from the federal government for March 24-30. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS’s Center for Medicare and Medicaid Innovation (CMMI) has extended its Medicare Advantage Value-Based Insurance Design (VBID) Model for calendar years 2025 through 2030 and will introduce changes intended to address more fully the health-related social needs of patients, advance health equity, and improve care for patients with serious illness. Learn more from this CMS announcement, which includes a link to additional information about the program. CMS [...]

iqtsupport2023-03-30T17:20:37-04:00March 30, 2023|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare reimbursement policy, Telehealth|

Federal Health Policy Update for February 16

The following is the latest health policy news from the federal government for February 6-16. Some of the language used below is taken directly from government documents. No Surprises Act A federal judge in Texas has vacated parts of a regulation governing the arbitration process that is a major aspect of implementation of the No Surprises Act. In his ruling, the judge found that the arbitration process unfairly favored payers over providers, most notably by placing undue emphasis on the qualified payment amount (QPA) that is a major part of the arbitration process. The decision explains that “The Court first [...]

iqtsupport2023-02-16T17:02:31-05:00February 16, 2023|Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, COVID-19, health equity, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations|

Federal Health Policy Update for January 20

The following is the latest health policy news from the federal government for the week of January 13-20. Some of the language used below is taken directly from government documents. Centers for Medicare & Medicaid Services CMS has published updates to the Healthcare Common Procedure Coding System (HCPCS) codes on the Required Face-to-Face Encounter and Written Order Prior to Delivery List. The update adds ten codes to the list of items that require a face-to-face encounter between provider and patient and a written order prior to delivery as a condition of payment. Go here for a summary of the update [...]

iqtsupport2023-01-20T15:28:07-05:00January 20, 2023|Centers for Medicare & Medicaid Services, COVID-19, MACPAC, Medicaid, Medicaid and CHIP Payment and Access Commission, Medicare, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|

CMS Seeks Comment on Efficiency, Administrative Burdens, and Health Equity

The Centers for Medicare & Medicaid Services has issued a request for information “…seeking public input on accessing healthcare and related challenges, understanding provider experiences, advancing health equity, and assessing the impact of waivers and flexibilities provided in response to the COVID-19 Public Health Emergency.” According to a CMS news release, The Make Your Voice Heard: Promoting Efficiency and Equity Within CMS Programs RFI furthers CMS’ commitment to engaging and learning from partners, communities, and individuals across the health system to inform how we can better support the populations we serve. The agency also explains that CMS is seeking to [...]

iqtsupport2022-09-09T06:00:47-04:00September 9, 2022|Centers for Medicare & Medicaid Services, health equity, Medicaid, Medicare|

Feds Getting Serious About Hospital Price Transparency

After warning many hospitals that they were not in compliance with a 2019 requirement that they post their prices on the internet, the Centers for Medicare & Medicaid Services has now fined two hospitals for failing to do so. Policy-makers and advocates have been warning for some time that too many hospitals were not complying with the requirement: a JAMA report found that within six to nine months of the requirement’s implementation only six percent of 5200 hospitals met the requirement and a later review conducted by patient advocates found only 14 percent of 1000 hospitals surveyed in compliance. Eventually [...]

iqtsupport2022-06-14T14:34:45-04:00June 14, 2022|Centers for Medicare & Medicaid Services|

New Health Care Leaders Share Priorities

New leaders at the Centers for Medicare & Medicaid Services and the Center for Medicare and Medicaid Innovation are quickly making their priorities known to health care industry stakeholders. For new CMS administrator Chiquita Brooks-LaSure, her priority is coverage. She has declared that “Our focus is going to be on making sure regulations and policies are going to be focused on improving coverage,” and while she hopes that states that have not yet expanded their Medicaid programs will take advantage of current federal incentives to do so, there is another path to coverage: “…the public option or other coverage certainly [...]

iqtsupport2021-06-10T06:00:44-04:00June 10, 2021|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, Medicaid|

CMS to Look at Accrediting Agencies

Health care accrediting organizations will be the subject of scrutiny and possible action by the federal government in the coming months. At a recent conference, Centers for Medicare & Medicaid Services administrator Seem Verma said that Receiving CMS’s authorization to inspect and deem healthcare providers compliant with Medicare’s quality standards is nothing short of assuming a sacred public trust…But an increasing amount of evidence indicates that accrediting organizations are not living up to that high bar. According to Verma, CMS’s interest is motivated by a number of recent incidents of “serious deficiencies” among hospitals that had been found compliant with [...]

iqtsupport2020-02-27T06:00:36-05:00February 27, 2020|Centers for Medicare & Medicaid Services|

Verma Responds to Medicaid Block Grant Critics

Last week the Trump administration unveiled its Healthy Adult Opportunity program, a new, optional, already-controversial approach to structuring state Medicaid programs. Ever since, the program – essentially, Medicaid block grants – has been the subject of criticism from many public officials and health care stakeholders. Now, Centers for Medicare & Medicaid Services administrator Seema Verma, who oversaw the development of Healthy Adult Opportunity, has responded to the program’s critics in an op-ed piece published in the Washington Post. See her commentary “No, the Trump administration is not cutting Medicaid.”

iqtsupport2020-02-11T11:55:58-05:00February 11, 2020|Centers for Medicare & Medicaid Services, Medicaid|