This week The Centers for Medicare & Medicaid Services announced that it is lifting a suspension on hospital survey activities that was implemented during this winter's surge in COVID-19 cases and hospitalizations. An immediate resumption of...CMS Rules
Last Wednesday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would streamline the application and renewal process for enrollees in Medicaid and the Children's Health Insurance Program (CHIP).
The overhaul aims to "reduce red tape" and simplify the application and verification process for children,...
Well ahead of the expected publication, the Centers for Medicare and Medicaid Services (CMS) posted a draft of updated Minimum Data Set specifications (MDS 3.0) last Friday. The comprehensive item set version 1.18.11 is expected to radically transform the future of nursing home reimbursements by states.
CMS said that the final version...
On July 26, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that included new payment model for rural emergency hospitals (REH). The designation seeks to alleviate financial disturbance in the continuity of care provided in areas with limited medical resources by shifting from an inpatient bed model to...
The Centers for Medicare and Medicaid Services (CMS) are signaling that the end of the COVID-19 public health emergency (PHE) is near.
Last week, CMS published a blog post called "Creating a Roadmap for the End of the COVID-19 Public Health Emergency," to help providers prepare for the end of the waivers and flexibilities that arrived...
Last Friday, the U.S. Departments of Health and Human Services, Labor and Treasury issued a joint final rule that rectifies issues with the implementation of the No Surprises Act, a law that aims to curb surprise billing practices.
The rule defines the processes for payers and providers to settle payment for services provided that...
Last week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that aims to improve quality reporting for Medicaid and the Children's Health Insurance Program (CHIP).
According to the CMS press release, the rule would include mandatory annual state reporting of three new quality measures, called "Core Sets,"...CMS Rules
The No Surprises Act has been a hot-button point of contention among insurers and providers as physician groups feel threatened by the leverage that insurers are given through the Act's enforcement. The Medical Group Management Association (MGMA) sent a letter to the U.S. Department of Health and Human Services (HHS) and the Centers for...CMS Rules
In a surprising turn of events, the Centers for Medicare and Medicaid Services issued the FY 2023 Skilled Nursing Facility Prospective Payment System (SNF PPS) Final Rule which contains a 2.7% increase in Medicare rates to nursing homes. When the proposed payment rule was published in April, the agency had proposed cutting Medicare Part...
Last week, the Centers for Medicare and Medicaid Services (CMS) released a Request for Information (RFI), seeking comment on ways to improve Medicare Advantage and make the program more equitable, affordable and sustainable.
Medicare Advantage (MA) has been under great scrutiny lately, for policies on prior authorization, the adequacy...
The rule updates Medicare fee-for-service payment rates and policies for inpatient hospitals and long-term care hospitals (LTCH) and builds on key priorities to advance health equity, including better measurements for healthcare quality disparities and improving the safety and quality of maternity care by establishing a...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) published a set of quality metrics for home and community-based services (HCBS) to assess patient health outcomes. According to CMS, the ratings will provide insight into HCBS programs and will enable states to determine the success of long-term services and support programs offered...CMS Rules
In 2023 hospice payments will increase by 3.8% and the most Medicare will pay per hospice patient in FY 2023 will be $32,486.92, this year the cap amount is $31,297.61. Hospices that don't meet quality reporting requirements get a 2% point reduction to the annual hospice payment update percentage increase for the year. The rule also...
No new changes yet to the Inpatient Psychiatric Facility (IPF) Quality Reporting Program, but payments to facilities are expected to increase 2.5% ($90 million) over FY 2022. The Centers for Medicare & Medicaid Services (CMS) said the IPF prospective payment system (PPS) rates in FY 2023 will be updated by 3.8%. The agency also...
The agency had proposed a more modest 2% increase ($170 million) but the FY 2023 Inpatient Rehabilitation Facility (IRF) payments will increase by 3.2% ($275 million) relative to payments in FY 2022. The IRF Quality Reporting Program (QRP) is a pay-for-reporting program. IRFs that do not meet reporting requirements are subject to a 2%...
In 2020, the Centers for Medicare and Medicaid Services (CMS) reevaluated and revised the Hospital Overall Star Ratings methodology to streamline the ratings process and improve equitable ratings throughout a highly-varied industry. The American Hospital Association (AHA) reviewed the changes and found that they provide some stability...
Last Thursday, the Centers for Medicare and Medicaid Services (CMS) published the proposed 2023 physician fee schedule (PFS) which included an overhaul to the agency's strategies on accountable care organizations (ACOs) through the Medicare Shared Savings Program (MSSP).
In February, CMS pulled the Accountable Care Organizations...
It's no secret that the Biden administration is planning to implement mandatory staffing levels in nursing facilities that are reimbursed through Medicare and Medicaid. In the most recent step to announcing this measure last Thursday, the Centers for Medicare and Medicaid Services (CMS) published new guidance on staffing measures tied to...CMS Rules
On June 29, the Centers for Medicare and Medicaid Services (CMS) updated its guidance on requirements for long-term care facilities on staffing levels, arbitration, infection prevention and the administration of certain medications. The agency attributed the guidance to President Joe Biden's efforts to improve nursing home safety and is...
A new final rule is in effect as of July 1, 2022. CMS says that the Transparency in Coverage Final Rule is the first of several rules that will be met with stronger compliance enforcement in accordance with the No Surprises Act of 2021 and instead of targeting hospitals for the clear publication of potential prices for a range of...
The Centers for Medicare and Medicaid Services (CMS) has approved Colorado's plan to create a public insurance option through a Section 1332 innovation waiver. The "Colorado Option" will be offered in the Colorado Affordable Care Act Health Insurance Exchange beginning in 2023.
According to Healthcare Dive, the Colorado Option is the...
