On Oct. 20, CMS approved a waiver that allows adult Medicaid beneficiaries in Nebraska to receive additional benefits, including vision and dental, if they participate in work requirements. The program is set to go into effect in April...CMS Rules
Last week, the Centers for Medicare and Medicaid Services (CMS) released a propose rule for 2022 Notice of Benefit and Payment Parameters. The proposed rule would lower the user fee or Affordable Care Act (ACA) insurers to 2.25% of the premium for the coverage year 2022 and also would enable states to partner directly with the private...CMS Rules
On Tuesday the Centers for Medicare and Medicaid Services (CMS) released the final rule for policy adjustments under the Physician Fee Schedule (PFS) for calendar year 2021. The rule confirmed changes to telehealth payments made during the COVID-19 pandemic, but will make cuts to specialty providers.
Last March, during the onset...CMS Rules
Last Friday, the Centers for Medicare and Medicaid Services announced a final rule that makes changes to the Physician Self-Referral Law, or Stark Law, which prohibits doctors from referring patients to services or providers owned or employed by the referring physician. The law has caused issues for participants in value-based...CMS Rules
Last Friday, the Trump administration announced two interim final rules in a last-ditch effort to fulfill the president’s campaign promises of lowering drug prices for seniors. Many of President Trump’s prior efforts were blocked by litigation or lost momentum during the rule making process. With eight weeks left in his presidency,...CMS Rules
Value-based care continues to be a focus in the news this week, as the Centers for Medicare and Medicaid Services Administrator Seema Verma penned an op-ed in Modern Healthcare about the Centers’ support for models driven by the Center for Medicare and Medicaid Innovation. These programs have on the whole lost more money than they’ve...CMS Rules
Last week CMS said it has taken steps to advance a package of state-led reforms that could result in thousands of uninsured Georgians gaining access to coverage. Specifically, CMS announced the approval of Georgia's new Medicaid section 1115 demonstration called "Pathways to Coverage."
CMS began implementing work requirements for...CMS Rules
The new model now requires providers to get prior authorization (PA) before scheduling a non-emergent ambulance transport for a patient and pays ambulance services for taking patients to non-hospital facilities.
A ride in an ambulance can cost between hundreds and thousands of dollars depending on locations, services and the...CMS Rules
CMS makes move to drive value-based reimbursement for cancer and chronic kidney disease (CKD) and end stage renal disease (ESRD) with a new final rule. The End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model uses value-based care payments to encourage the usage of home dialysis and kidney transplants. The new model also benefits...CMS Rules
On Thursday, Sept. 3, the Centers for Medicare & Medicaid Services (CMS) launched Care Compare – an online consumer-facing database of provider quality information.
In January, CMS originally announced its plan to merge Home Health Compare with its seven other Compare sites. Agency officials said the goal was to create one...CMS Rules
On Aug. 31 CMS issued a proposed rule that aims to make innovative devices and breakthrough technologies more accessible to Medicare beneficiaries.
Once the Medicare Coverage of Innovative Technology final rule goes into effect, national Medicare coverage will begin on the date of a breakthrough device’s FDA market authorization and...CMS Rules
On September 2, the Centers for Medicare & Medicaid Services (CMS) issued a final rule for acute care and long-term care hospitals that increases Medicare spending on acute care inpatient hospital services by about $3.5 billion and ties Medicare FFS inpatient hospital pay to MA negotiated rates in FY 2024.
Long-term care...CMS Rules
ACA-enrollment has dropped each year of the Trump presidency, a trend that’s also been seen in Arizona. The most recent data from Kaiser Family Foundation reports there are 153,020 Arizonans enrolled in marketplace plans. The Trump administration has dramatically cut funding for Navigators tasked with getting the word out about ACA...CMS Rules
The Centers for Medicare & Medicaid Services has strongly encouraged nursing homes to increase their efforts in controlling COVID-19 inside facilities after the number of residents infected reached a record high, and as new deaths have started rising once again.
Arizona is close to reopening nursing homes to visitors after...CMS Rules
Cigna is charged with falsifying the health conditions of its Medicare Advantage plan members, essentially scamming CMS out of larger payments to cover the cost of care for beneficiaries diagnosed through the insurer's medical assessment program.
Last year the Office of Inspector General undertook a study because it suspected...CMS Rules
Nursing homes, hospices, and inpatient psych facilities are getting some long overdue attention and can expect to see pay bumps come Oct. 1, albeit slightly less than previously proposed by CMS.
The final rule finalizes a 2.2% increase in overall payments to skilled nursing facilities in fiscal 2021. CMS says this means payments...CMS Rules
A U.S. Department of Health and Human Services watchdog reported that Seema Verma, Centers for Medicare and Medicaid Services chief, mishandled millions of dollars in federal contracts that ultimately benefited friends and former Trump officials.
The Office of Inspector General Report concluded Verma violated federal contracting...CMS Rules
Earlier this month, HHS repealed protections for transgender individuals seeking medical care and three days later, the United States Supreme Court delivered a ruling defending LGBT people from discrimination in the workplace under Title VII.
These two major changes in how the law impacts care for sexual and reproductive health...CMS Rules
Those who are older, lower income, minorities and have chronic conditions are at higher risk for COVID-19.
On June 22, CMS released sought-after Medicare data (Jan 1 to May 16) on beneficiaries’ COVID-19 outcomes that found that more than 325,000 beneficiaries were diagnosed with COVID-19 during that time.
Almost 110,000 were...CMS Rules
The announcement on Friday, June 19, CMS announced that MA plans must continue not to charge cost sharing (including deductibles, copayments, and coinsurance) or apply prior authorization or other utilization management requirements for COVID-19 tests and testing-related services.
The Centers for Medicare & Medicaid Services...