The proposed Medicaid rule would have scrutinized eligibility determinations in the Medicaid program. Scheduled for publication in April, the policy was withdrawn Tuesday, March 24 by the Centers for Medicare & Medicaid Services.
The...CMS Rules
Hospitals and providers participating in Medicare quality value-based purchasing programs received unprecedented relief on Sunday from a Centers of Medicare and Medicaid Services (CMS) announcement that relaxes reporting requirements and extends data submission deadlines.
The action is part of the Trump Administration's response...CMS Rules
Last year, the Centers for Medicare and Medicaid Innovation (CMMI) released a Request for Information as it sought comments for its Oncology Care First (OCF) proposal, a voluntary model open to physician groups and hospital outpatient departments offering two payment mechanisms. Now it is considering the addition of clinical laboratory...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) released a proposed rate increase of less than 1 percent on 2021 baseline payments for insurers managing Medicare Advantage (MA) plans. The proposal pales in comparison to the more than 2.5 percent increase plans saw this year, but the rate is set to finalize in April.
An...CMS Rules
With two-thirds of U.S. Medicaid beneficiaries receiving care from managed care organizations, private insurers are unlikely to suffer from the Medicaid block grant plan.
A majority of states contract with MCOs to provide coverage and the government space is still perceived as a prime growth strategy for large insurers such as...
The Trump Administration's rollout of its new Medicaid block grant policy, dubbed "Healthy Adult Opportunity" was met with backlash from House Democrats, who are moving to vote on a resolution next week that would disapprove the plan.
Block grants give states fixed federal grants to use toward Medicaid spending based on individual...
Following last year’s controversial price transparency rule mandating that hospitals disclose the rates they negotiate with insurers online for specific services, payers have decided to counter the rule with an initiative of their own.
The Centers for Medicare and Medicaid Services (CMS) revealed the list of 70 mandated services...CMS Rules
Terms of a settlement agreement will allow Hacienda Healthcare to keep its state license and Medicaid contract under several conditions, including the mandatory hiring of a quality improvement expert.
In June 2019, the Arizona Department of Health Services issued a notice of intent to revoke the facility's license following the...CMS Rules
CMS wants to increase the amount of encounter data the agency uses to calculate Medicare Advantage (MA) risk scores from 50% to 75%; final 2021 MA payment rates are expected on or before April 6.
Even as the industry continues to express concern over the reliability of encounter data, The HCC Risk Adjustment Model is now driven by...CMS Rules
This year, the Centers for Medicare and Medicaid Services (CMS) will implement a lower physician supervision requirement for hospital outpatient therapeutic services. CMS has required direct supervision of services such as, chemotherapy and radiation therapy for the past decade.
The change was finalized in November 2019, making...CMS Rules
Hospice advocates are calling for a delay to the Centers for Medicare and Medicaid Services' (CMS) Medicare Advantage (MA) carve-in demonstration set to begin in Jan. 2021.
Earlier this year, the agency announced it would start testing hospice care coverage through MA plans in 2021 with the intention of increasing care...CMS Rules
National enrollment for 2020 health plans on HealthCare.gov totaled 8.3 million for the open enrollment period ending on Dec. 15. But this year because some consumers attempting to enroll during the final hours experienced issues, the deadline for sign up was extended until 3 a.m. EST Dec. 18.
This year, shoppers seeking health...CMS Rules
Last Monday, a federal judge denied a request from hospitals to halt the site-neutral provisions in the Outpatient Prospective Payment System (OPPS) for 2020, a rule finalized in September by the Centers for Medicare and Medicaid Services (CMS). Following the original announcement, United States District Court Judge Rosemary Collyer in...
A report from the Department of Health and Human Services (HHS) inspector general's office analyzed Medicare Advantage (MA) encounter data from 2016, stemming from concerns that MA organizations use chart reviews to inaccurately inflate risk adjusted payments. The result was billions in additional payments.
The Office of Inspector...
The Centers for Medicare and Medicaid Services (CMS) recently issued a request for applications (RFA) for two of the three voluntary payment model options, specifying how accountable care organizations can apply to participate in the professional and global options of Direct Contracting (DC).
Defined within DC are three different...CMS Rules
Medicare open enrollment for 2020 coverage ended Saturday, Dec. 7, and while the Centers for Medicare and Medicaid Services (CMS) indicated a special enrollment period (SEP) for seniors who enrolled in a plan based on erroneous information, senators are calling for CMS to specify information regarding the SEP and make it available for...CMS Rules
For the first time in the last decade, the Centers for Medicare and Medicaid Services (CMS) updated the popular health plan shopping tool Medicare Plan Finder, but the recent redesign initiative has raised concerns for consumer advocacy groups that say the tool offers inaccurate information.
The federal government spent $11 million...CMS Rules
A new analysis of the decline in hospital readmission rates suggests ties to a drop in hospital admissions all together, rather than a Centers for Medicare and Medicaid Services (CMS) value-based purchasing program as previously credited.
The Medicare Hospital Readmissions Reduction Program (HRRP) is a value-based purchasing...CMS Rules
The final rule provides details on the requirements for making public discounted cash prices, payer-specific negotiated charges and de-identified minimum and maximum negotiated charges for at least 300 ‘shoppable’ services, publicly available in a consumer-friendly format effective January 1, 2021.
The Health & Human Services...CMS Rules
The American Association of Nurse Anesthetists (AANA) is celebrating newly established rules, expanding the recognition and responsibilities of Certified Registered Nurse Anesthetists (CRNA).
On Nov. 1, the Centers for Medicare & Medicaid Services (CMS) released the new Medicare Physician Fee Schedule (PFS) to take effect...
