The Centers for Medicare and Medicaid Services (CMS) targets new oversight of Medicaid demonstration project spending authorization through Section 1115 waivers. Nearly all states use demonstration waivers, including Arizona.
Late last week, CMS issued the new guidance for upcoming demonstrations beginning January 1, 2027. From that...National News
The American Hospital Association (AHA) and the Alliance of Community Health Plans (ACHP) are asking the Centers for Medicare and Medicaid Services (CMS) to finalize its 2025 Medicare Advantage and Part D proposed rule that would provide a number of reforms for the MA program.
In a lengthy letter highlighting several key points of the...CMS Rules
This week, federal regulators issued an interim final rule that would take action against states that have not complied with the federal Medicaid eligibility rules or reporting requirements during the redetermination period.
The rule says that the Centers for Medicare and Medicaid Services (CMS) will require noncompliant states to...National News
Last Thursday, the Centers for Medicare and Medicaid Services (CMS) published its proposed guidance for carrying out drug price reforms included in the Inflation Reduction Act. The agency is requesting public input on the outline and timeframe for implementing the Medicare Prescription Drug Inflation Rebate Program.
The program will...
On Monday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that includes revisions to network adequacy standards for Marketplace plans and paths to transitioning Medicaid members to the Marketplace. The proposed rule adds behavioral healthcare, including substance use disorder facilities and providers, to the...
Through the last few weeks in office and in anticipation of the new calendar year, the Centers for Medicare and Medicaid Services (CMS) passed a slew of rules, deadline extensions and requests for participation in order to bolster cost-lowering initiatives and incentivize participation in value-based care programs.
The federal...CMS Rules
The Centers for Medicare and Medicaid Services (CMS) finalized requirements seeking to increase access to telehealth for seniors in Medicare Advantage (MA) plans. The changes made to MA and Medicare Part D also expand supplemental benefit options for beneficiaries with chronic diseases.
CMS will grant MA plans more flexibility to...News
The proposed rule for Year 3 of the Quality Payment Program (QPP) may boost participation and cut paperwork for eligible clinicians. Proposal adds ten new quality measures and dumps dozens of "low value" measures.
Providers, healthcare organization executives, association heads, and other stakeholders have until September 10 to...National News
BPCI Advanced will qualify as an Advanced Alternative Payment Model (APM) under the Quality Payment Program.
BPCI Advanced will operate under a total-cost-of-care concept, in which the total Medicare fee for services (FFS) spending on all items and services furnished to a BPCI Advanced Beneficiary during the Clinical Episode,...National News
A major shift in the 50-year-old program, the guidelines will set the conditions for allowing states to add work requirements to their Medicaid programs, bringing a conservative twist to the health insurance program for the poor.
The Hill reports the changes represent the vision of Seema Verma, the administrator of the Centers for...
The 21st Century Cures Act requires changes to the risk adjustment model for aged and disabled beneficiaries enrolled in Medicare Advantage Part C plans beginning in calendar year 2019.
For 2019, the agency proposes adding mental health, substance use disorder and chronic kidney disease conditions to the risk adjustment model and...
Not everyone will be happy.
November 2 the Centers for Medicare and Medicaid Services exposed the final rule implementing the changes. The rule is 1,250 pages long. You may wish to read it here. Thoughtfully included are the names and phone numbers of staff that can be contacted for more information , listed by topic areas.
For the...National News
Restrictions to be waived in the joint replacement model.
Stakeholders convinced CMS that the costs of email interaction was not covered by other sources and did entail additional costs to deliver telehealth services such as maintaining the telecommunications equipment, software and security.
Researchers in Wisconsin caution that...National News
HHS Secretary Tom Price and CMS Administrator Seema Verma have access to powerful tools.
HHS can help states combat the problems of raising rates and shrinking individual marketplaces. Here are four ideas that HHS and the states can explore and expand:
Expand state reinsurance options
Allow innovative pilot plan designs for high...National News
Most of the cuts were called for in the Affordable Care Act, which mandated the reduction to address Medicare overpayments for home health services dating back to 2000.
The rule exposed Tuesday called for a 0.4 percent reduction for providers in 2018. In a major change, CMS is proposing to reimburse for home healthcare in 30-day...National News
A 1058 page proposed rule to craft 2018 Updates to the Quality Payment Program is released.
Changes announced Tuesday afternoon feature continuation of "pick your pace" for the new payment system's data reporting and expands exemption of physicians from mandatory participation. "The most significant proposed changes for 2018 intend...
