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Postings from CMS April-June 2017

June 30, 2017

CMS’ Open Payments Program Posts 2016 Financial Data

Applicable manufacturers and Group Purchasing Organizations (GPOs) collectively reported $8.18 billion in payments and ownership and investment interests to physicians and teaching hospitals in 2016

Today, the Centers for Medicare & Medicaid Services (CMS) published the Program Year 2016 Open Payments data, along with newly submitted and updated payment records for Program Years 2013, 2014, and 2015 at https://openpaymentsdata.cms.gov/.

Dementia Care Call: Audio Recording and Transcript — New

An audio recording and transcript are available for the June 15 call on the National Partnership to Improve Dementia Care in Nursing Homes and Quality Assurance and Performance Improvement (QAPI). During this call, learn about appropriate assessment and evaluation for the accurate diagnosis of schizophrenia and other mental disorders.

Medical Privacy of Protected Health Information Fact Sheet — Revised

A revised Medical Privacy of Protected Health Information Fact Sheet is available. Learn about:

  • How the Privacy rule applies to customary health care practices
  • Tips for securing health information when using a mobile device
  • HHS HIPAA webpage resources
June 23, 2017

April 2017 Medicaid & CHIP Eligibility and Enrollment Report

Today the Centers for Medicare & Medicaid Services (CMS) released the April 2017 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data.

The full report is available on Medicaid.gov

June 15, 2017

Chronic Care Management Services: New Connected Care Materials

CMS has new resources to help you and your patients understand Chronic Care Management (CCM) services. Order these free materials from the CMS Product Ordering website:

June 7, 2017

CIB: Strategies to Streamline Transitions for Medicaid-eligible Beneficiaries Who Newly Qualify for Medicare

Centers for Medicare & Medicaid Services (CMS) issued an Informational Bulletin to promote smooth transitions for individuals in the adult group who become Medicare eligible. Specifically, the bulletin clarifies the required processes for completing redeterminations of eligibility when Medicaid adult group beneficiaries turn 65 or attain Medicare eligibility, and it highlights opportunities for states to promote smooth transitions for these beneficiaries while reducing administrative burden on them and states.

June 5, 2017

Medicare Basics: Parts A and B Claims Overview Video — Reminder

The Medicare Basics: Parts A and B Claims Overview video is available. Learn about Medicare claims, what you need to know before filing a claim, and how to submit a claim.

May 26, 2017

The Affordable Care Act Federal Upper Limits Have Been UpdatedThe Affordable Care Act Federal Upper Limits Have Been Updated

The updated Affordable Care Act Federal upper limits (FUL) calculated in accordance with the Medicaid Covered Outpatient Drug final rule with comment are now available on the Medicaid.gov website here. States will have up to 30 days from the June 1, 2017 effective date to implement these updated FULs.

May 23, 2017

SNF QRP Quality Measure User’s Manual Now Available

This manual presents methods used to calculate quality measures that are included in the Centers for Medicare & Medicaid Services (CMS) Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). This manual provides detailed information for each quality measure, including quality measure definitions, inclusion and exclusion criteria and measure calculation specifications. View the manual on the SNF Quality Reporting Program Measures and Technical Information webpage; in the downloads section.

May 19, 2017

Rules: Medicare Program

Medicare Program: Advancing Care Coordination Through Episode Payment Models; Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model; Delay of Effective Date

May 17, 2017

March 2017 Medicaid & CHIP Eligibility and Enrollment ReportMarch 2017 Medicaid & CHIP Eligibility and Enrollment Report

Today the Centers for Medicare & Medicaid Services (CMS) released the March 2017 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data.

CMS Issues Section 1332 State Innovation Waiver Checklist

Checklist Aims to Help Stabilize State Health Insurance Markets for 2018

May 4, 2017May 4, 2017

CMS Publishes Proposed SNF PPS Rates for 2018

CMS Published the annual proposed PPS upodate for SNFs in the Federal Register. The agency proposes to increase payments by one percent in the next fiscal year.

CMS Proposes Modifications to SNF PPS System for 2019

The long-awaited proposed rule changing the Medicare Part A payment structure for SNFs has been published. In this proposal, CMS considers shifting away from therapy-based payments to more objective patient characteristics. Comments due June 26.

April 28, 2017

The Affordable Care Act Federal Upper Limits Have Been Updated

The updated Affordable Care Act Federal upper limits (FUL) calculated in accordance with the Medicaid Covered Outpatient Drug final rule with comment are now available on the Medicaid.gov website. States will have up to 30 days from the May 1, 2017 effective date to implement these updated FULs.

April 20, 2017

SNF QRP Quick Reference Guide Now Available

A new Quick Reference Guide for Skilled Nursing Facilities (SNFs) is available. This guide includes frequently asked questions, information on Quality Reporting Program (QRP) help desks, and helpful links to additional resources for the QRP.

SNF Billing Reference Booklet — Revised

A revised SNF Billing Reference Booklet is available. Learn about:

  • Medicare-covered Skilled Nursing Facility (SNF) stays
  • SNF payment and billing requirements
April 13, 2017

January 2017 Medicaid & CHIP Eligibility and Enrollment Report

Today the Centers for Medicare & Medicaid Services (CMS) released the January 2017 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data.

See Report Here

Mapping Medicare Disparities Tool: Identify Disparities in Chronic Disease

The Mapping Medicare Disparities Tool is an interactive website that can help you identify and visualize disparities among Medicare Fee-For-Service beneficiaries. The Tool displays health-related measures from Medicare claims by sex, age, dual eligibility for Medicare and Medicaid, race, ethnicity, state, and county. Use the Mapping Medicare Disparities Tool to target interventions for populations with special health needs:

  • Visualize prevention quality indicators, disease prevalence, readmissions, and cost at the state or county level
  • Compare measures by race, ethnicity, dual-eligibility, age, and sex
  • Analyze geographic needs, including rural and urban counties and the U.S. territories
April 6, 2017

April Quarterly Provider Update Available

The April Quarterly Provider Update is available. Find out about:

  • Regulations and major policies currently under development during this quarter
  • Regulations and major policies completed or cancelled
  • New or revised manual instructions

Dementia Care Call: Audio Recording and Transcript — New

An audio recording and transcript are available for the March 21 call on the National Partnership to Improve Dementia Care in Nursing Homes and Quality Assurance and Performance Improvement (QAPI). During this call, learn about a project grant award and new QAPI Written Plan How-To Guide that can assist long-term care providers with performance improvement efforts.

April 5, 2017

NADAC Equivalency Metrics Added to Retail Price Survey Page on Medicaid.gov

The Retail Price Survey page on the Medicaid.gov website has been updated to include a link to the National Average Drug Acquisition Cost (NADAC) Equivalency Metrics . The NADAC Equivalency Metrics will be published on a quarterly basis and are intended to be utilized for analyzing and monitoring the NADAC pricing relationship to compendia drug pricing values. In addition, the NADAC Equivalency Metrics can be utilized by state Medicaid programs for evaluating their respective pharmacy reimbursement protocols.

A methodology document titled NADAC Equivalency Methodology has been developed to outline the processes used to derive the NADAC Equivalency Metrics file

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