CMS Updates

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Postings from CMS January to March 2017

March 23, 2017

Connected Care: New Educational Initiative to Raise Awareness of Chronic Care Management

On March 15, the CMS Office of Minority Health and the Federal Office of Rural Health Policy at the Health Resources and Service Administration introduced Connected Care, an educational initiative to raise awareness of the benefits of Chronic Care Management (CCM) services for Medicare beneficiaries with multiple chronic conditions and to provide health care professionals with support to implement CCM programs. Connected Care is a nationwide effort within fee-for-service Medicare that includes a focus on racial and ethnic minorities, as well as rural populations, who tend to have higher rates of chronic disease.

Visit the Connected Care webpage for more information and CCM resources.

PACE Innovation Act Public Comments Posted

CMS is posting the comments we received in response to the Request for Information released December 23, 2016 on the PACE Innovation Act. The PACE Innovation Act of 2015 (PIA) provides authority to waive certain provisions of Section 1934 of the Social Security Act to test application of PACE-like models for additional populations, including populations under the age of 55 and those who do not qualify for a nursing home level of care, under Section 1115A of the Social Security Act. Comments to the RFI were due February 10, 2017.

March 10, 2017

CMS has posted frequently asked questions concerning the Medicare Outpatient Observation Notice (MOON).

The “MOON FAQs” are available on the CMS website: www.cms.gov/bni

March 9, 2017

Chronic Care Management Services Call: Audio Recording and Transcript

An audio recording, transcript, and post-call clarification are available for the February 21 call on Understanding and Promoting the Value of Chronic Care Management (CCM) Services. During this call, CMS experts discuss the benefits of providing CCM services and changes for CCM in the Physician Fee Schedule final rule.

IMPACT Act Call: Audio Recording and Transcript

An audio recording and transcript are available for the February 23 call on Looking Ahead: The Improving Medicare Post-Acute Care Transformation of 2014 (IMPACT Act) in 2017. During this call, CMS experts discuss goals, requirements, progress to date, and key milestones for 2017.

March 6, 2017

IMPACT Act: Standardized Patient Assessment Data Activities MLN Connects Call

During this call, find out about efforts to develop, implement, and maintain standardized Post-Acute Care (PAC) patient assessment data, including pilot testing results and plans for the upcoming national field test.

Wednesday, March 29 from 1:30 to 3 pm ET

To register or for more information, visit MLN Connects Event Registration.

March 3, 2017

Home Health Quality Reporting Program Provider Training — May 3 and 4

CMS is hosting a 2-day, in person training event on the Home Health (HH) Quality Reporting Program in Baltimore, MD. Visit the HH Quality Reporting Training webpage for more information and to register.

March 1, 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 at https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Pharmacy-Pricing.html. States will have up to 30 days from the March 1, 2017 effective date to implement these updated FULs. 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 March 1, 2017 effective date to implement these updated FULs.

February 28, 2017

December 2016 Medicaid & CHIP Eligibility and Enrollment Report

Today the Centers for Medicare & Medicaid Services (CMS) released the December 2016 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data.

The full report is available on Medicaid.gov

February 23, 2017

Market Saturation and Utilization Data Tool

Market saturation, in the present context, refers to the density of providers of a particular service within a defined geographic area relative to the number of beneficiaries receiving that service in the area. The Market Saturation and Utilization Data Tool includes an interactive map and a data set that shows national-, state-, and county-level provider services and utilization data for selected health service areas.

See more

Medicare and Medicaid Programs: Quarterly Listing of Program Issuances: October through December 2016

This quarterly notice lists CMS manual instructions, substantive and interpretive regulations, and other Federal Register notices that were published from October through December 2016, relating to the Medicare and Medicaid programs and other programs administered by CMS.

February 6, 2017

CMS Publication on Medicare Limits on Therapy Services

Medicare law limits how much it pays for your medically necessary outpatient therapy services in one calendar year. These limits are called “therapy caps” or “therapy cap limits.”

See more

February 2, 2017

CMS MedLearn Articles

Telehealth Services Fact Sheet

Skilled Nursing Facility 30-Day All Cause Readmission Measure (SNFRM)

In the Fiscal Year (FY) 2016 SNF Prospective Payment System (PPS) final rule, CMS adopted the SNFRM as the first measure for the Skilled Nursing Facility Value Based Purchasing (SNF VBP) Program. The measure is defined as the risk-standardized rate of all-cause, unplanned hospital readmissions of Medicare beneficiaries within 30 days of discharge from their prior hospitalization. Hospital readmissions are identified through Medicare hospital claims (not SNF claims) so no readmission data is collected from SNFs and there are no additional reporting requirements for the measure.

See more

January 19, 2017

New Care Management Webpage

A Care Management webpage is now available on the Physician Fee Schedule website. This new webpage includes fact sheets, FAQs, and other information on chronic care management, transitional care management, and similar services under the Medicare physician fee schedule.

Independence at Home Demonstration Corrected Performance Year 2 Results

The Independence at Home Demonstration provides chronically ill patients with a complete range of primary care services in the home setting. Medical practices led by physicians or nurse practitioners provide primary care home visits tailored to the needs of beneficiaries with multiple chronic conditions and functional limitations. The Demonstration also tests whether home-based care can reduce the need for hospitalization, improve patient and caregiver satisfaction, and lead to better health for beneficiaries and lower costs to Medicare.

See more

Medicare Quarterly Provider Compliance Newsletter

A new Medicare Quarterly Provider Compliance Newsletter [Volume 7, Issue 2] Educational Tool is available. Learn about:

  • How to avoid common billing errors and other erroneous activities
  • How to address and avoid the top issues this quarter
January 18, 2017

November 2016 Medicaid & CHIP Eligibility and Enrollment Report

Today the Centers for Medicare & Medicaid Services (CMS) released the November 2016 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data.

New Participants Join Several CMS Alternative Payment Models

Today, the Centers for Medicare & Medicaid Services (CMS) announced over 359,000 clinicians are confirmed to participate in four of CMS’s Alternative Payment Models (APMs) in 2017. Clinicians who participate in APMs are paid for the quality of care they give to their patients. APMs are an important part of the Administration’s effort to build a system that delivers better care and one in which clinicians work together to have a full understanding of patients’ needs. APMs also strive to ensure that patients are in the center of their care, and that Medicare pays for what works and spends taxpayer money more wisely resulting in a healthier country.

See Press Release and more info

January 17, 2017

CMS Informational Bulletin on Expansion of Pharmacist Scope of Practice

This guidance addresses flexibilities that states may have to facilitate timely access to specific drugs by expanding the scope of practice and services that can be provided by pharmacists, including dispensing drugs based on their own independently initiated prescriptions, collaborative practice agreements (CPA) with other licensed prescribing healthcare providers like physicians, “standing orders” issued by the state, or other predetermined protocols.

Data Brief: Sharp reduction in avoidable hospitalizations among long-term care facility residents

Over the last several years, with the help from the Affordable Care Act, Medicare and Medicaid have worked with other federal government agencies, states, patient organizations, and others to identify and prevent those health conditions that have caused long-term care residents to be unnecessarily hospitalized. Because of these efforts, we have seen a dramatic reduction in avoidable hospitalizations over the last several years, according to below analysis released by CMS today.

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See Blog Post

Final Rule: Medicare Program: Changes to Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures

FFY 2015 Drug Utilization Review Annual State Reports and State Comparison/Summary Report FFY 2015 Now Available on Medicaid.gov

CMS has posted the FFY 2015 Drug Utilization Review (DUR) Annual State Reports

State Comparison/Summary Report for FFY 2015
January 12, 2017

Chronic Care Management Services Changes for 2017

CMS recently approved a number of changes to the payment rules for Chronic Care Management (CCM) services under Medicare Part B for CY 2017 to reduce administrative burden and improve payment accuracy. See the CCM Services Changes for 2017 fact sheet, FAQs, and the Care Management webpage for more information.

Presentation Available - "Delivering Coordinated Care through Chronic Care Management Services"

CMS has published slides from a recent webinar on delivering chronic care management services. See slides here

January 9, 2017

CMS Finalizes New Medicare and Medicaid Home Health Care Rules and Beneficiary Protections

On January 9, CMS finalized rules governing Home Health Agencies (HHAs) that will improve the quality of health care services and strengthen patients’ rights. These conditions of participation are the minimum health and safety standards HHAs must meet to participate in the Medicare and Medicaid programs.

See final rule

January 5, 2017

Third CMS Innovation Center Report to Congress Posted

The CMS Innovation Center has released its third Report to Congress, as mandated by section 1115A(g) of the Social Security Act. It focuses on activities between October 1, 2014 and September 30, 2016, but also highlights a number of important activities started during that time period that were announced between September 30, 2016 and December 31, 2016.

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