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September 8, 2017

Medicare Drug Coverage under Medicare Part A, Part B, Part C, & Part D

This tip sheet provides an overview of drug coverage under Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance), Medicare Part C (Medicare Advantage) and Medicare Part D (Medicare prescription drug coverage).

September 1, 2017

Hurricane Harvey and Medicare Disaster Related Texas Claims

This MLN Matters® Special Edition Article is intended for providers and suppliers who submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries in the State of Texas who were affected by Hurricane Harvey. This MLN Matters® Special Edition Article is intended for providers and suppliers who submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries in the State of Texas who were affected by Hurricane Harvey.

Tropical Storm Harvey and Medicare Disaster Related Louisiana Claims

This MLN Matters® Special Edition Article is intended for providers and suppliers who submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries in the State of Louisiana who were affected by Tropical Storm Harvey.

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 September 1, 2017 effective date to implement these updated FULs. States will have up to 30 days from the September 1, 2017 effective date to implement these updated FULs.

IMPACT Act Call: Audio Recording and Transcript — NewIMPACT Act Call: Audio Recording and Transcript — New

An audio recording and transcript are available for the August 17 call on the IMPACT Act: Drug Regimen Review Measure Overview for the Home Health Quality Reporting Program. The Improving Medicare Post-Acute Care Transformation of 2014 (IMPACT Act) requires reporting of standardized patient assessment data.An audio recording and transcript are available for the August 17 call on the IMPACT Act: Drug Regimen Review Measure Overview for the Home Health Quality Reporting Program. The Improving Medicare Post-Acute Care Transformation of 2014 (IMPACT Act) requires reporting of standardized patient assessment data.

A Physician’s Guide to Medicare Part D Medication Therapy Management Programs MLN Matters Article — Revised

A revised MLN Matters Special Edition Article on A Physician’s Guide to Medicare Part D Medication Therapy Management (MTM) Programs is available. Learn how to refer patients to MTM services.

Inpatient Rehabilitation Facility Prospective Payment System Fact Sheet

An Inpatient Rehabilitation Facility Prospective Payment System Fact Sheet is available. Learn about:

  • Elements of the Inpatient Rehabilitation Facility (IRF) Prospective Payment System
  • Payment updates
  • IRF Quality Reporting Program

Medicare Home Health Benefit Booklet

A Medicare Home Health Benefit Booklet is available. Learn about:

  • Qualifying for home health services
  • Consolidated billing
  • Therapy services
  • Physician billing and payment

August 30, 2017

June 2017 Medicaid & CHIP Eligibility and Enrollment Report

Centers for Medicare & Medicaid Services (CMS) released the June 2017 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data. The full report is available here on Medicaid.gov

August 18, 2017

FAQ: Medicaid and CHIP Managed Care Final Rule

Today the Centers for Medicare & Medicaid Services (CMS) released the has published the second set of frequently asked questions (FAQs) for the Medicaid and CHIP Managed Care Final Rule here:

This second set of published FAQs addresses common questions related to section 438.6(e) for payments to MCOs and PIHPs for an enrollee that is a patient in an institution for mental disease (IMD) in the Medicaid and CHIP Managed Care Final Rule.This second set of published FAQs addresses common questions related to section 438.6(e) for payments to MCOs and PIHPs for an enrollee that is a patient in an institution for mental disease (IMD) in the Medicaid and CHIP Managed Care Final Rule.

CMS Announces New Hospice Compare Website

The Hospice Compare site allows patients, family members, caregivers, and healthcare providers to compare hospice providers based on important quality metrics, such as the percentage of patients that were screened for pain or difficult or uncomfortable breathing, or whether patients’ preferences are being met. Currently, the data on Hospice Compare is based on information submitted by approximately 3,876 hospices.

Proposed Changes to Comprehensive Care for Joint Replacement Model, Cancellation of Other Models

On August 15, CMS announced a proposed rule to reduce the number of mandatory geographic areas participating in the Center for Medicare and Medicaid Innovation’s Comprehensive Care for Joint Replacement (CJR) model from 67 to 34. In addition, CMS proposes to allow CJR participants in the 33 remaining areas to participate on a voluntary basis. In this rule, CMS also proposes to make participation in the CJR model voluntary for all low volume and rural hospitals in all of the CJR geographic areas.On August 15, CMS announced a proposed rule to reduce the number of mandatory geographic areas participating in the Center for Medicare and Medicaid Innovation’s Comprehensive Care for Joint Replacement (CJR) model from 67 to 34. In addition, CMS proposes to allow CJR participants in the 33 remaining areas to participate on a voluntary basis. In this rule, CMS also proposes to make participation in the CJR model voluntary for all low volume and rural hospitals in all of the CJR geographic areas.

CMS also is proposing through this rule to cancel the Episode Payment Models and the Cardiac Rehabilitation incentive payment model, which were scheduled to begin on January 1, 2018. Eliminating these models would give CMS greater flexibility to design and test innovations that will improve quality and care coordination across the in-patient and post-acute-care spectrum. “Changing the scope of these models allows CMS to test and evaluate improvements in care processes that will improve quality, reduce costs, and ease burdens on hospitals,” said CMS Administrator Seema Verma.CMS also is proposing through this rule to cancel the Episode Payment Models and the Cardiac Rehabilitation incentive payment model, which were scheduled to begin on January 1, 2018. Eliminating these models would give CMS greater flexibility to design and test innovations that will improve quality and care coordination across the in-patient and post-acute-care spectrum. “Changing the scope of these models allows CMS to test and evaluate improvements in care processes that will improve quality, reduce costs, and ease burdens on hospitals,” said CMS Administrator Seema Verma.

For more information

July 31, 2017

Medicare finalizes fiscal year 2018 payment & policy changes for skilled nursing facilities

On July 31, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1679-F] outlining Fiscal Year (FY) 2018 Medicare payment rates and quality programs for skilled nursing facilities (SNFs).

This fact sheet discusses major provisions of the final rule, including policies related to the SNF Value-Based Purchasing Program and the SNF Quality Reporting Program. The final rule also finalizes an updated performance period for the National Healthcare Safety Network (NHSN) Healthcare Personnel (HCP) Influenza Vaccination Reporting Measure included in the End Stage Renal Disease (ESRD) Quality Incentive Program (QIP) for Payment Year 2020 and other key elements.

July 6, 2017

Mass Immunizers and Roster Billing Booklet — Reminder

The Mass Immunizers and Roster Billing Booklet is available. Learn aboutThe Mass Immunizers and Roster Billing Booklet is available. Learn about:

  • Requirements for mass immunizers
  • Roster billing
  • Centralized billing

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