CMS Updates


Postings from CMS October to December 2016

December 21, 2016

The Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents – Payment Reform

This article is intended for nursing facilities and practitioners participating in this initiative. Those are selected nursing facilities and practitioners in Alabama, Colorado, Indiana, Missouri, Nevada, New York, and Pennsylvania. The article is informational for other nursing facilities and practitioners.

New Payment Models Announced to Improve Cardiac and Joint Care

On December 20, 2016, the Centers for Medicare & Medicaid Services (CMS) finalized new Innovation Center models that continue the Administration’s progress to shift Medicare payments from rewarding quantity to rewarding quality by creating strong incentives for hospitals to deliver better care to patients at a lower cost. These models will reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery.

For more information about the individual models finalized through this rule, visit the CMS Innovation Center website.

December 8, 2016

SNF Quality Reporting Program Video Presentation

A video presentation is available for the September 14 webcast on the Skilled Nursing Facility (SNF) Quality Reporting Program (QRP). Learn about the reporting requirements for the new SNF QRP, effective October 1, 2016.

CMS Innovation Center announces two new models that will increase patient engagement care decision making

CMS has announced two new models from the CMS Innovation Center that will increase patient engagement in care decisions by putting more information in the hands of Medicare beneficiaries. These two Beneficiary Engagement and Incentives (BEI) Models are the Shared Decision Making Model (SDM Model) and the Direct Decision Support Model (DDS Model).

CMS Blog: Improving the Quality of Care for Medicare Beneficiaries by Increasing Patient Engagement

December 7, 2016

New Medicare Drug Spending Data Files Now Available

CMS released Medicare spending and utilization data for all Part B drugs (drugs administered in doctors’ offices and other outpatient settings) and Part D drugs (drugs patients generally administer themselves) for 2011 to 2015.

December 2, 2016

CMS Releases 2015 National Health Expenditures

In 2015, per-capita health care spending grew by 5.0 percent and overall health spending grew by 5.8 percent, according to a study by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) published today as a Web First by Health Affairs.

September 2016 Medicaid and CHIP Enrollment Data Highlights

The September 2016 Medicaid and CHIP Application, Eligibility Determination, and Enrollment Report represents state Medicaid and Children's Health Insurance Program (CHIP) agency activity for the month. The report is one of a series of reports on state Medicaid and CHIP data, and it includes data reported by states.

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 website

November 16, 2016

CMS releases second year of durable medical equipment, prosthetics, orthotics and supplies utilization and payment data

CMS has posted the second annual release of the Referring Provider Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Public Use File (PUF) with data for 2014. The Referring Provider DMEPOS PUF presents summarized information on physicians and other healthcare professionals who referred DMEPOS products and services, such as wheelchairs, walkers and diabetes supplies for Medicare beneficiaries.

November 14, 2016

CMS Updates Drug Spending Dashboard

Acting Administrator Andy Slavit announced in a recent blog post that the agency has updated its Medicare drug spending dashboard with new data on Medicaid, in addition to its continued focus on Medicare drug costs. The dashboard is a not-so-subtle effort to shame the pharmaceutical industry into moderation. According to agency data, it seems not to be working, with annual spending increases pegged at 6.5 percent or more through 2025.

November 10, 2016

CMS Announces Deductibles and Premiums for Parts A and B for 2017

CMS announced that 2017 Part B premiums will remain essentially flat for most Medicare beneficiaries, while higher-income enrollees will increase by about 10 percent.

See Announcement

November 8, 2016

IMPACT Act Videos

The Improving Medicare Post-Acute Care Transformation of 2014 (IMPACT Act) requires that patient assessment data used in post-acute care settings be standardized to improve quality of care. Watch MLN Connects videos to learn more about this important legislation:

Introduction to the IMPACT Act: Moderated by Dr. Patrick Conway, CMS Principle Deputy Administrator and Chief Medical Officer

CMS Quality Conference 2015: Industry Leaders Discuss IMPACT Act: Industry leaders share their thoughts on the relevance and importance to the health care delivery system

November 7, 2016

Long-Term Care Facilities: Reform of Requirements Call. Audio Recording and Transcript Available

The audio recording and transcript are now available. This call discussed the changes included in the final rule; implementation and survey process; and provider training and resources.

November 4, 2016

CMS Issues RFI for Home and Community Care

CMS published a request for information on how the agency can accelerate access to home and community-based services in the Medicaid program. The notice will be published in the Federal Register on November 9th

November 3, 2016

CMS Publishes Final Home Health PPS Update for CY 2017

This final rule updates the Home Health Prospective Payment System (HH PPS) payment rates, including the national, standardized 60- day episode payment rates, the national per-visit rates, and the non-routine medical supply (NRS) conversion factor; effective for home health episodes of care ending on or after January 1, 2017.

See CMS Fact Sheet

November 3, 2016

Antipsychotic Drug use in Nursing Homes: Trend Update

CMS is tracking the progress of the National Partnership to Improve Dementia Care in Nursing Homes by reviewing publicly reported measures. The official measure is the percentage of long-stay nursing home residents who receive an antipsychotic medication, excluding residents diagnosed with schizophrenia, Huntington's disease, or Tourette’s syndrome. In the fourth quarter of 2011, 23.9 percent of long-stay nursing home residents received an antipsychotic medication; since then there has been a decrease of 31.8 percent to a national prevalence of 16.3 percent in second quarter of 2016.

November 1, 2016

DMEPOS Competitive Bidding Program: CMS Awards Contracts for Round 1 2017

On November 1, CMS announced the Round 1 2017 contract suppliers for the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. View the fact sheet for additional information.

October 31, 2016

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 website. States will have up to 30 days from the November 1, 2016 effective date to implement these updated FULs.

October 27, 2016

Provider Compliance Fact Sheets — Skilled Nursing Facility Inpatient Services

DMEPOS Information for Pharmacies Fact Sheet — Revised

October 31, 2016

Date Change & Phased Enforcement of Part D Prescriber Enrollment

CMS previously announced that enforcement of the prescriber enrollment requirement would begin on February 1, 2017.

CMS will implement a multifaceted, phased approach that will align full enforcement of the Part D prescriber enrollment requirements with other ongoing CMS initiatives. Full enforcement of the Part D prescriber enrollment requirement will begin on January 1, 2019.

October 17, 2016

Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Provider Training: Post-Training Materials Available

Post-training materials from the June 21 and 22, 2016, SNF QRP Provider Training in Atlanta, GA, are now available under the download section of the SNF QRP Training webpage. These include the PowerPoint presentations with answers to polling scenarios and collateral material used to facilitate the integrated case study and other classroom activities.

Drug Regimen Review Item Pilot Test for Inpatient Rehabilitation Facilities, Skilled Nursing Facilities, and Long-Term Care Hospitals: A Summary of Findings – Report Now Available

The DRR Item Pilot Test collected data on the DRR measure items in the IRF, SNF, and LTCH settings to inform CMS on the feasibility of collecting the DRR measure items in these settings. The pilot testing data suggested that use of the DRR measure items can facilitate use of a systematic approach to the processes of medication reconciliation (MR) and DRR, supporting the need for PAC facilities to collect the DRR measure items to drive enhanced quality assurance and patient/resident safety, especially surrounding transitions of care.

View the full report on the IMPACT Act Downloads and Videos webpage.

State Drug Utlization Data available on

CMS is pleased to announce that the State Drug Utilization Data is once again available on at this link

October 14,, 2016

CMS Finalizes the New Medicare Quality Payment Program

The final rule with comment period offers a fresh start for Medicare by centering payments around the care that is best for the patients, providing more options to clinicians for innovative care and payment approaches, and reducing administrative burden to give clinicians more time to spend with their patients, instead of on paperwork.

Accompanying the announcement is a new Quality Payment Program website, which will explain the new program and help clinicians easily identify the measures most meaningful to their practice or specialty.

For More Information

October 13, 2016

Home Health Quality Reporting Program Provider Training: Registration Open

CMS is hosting a 2-day training event on the Home Health (HH) Quality Reporting Program (QRP). This event will be held in Dallas, Texas on Wednesday, November 16, and Thursday, November 17, 2016.

Visit the Home Health Quality Reporting Training webpage for more information and to register.

October 6, 2016

CMS Finalizes Improvements in Care, Safety, and Consumer Protections for Long-Term Care Facility Residents

On September 28, CMS issued a final rule to make major changes to improve the care and safety of the nearly 1.5 million residents in the more than 15,000 long-term care facilities that participate in the Medicare and Medicaid programs. The policies in this final rule are targeted at reducing unnecessary hospital readmissions and infections, improving the quality of care, and strengthening safety measures for residents in these facilities.

For More Information see Final Rule, and CMS Press Release

CMS releases new data on Medicare hospice utilization and payment

The public data set includes information on 4,025 hospice providers, over 1.3 million hospice beneficiaries, and over $15 billion in Medicare payments for 2014. It does not contain any individually identifiable information about Medicare beneficiaries.

For more information, you can view the Hospice Utilization and Payment Public Use File website.

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