CMS Updates

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Recent Postings from CMS

December 19, 2017

October 2017 Medicaid & CHIP Eligibility and Enrollment Report

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

December 6, 2017

CMS Office of the Actuary Releases 2016 National Health Expenditures

In 2016, overall national health spending increased 4.3 percent following 5.8 percent growth in 2015, 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. Following Affordable Care Act (ACA) coverage expansion and significant retail prescription drug spending growth in 2014 and 2015, health care spending growth decelerated in 2016. The report concludes that the 2016 expenditure slowdown was broadly based as growth for all major payers (private health insurance, Medicare, and Medicaid) and goods and service categories (hospitals, physician and clinical services, and retail prescription drugs) slowed in 2016.

November 30, 2017

CMS finalizes changes to the Comprehensive Care for Joint Replacement Model

The Centers for Medicare & Medicaid Services (CMS) finalized the cancellation of the mandatory hip fracture and cardiac bundled payment models that were to be operated by the CMS Innovation Center and implemented changes to the Comprehensive Care for Joint Replacement (CJR) Model. These changes will offer greater flexibility and choice for hospitals in providing care to Medicare patients.

technical fact sheet on the changes in this final rule

November 29, 2017

CMS posts update of Medicare Part D Opioid Prescribing Mapping Tool

Today, the Centers for Medicare & Medicaid Services (CMS) released an updated version of the Medicare Part D opioid prescribing mapping tool. The mapping tool is an interactive, web-based visualization resource that presents geographic comparisons- at the state, county, and ZIP code levels - of Medicare Part D opioid prescribing rates. It allows users to understand and compare opioid prescribing at the local level and better understand how this critical issue affects communities across the country.

November 22 2017

IMPACT Act Special Open Door Forum — December 12

Tuesday, December 12 from 2 to 3 pm ET

This Special Open Door Forum (SODF) provides information and solicits feedback on the Improving Medicare Post-Acute Care Transformation Act of 2014

  • Update on RAND's national field test launch
  • Planned stakeholder engagement activities for 2018
  • Ways to remain engaged and informed during the upcoming year

View the announcement for more information.

September 2017 Medicaid & CHIP Eligibility and Enrollment Report

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

November 9, 2017

Medicare Diabetes Prevention Program (MDPP) expanded model starting in 2018

The Medicare Diabetes Prevention Program (MDPP) expanded model is a structured behavior change intervention that aims to prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes. This model is an expansion of the Diabetes Prevention Program (DPP) model test, which was tested through the Center for Medicare and Medicaid Innovation’s Health Care Innovation Awards.

The newest phase of the program will begin April 1, 2018. See the Fact Sheet from CMS

For more information, see the Diabetes Prevention Program webpage at CMS

Quality Payment Program Resources in New Location on CMS.gov

To make it easier for clinicians to search and find information on the Quality Payment Program, CMS has moved its library of Quality Payment Program resources to CMS.gov. Clinicians will be able to search the library for Quality Payment Program resources by title, topic, or year.

Resources include fact sheets, user guides, and other materials to help clinicians successfully participate in the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs) in 2017.

CMS has posted the the Medicaid Drug Utilization Review State Comparison/Summary Report for FFY 2016

CMS has posted the FFY 2016 Drug Utilization Review (DUR) Annual State Reports,along with the State Comparison/Summary Report for FFY 2016

To help address the opioid abuse epidemic, please note that states have actively implemented several management control measures such as: using quantity limits and days supply limits for short-acting and long-acting opiates, applying statewide prescription drug monitoring programs and utilizing morphine daily dose alerts to prevent drug overdose.

Verma Outlines Vision for Medicaid

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed her vision for the future of Medicaid and unveiled new CMS policies that encourage states to propose innovative Medicaid reforms, reduce federal regulatory burdens, increase efficiency, and promote transparency and accountability during a plenary session at the National Association of Medicaid Directors (NAMD) Fall Conference in Arlington, Virginia.

November 2, 2017

Home Health Agency Payment Update

On November 1, CMS issued a final rule that updates the CY 2018 Medicare payment rates and the wage index for Home Health Agencies (HHAs) serving Medicare beneficiaries. The rule also finalizes proposals for the Home Health Value-Based Purchasing Model and the Home Health Quality Reporting Program.

Final Rule

CMS Fact Sheet

October 31, 2017

August 2017 Medicaid & CHIP Eligibility and Enrollment Report

The Centers for Medicare & Medicaid Services (CMS) released the August 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

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

October 12, 2017

Annual Reassignments for Certain Low-Income Subsidy Eligible Individuals

the Centers for Medicare & Medicaid Services (CMS) released an informational bulletin to provide an update on the next steps in the processes reassignments for certain low-income subsidy (LIS)-eligible individuals. The bulletin provides information to ensure that states understand their role in ensuring that dual eligible beneficiaries have timely, affordable, and comprehensive coverage under the Medicare Part D prescription drug benefit.

October 5, 2017

National Partnership to Improve Dementia Care Achieves Goals to Reduce Unnecessary Antipsychotic Medications in Nursing Homes

On October 2, the National Partnership to Improve Dementia Care announced that it met its goal of reducing the national prevalence of antipsychotic use in long-stay nursing home residents by 30 percent by the end of 2016. It also announced a new goal of a 15 percent reduction by the end of 2019 for long-stay residents in those homes with currently limited reduction rates. Nursing homes with low rates of antipsychotic medication use are encouraged to continue their efforts and maintain their success.

Fact sheet

Extension of Medicare IVIG Demonstration through December 31, 2020

The Medicare Intravenous Immune Globulin (IVIG) Demonstration, scheduled to end on September 30, 2017, is extended through December 31, 2020:

  • Beneficiaries enrolled as of September 30, 2017 do not need to re-enroll
  • New beneficiaries can enroll in accordance with the demonstration procedures
For information, visit the IVIG Demonstration webpage.

SNF QRP: Quick Reference Guide Now Available

A Quick Reference Guide for the SNF QRP is now available on the SNF Quality Reporting Program Data Submission Deadlines webpage. The guide includes frequently asked questions, information on QRP help desks, and helpful links to additional resources for the SNF QRP.

IMPACT Act Audio Recording and Transcripts Available

An audio recording and transcript are posted for the August 17 call on IMPACT Act: Drug Regimen Review Measure Overview for the Home Health Quality Reporting Program.

An audio recording and transcript are posted for the September 06 call on IMPACT Act: Medicare Spending Per Beneficiary Measures.

September 29, 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 October 1, 2017 effective date to implement these updated FULs.

2017-2018 Influenza Resources for Health Care Professionals MLN Matters® Article — New

An MLN Matters Special Edition Article on 2017-2018 Influenza (Flu) Resources for Health Care Professionals is available. Learn about codes and payment rates for influenza and pneumococcal vaccines.

Nursing Home Call: Audio Recording and Transcript — New

An audio recording, transcript, and clarification are available for the September 7 call for nursing homes. Learn about the new Facility Assessment Tool to help identify and develop the specific assessment of your facility. Also, find out about frequently asked questions related to revision of the State Operations Manual Appendix PP.

December 19, 2017

October 2017 Medicaid & CHIP Eligibility and Enrollment Report

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

December 6, 2017

CMS Office of the Actuary Releases 2016 National Health Expenditures

In 2016, overall national health spending increased 4.3 percent following 5.8 percent growth in 2015, 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. Following Affordable Care Act (ACA) coverage expansion and significant retail prescription drug spending growth in 2014 and 2015, health care spending growth decelerated in 2016. The report concludes that the 2016 expenditure slowdown was broadly based as growth for all major payers (private health insurance, Medicare, and Medicaid) and goods and service categories (hospitals, physician and clinical services, and retail prescription drugs) slowed in 2016.

November 30, 2017

CMS finalizes changes to the Comprehensive Care for Joint Replacement Model

The Centers for Medicare & Medicaid Services (CMS) finalized the cancellation of the mandatory hip fracture and cardiac bundled payment models that were to be operated by the CMS Innovation Center and implemented changes to the Comprehensive Care for Joint Replacement (CJR) Model. These changes will offer greater flexibility and choice for hospitals in providing care to Medicare patients.

technical fact sheet on the changes in this final rule

November 29, 2017

CMS posts update of Medicare Part D Opioid Prescribing Mapping Tool

Today, the Centers for Medicare & Medicaid Services (CMS) released an updated version of the Medicare Part D opioid prescribing mapping tool. The mapping tool is an interactive, web-based visualization resource that presents geographic comparisons- at the state, county, and ZIP code levels - of Medicare Part D opioid prescribing rates. It allows users to understand and compare opioid prescribing at the local level and better understand how this critical issue affects communities across the country.

November 22 2017

IMPACT Act Special Open Door Forum — December 12

Tuesday, December 12 from 2 to 3 pm ET

This Special Open Door Forum (SODF) provides information and solicits feedback on the Improving Medicare Post-Acute Care Transformation Act of 2014

  • Update on RAND's national field test launch
  • Planned stakeholder engagement activities for 2018
  • Ways to remain engaged and informed during the upcoming year

View the announcement for more information.

September 2017 Medicaid & CHIP Eligibility and Enrollment Report

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

November 9, 2017

Medicare Diabetes Prevention Program (MDPP) expanded model starting in 2018

The Medicare Diabetes Prevention Program (MDPP) expanded model is a structured behavior change intervention that aims to prevent the onset of type 2 diabetes among Medicare beneficiaries with an indication of prediabetes. This model is an expansion of the Diabetes Prevention Program (DPP) model test, which was tested through the Center for Medicare and Medicaid Innovation’s Health Care Innovation Awards.

The newest phase of the program will begin April 1, 2018. See the Fact Sheet from CMS

For more information, see the Diabetes Prevention Program webpage at CMS

Quality Payment Program Resources in New Location on CMS.gov

To make it easier for clinicians to search and find information on the Quality Payment Program, CMS has moved its library of Quality Payment Program resources to CMS.gov. Clinicians will be able to search the library for Quality Payment Program resources by title, topic, or year.

Resources include fact sheets, user guides, and other materials to help clinicians successfully participate in the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs) in 2017.

CMS has posted the the Medicaid Drug Utilization Review State Comparison/Summary Report for FFY 2016

CMS has posted the FFY 2016 Drug Utilization Review (DUR) Annual State Reports,along with the State Comparison/Summary Report for FFY 2016

To help address the opioid abuse epidemic, please note that states have actively implemented several management control measures such as: using quantity limits and days supply limits for short-acting and long-acting opiates, applying statewide prescription drug monitoring programs and utilizing morphine daily dose alerts to prevent drug overdose.

Verma Outlines Vision for Medicaid

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed her vision for the future of Medicaid and unveiled new CMS policies that encourage states to propose innovative Medicaid reforms, reduce federal regulatory burdens, increase efficiency, and promote transparency and accountability during a plenary session at the National Association of Medicaid Directors (NAMD) Fall Conference in Arlington, Virginia.

November 2, 2017

Home Health Agency Payment Update

On November 1, CMS issued a final rule that updates the CY 2018 Medicare payment rates and the wage index for Home Health Agencies (HHAs) serving Medicare beneficiaries. The rule also finalizes proposals for the Home Health Value-Based Purchasing Model and the Home Health Quality Reporting Program.

Final Rule

CMS Fact Sheet

October 31, 2017

August 2017 Medicaid & CHIP Eligibility and Enrollment Report

The Centers for Medicare & Medicaid Services (CMS) released the August 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

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

October 12, 2017

Annual Reassignments for Certain Low-Income Subsidy Eligible Individuals

the Centers for Medicare & Medicaid Services (CMS) released an informational bulletin to provide an update on the next steps in the processes reassignments for certain low-income subsidy (LIS)-eligible individuals. The bulletin provides information to ensure that states understand their role in ensuring that dual eligible beneficiaries have timely, affordable, and comprehensive coverage under the Medicare Part D prescription drug benefit.

October 5, 2017

National Partnership to Improve Dementia Care Achieves Goals to Reduce Unnecessary Antipsychotic Medications in Nursing Homes

On October 2, the National Partnership to Improve Dementia Care announced that it met its goal of reducing the national prevalence of antipsychotic use in long-stay nursing home residents by 30 percent by the end of 2016. It also announced a new goal of a 15 percent reduction by the end of 2019 for long-stay residents in those homes with currently limited reduction rates. Nursing homes with low rates of antipsychotic medication use are encouraged to continue their efforts and maintain their success.

Fact sheet

Extension of Medicare IVIG Demonstration through December 31, 2020

The Medicare Intravenous Immune Globulin (IVIG) Demonstration, scheduled to end on September 30, 2017, is extended through December 31, 2020:

  • Beneficiaries enrolled as of September 30, 2017 do not need to re-enroll
  • New beneficiaries can enroll in accordance with the demonstration procedures
For information, visit the IVIG Demonstration webpage.

SNF QRP: Quick Reference Guide Now Available

A Quick Reference Guide for the SNF QRP is now available on the SNF Quality Reporting Program Data Submission Deadlines webpage. The guide includes frequently asked questions, information on QRP help desks, and helpful links to additional resources for the SNF QRP.

IMPACT Act Audio Recording and Transcripts Available

An audio recording and transcript are posted for the August 17 call on IMPACT Act: Drug Regimen Review Measure Overview for the Home Health Quality Reporting Program.

An audio recording and transcript are posted for the September 06 call on IMPACT Act: Medicare Spending Per Beneficiary Measures.

September 29, 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 October 1, 2017 effective date to implement these updated FULs.

2017-2018 Influenza Resources for Health Care Professionals MLN Matters® Article — New

An MLN Matters Special Edition Article on 2017-2018 Influenza (Flu) Resources for Health Care Professionals is available. Learn about codes and payment rates for influenza and pneumococcal vaccines.

Nursing Home Call: Audio Recording and Transcript — New

An audio recording, transcript, and clarification are available for the September 7 call for nursing homes. Learn about the new Facility Assessment Tool to help identify and develop the specific assessment of your facility. Also, find out about frequently asked questions related to revision of the State Operations Manual Appendix PP.

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