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Recent Postings from CMS

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.

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
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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