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October-December 2017

Recent Postings from CMS

December 6, 20-18

CMS Strengthens Nursing Home Oversight and Safety to Ensure Adequate Staffing

On November 30, CMS announced actions that will bolster nursing home oversight and improve transparency in order to ensure that facilities are staffed adequately to provide high-quality care. These actions include sharing data with states when potential issues arise regarding staffing levels and the availability of onsite registered nurses; clarifying how facilities should report hours and deduct time for staff meal breaks; and providing facilities with new tools to help ensure their resident census is accurate.
Read CMS Press Release

New Medicare Webpage on Patient Driven Payment Model MLN Matters Article — New

A new MLN Matters Special Edition Article SE18026 on New Medicare Webpage on Patient Driven Payment Model is available. Learn about educational and training resources.

HIPAA Basics for Providers: Privacy, Security, and Breach Notification Rules Fact Sheet — Revised

A revised HIPAA Basics for Providers: Privacy, Security, and Breach Notification Rules Fact Sheet is available. Learn:

  • Who must comply with HIPAA rules
  • Covered entities
  • Enforcement

CIB: Nursing Facility Case-Mix Payment Changes

Today, the Centers for Medicare & Medicaid Services (CMS) released an informational bulletin that informs states of two changes that may impact states’ payments for Medicaid beneficiaries in a nursing home setting.
The Bulletin is available here

November 30, 2018

CMS Takes Action to Lower Prescription Drug Costs by Modernizing Medicare

On November 26, CMS published a proposed rule for Medicare Parts C and D that would strengthen negotiations with prescription drug manufacturers to lower costs and increase transparency for patients. The proposed policies for 2020 would ensure that Medicare Advantage and Part D plans have more tools to negotiate lower drug prices, and CMS is also considering a policy that would require pharmacy rebates to be passed on to seniors to lower their drug costs at the pharmacy counter. Comment on these proposals and other policies under consideration by January 25.
For More Information:

September 2018 Medicaid & CHIP Eligibility and Enrollment Report

Today the Centers for Medicare & Medicaid Services (CMS) released the September 2018 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data.

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 December 1, 2018 effective date to implement these updated FULs.

November 21, 2018

November 15, 2018

SNF PPS: New Patient Driven Payment Model Webpage

On October 1, 2019, the new Patient Driven Payment Model (PDPM) is replacing Resource Utilization Group, Version IV (RUG-IV) for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS). Visit the new PDPM webpage to prepare for this change:

  • FAQs
  • Fact Sheets
  • Presentation Implementation tools

DMEPOS Update MLN Matters Article — New

A new MLN Matters Article MM10838 on Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Update is available. Learn about updating the ViPS Medicare System to process claims.

Certifying Patients for the Medicare Home Health Benefit MLN Matters Article — Revised

A revised MLN Matters Article SE1436 on Certifying Patients for the Medicare Home Health Benefit is available. Learn about patient eligibility and certification/recertification requirements.

Medicare Part B Immunization Billing Educational Tool — Revised

A revised Medicare Part B Immunization Billing: Seasonal Influenza Virus, Pneumococcal, and Hepatitis B Educational Tool is available. Learn about:

  • Administration and diagnosis codes
  • Vaccine codes and descriptors
  • Frequency of administration

Patients Over Paperwork November Newsletter

In this eighth issue of our Patients over Paperwork newsletter, we are updating you on our ongoing work to reduce administrative burden and improve the customer experience for beneficiaries.

November 8, 2018

DMEPOS Competitive Bidding Updates

On November 1, 2018, CMS issued a final rule requiring changes to bidding and pricing methodologies to be implemented under the next round of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. Starting January 1, 2019, there will be a temporary gap in the DMEPOS Competitive Bidding Program that we expect to last until December 31, 2020.

Prescriber’s Guide: New Medicare Part D Opioid Overutilization Policies for 2019 MLN Matters Article — New

A new MLN Matters Article on A Prescriber’s Guide to the New Medicare Part D Opioid Overutilization Policies for 2019 is available. Learn about new policies for Medicare drug plans starting on January 1, 2019.

Temporary Transitional Payment for HIT Services for CYs 2019 and 2020 MLN Matters Article — New

A new MLN Matters Article on Temporary Transitional Payment for Home Infusion Therapy (HIT) Services for CYs 2019 and 2020 is available. Learn about payment categories.

CMS on Reducing Clinician Burden

Today CMS released a letter to clinicians outlining how the agency is reducing burden through reform of documentation and coding requirements.

November 1, 2018

CMS Takes Action to Modernize Medicare Home Health

On October 31, CMS finalized significant changes to the Home Health Prospective Payment System (PPS) to strengthen and modernize Medicare. Specifically, CMS made changes to improve access to solutions via remote patient monitoring technology, updated payments for home health care with a new case-mix system, begin the new home infusion therapy benefit, and reduce burden.
Final Rule
Fact Sheet

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 November 1, 2018 effective date to implement these updated FULs.

October 26, 2018

Drug Utilization Review State Comparison/Summary Report for FFY 2017

Today, the Center for Medicare and Medicaid (CMS) released the FFY 2017 Drug Utilization Review (DUR) State Comparison/Summary Report.

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

CMS also continues to work with states and manufacturers on new and innovative legislative, regulatory and policy initiatives to help reduce the use and abuse of opioids in Medicaid patients. The FFY 2017 report is available on Medicaid.gov

August 2018 Medicaid & CHIP Eligibility and Enrollment Report

Centers for Medicare & Medicaid Services (CMS) released the August 2018 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data.

September 28, 2018

July 2018 Medicaid & CHIP Eligibility and Enrollment Report

Today the Centers for Medicare & Medicaid Services (CMS) released the July 2018 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data.

Patients Over Paperwork

CMS has published its latest newsletter for Patients over Paperwork, highlighting ways the agency is trimming regulations and simplifying processes to allow healthcare providers to focus more on providing care to Medicare beneficiaries.

Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Today, the Centers for Medicare & Medicaid Services (CMS) announced that, on average, Medicare Advantage premiums will decline while plan choices and new benefits increase. In addition, Medicare Advantage enrollment is projected to reach a new all-time high with more than 36 percent of Medicare beneficiaries projected to be enrolled in Medicare Advantage in 2019. This news comes as the agency releases the benefit and premium information for Medicare health and drug plans for the 2019 calendar year.

See CMS News Release

Connected Care Toolkit

The Connected Care Toolkit: Chronic Care Management (CCM) Resources for Health Care Professionals and Communities is revised based on partner feedback to provide better clarity and add resources about CCM services. This version includes current care coordination information for rural health clinics and federally qualified health centers.

September 4, 2018

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, 2018 effective date to implement these updated FULs.

August 31, 2018

CMS provides new flexibility to increase prescription drug choices and strengthen negotiation for Medicare enrollees

Currently, if a Part D plan includes a particular drug on its formulary, the plan must cover that drug for every FDA-approved indication, or patient condition, even if the plan would otherwise instead cover a different drug for a particular indication. The requirement to cover drugs in this manner can discourage Part D plans from including more drugs on their formularies and limit their power to negotiate discounts.Currently, if a Part D plan includes a particular drug on its formulary, the plan must cover that drug for every FDA-approved indication, or patient condition, even if the plan would otherwise instead cover a different drug for a particular indication. The requirement to cover drugs in this manner can discourage Part D plans from including more drugs on their formularies and limit their power to negotiate discounts.

Today’s memo explains that starting in 2020, plans will have new flexibility to tailor their formularies so that different drugs can be included for different indications. This policy, known as “indication-based formulary design,” is used in the private sector and will enable Part D plans to negotiate lower prices for patients. Targeted formulary coverage based on indication will also provide Part D beneficiaries with more drug choices and will empower beneficiaries to select a plan that is designed to meet their unique health needs.
To view a fact sheet on today’s announcement, please visit CMS:

June 2018 Medicaid & CHIP Eligibility and Enrollment Report

Today the Centers for Medicare & Medicaid Services (CMS) released the June 2018 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data.
The full report is available on Medicaid.gov here

Home Health Agencies: 2016 Utilization and Payment Data

CMS released the fourth annual Medicare Home Health Agency Utilization and Payment Public Use File, which includes utilization, payment (Medicare payment and Medicare standardized payment), submitted charges, and demographic and chronic condition indicators organized by CMS Certification Number, Home Health Resource Group and state of service. The public data set includes information on 10,139 home health agencies, almost 6 million claims, and $18 billion in Medicare payments for 2016. Access the data on the Medicare Provider Utilization and Payment Data: Home Health Agencies webpage.

August 22, 2018

CMS Releases Formal Approach to Ensure Medicaid Demonstrations Remain Budget Neutral

Today, the Centers for Medicare and Medicaid Services (CMS) released a letter to State Medicaid Directors that clearly describes CMS’s current approach to calculating budget neutrality expenditure limits for Medicaid section 1115 demonstration projects. Medicaid demonstration projects allow states to design innovative ways to better serve the nation’s more than 65 million Medicaid recipients. In response to longstanding concerns raised by the Government Accountability Office (GAO), this letter marks the first time that CMS has formally outlined how states must calculate budget neutrality for demonstration projects, in order to strengthen fiscal accountability. The guidance also comes a day after Administrator Seema Verma testified before the Senate Homeland Security and Government Accountability Committee on improper payments in the Medicaid program, which often result in higher federal spending.

August 2, 2018

SNF FY 2019 Payment and Policy Changes

On July 31, CMS issued a final rule outlining Fiscal Year (FY) 2019 Medicare payment updates and quality program changes for skilled nursing facilities (SNFs). Three major provisions of the rule:

  • Changes to the case-mix classification system used under the SNF Prospective Payment System (PPS)
  • SNF Value-Based Purchasing Program (VBP)
  • SNF Quality Reporting Program (QRP)
The final rule includes policies that continue a commitment to shift Medicare payments from volume to value, with continued implementation of the SNF VBP and SNF QRP.

Data Element Library Webinar: Video Recording

A video is available of the July 11 webinar about the Data Element Library; a public resource about CMS assessments. This video includes a review of the Improving Medicare Post-Acute Care Transformation Act of 2014, standardization and interoperability, and an overview and demonstration of the Data Element Library.

CMS Administrator Address on Strengthening Medicare

On July 25, CMS Administrator Seema Verma delivered a speech focused on Strengthening Medicare at the Commonwealth Club of California.
Learn more in the prepared remarks and video .

July 31, 2018

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/prescription-drugs/pharmacy-pricing/index.html. States will have up to 30 days from the August 1, 2018 effective date to implement these updated FULs.

May 2018 Medicaid & CHIP Eligibility and Enrollment Report

Today the Centers for Medicare & Medicaid Services (CMS) released the May 2018 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data.

July 25, 2018

CMS Empowers Patients and Ensures Site-Neutral Payment in Proposed Rule

The proposed policies in the CY 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule would help lay the foundation for a patient-driven healthcare system. To increase the sustainability of the Medicare program and improve quality of care for seniors, CMS is moving toward site neutral payments for clinic visits (which are essentially check-ups with a clinician). Clinic visits are the most common service billed under the OPPS. Currently, CMS often pays more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting.

July 17, 2018

Hospice Quick Reference Guides

A Quick Reference Guide for the Hospice QRP for FY2020 is now available on the HQRP reconsiderations page. The guide includes frequently asked questions, information on QRP help desks, and helpful links to additional resources for the Hospice QRP.

July 11, 2018

New CMS Proposals to Modernize and Drive Innovation in DME and ESRD Programs

On July 11, CMS proposed innovative changes to the payment rules for Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) and the End-Stage Renal Disease (ESRD) program. The DME proposals in the proposed rule aim to increase access to items for patients and simplify Medicare’s DMEPOS Competitive Bidding Program (CBP) to drive competition and increase affordability. The rule also includes ESRD proposals, including a proposal to address new renal dialysis drug and biological costs and foster innovations in treatment by incentivizing new therapies for patients on dialysis and a proposal to reduce facility-related documentation burden.

July 2, 2018

CMS Takes Action to Modernize Medicare Home Health

On July 2, CMS proposed significant changes to the Home Health Prospective Payment System (PPS) to strengthen and modernize Medicare, drive value, and focus on individual patient needs rather than volume of care. Specifically, CMS is proposing changes to improve access to solutions via remote patient monitoring technology, and to update the payment model for home health care.
For additional information:

June 27, 2018

CMS Issues Guidance to States on Medicaid Coverage of Drugs Approved by FDA under Accelerated Approval Pathway

Centers for Medicare & Medicaid Services (CMS) released guidance to states through State Release #185 which provides information pertaining to State Medicaid Coverage of Drugs Approved by the FDA under Accelerated Approval Pathway. This release is now available for download here:

June 21, 2018

CMS Data Element Library Now Available

CMS has launched the first CMS Data Element Library (DEL) --- a public resource for providers, vendors, researchers, and other stakeholders that use CMS assessments. End users will be able to search and obtain reports on CMS post-acute care assessment contents, including questions, response codes, relevant attributes, and importantly their associated health IT standards, in one location. The availability of the DEL will further support interoperability and the exchange and reuse of data across post-acute care and other providers by using common assessment standards and definitions to facilitate coordinated care and improved health outcomes.

July Quarterly Update for 2018 DMEPOS Fee Schedule MLN Matters Article — New

A new MLN Matters Article on July Quarterly Update for 2018 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Fee Schedule is available. Learn about quarterly update listing fee schedule amounts for non-rural and rural areas.

June 5, 2018

2016 Medicaid Expenditures for Long-Term Services and Supports Report

Today the Centers for Medicare & Medicaid Services (CMS) announced that the report on Medicaid Expenditures for Long-Term Services and Supports (LTSS) in federal fiscal year (FY) 2016 is now available. Federal and state spending on Medicaid LTSS totaled approximately $167 billion in FY 2016, a 4.5 percent increase from $159 billion in FY 2015.

May 31, 2018

IMPACT Act: Frequently Asked Questions Call — June 21

Thursday, June 21 from 2 to 3 pm ET
During this call, learn more about the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). CMS answers your frequently asked questions on quality measures, standardized data elements, the CMS data element library, and future directions of the IMPACT Act. A question and answer session follows the presentation.
Register for Medicare Learning Network events.

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 June 1, 2018 effective date to implement these updated FULs.

March 2018 Medicaid & CHIP Eligibility and Enrollment Report

The Centers for Medicare & Medicaid Services (CMS) released the March 2018 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data. The full report is available on Medicaid.gov here

May 17, 2018

Enhanced “Drug Dashboards” to Increase Transparency on Drug Prices

On May 15, CMS released a redesigned version of the Drug Spending Dashboards. For the first time, the dashboards include year-over-year information on drug pricing and highlight which manufactures have been increasing their prices.

See CMS Press Release

May 11, 2018

CMS releases updated data on geographic variation in the Medicare program

CMS has posted the annual release of the Geographic Variation Public Use File with data for 2007-2016. The Geographic Variation Public Use File is a series of downloadable tables and reports that contain demographic, spending, utilization, and quality indicators for the Medicare fee-for-service population. It presents data at the state-level (including the District of Columbia, Puerto Rico, and the Virgin Islands), hospital referral region (HRR)-level, and county-level.

This public use file is available from the CMS website and can be downloaded here

First CMS Rural Health Strategy

On May 8, CMS released its first Rural Health Strategy intended to provide a proactive approach on healthcare issues to ensure that the nearly one in five individuals who live in rural America have access to high quality, affordable healthcare. “For the first time, CMS is organizing and focusing our efforts to apply a rural lens to the vision and work of the agency,” said CMS Administrator Seema Verma. “The Rural Health Strategy supports CMS’ goal of putting patients first. Through its implementation and our continued stakeholder engagement, this strategy will enhance the positive impacts CMS policies have on beneficiaries who live in rural areas.”

Rural Health Web page
Fact Sheet
CMS Press Release

2018 Measure Development Plan Annual Report

CMS posted the 2018 Quality Measure Development Plan Annual Report, which describes progress in developing clinician quality measures to support the Quality Payment Program. For more information about the report, visit the Measure Development webpage.

April 30, 2018

February 2018 Medicaid & CHIP Eligibility and Enrollment Report

Today the Centers for Medicare & Medicaid Services (CMS) released the February 2018 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data.
The full report is available here

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 May 1, 2018 effective date to implement these updated FULs.

April 23, 2018

Feedback on New Direction Request for Information (RFI) Released

CMS received over 1,000 responses to the RFI from a wide variety of individuals and organizations located across the country, including medical societies and associations, health systems, physician groups, and private businesses. Since the RFI comment period closed last November, CMS has been reviewing the responses, which provided valuable insight on the potential to improve existing models as well as ideas for transformative new models that aim to empower patients with more choices and better health outcomes.
The public comments that were received by the CMS Innovation Center in response to the New Direction RFI are available here

April 13, 2018

Home Health Utilization and Payment Data

CMS posted the home health agency Public Use File (PUF) with data for 2015, including utilization, payment, submitted charges, and condition indicators. The PUF has information for 10,526 home health agencies, over 6 million claims, and $18 billion in Medicare payments.

Visit the Provider Utilization and Payment Data webpage for more information, including updated PUFs for 2013 and 2014.

Market Saturation and Utilization Data Tool

The Centers for Medicare & Medicaid Services (CMS) has developed a Market Saturation and Utilization Data Tool that includes interactive maps and a dataset that shows national-, state-, and county-level provider services and utilization data for selected health service areas. 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 the beneficiaries receiving that service in the area.

April 5, 2018

Medicare Diabetes Prevention Program: New Resources

New resources are available on the Medicare Diabetes Prevention Program Expanded Model website:

  • Orientation Video: 5-minute overview, including introductory information on enrollment and services
  • Enrollment Process Timeline: Steps CMS will take to process your enrollment application, how the Medicare Administrative Contractors are involved, and actions to take in this process
  • Supplier Requirements Checklist: Requirements you must comply with to maintain enrollment in Medicare

March 30, 2018

CMS releases 2015 Public Use File for the Medicare Current Beneficiary Survey

The Medicare Current Beneficiary Survey (MCBS), sponsored by the Centers for Medicare & Medicaid Services Office of Enterprise Data and Analytics (OEDA) through a contract with NORC at the University of Chicago is a continuous, in-person, longitudinal survey of a representative national sample of the Medicare population, covering the population of beneficiaries in the US, District of Columbia, and Puerto Rico. It has been carried out continuously for more than 25 years, encompassing more than one million total interviews.

The MCBS 2015 Survey File PUF is available free for download

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

March 22, 2018

Methods for Assuring Access to Care: Exceptions for High Managed Care Penetration & Rate Reduction Threshold

The Centers for Medicare and Medicaid Services (CMS) issued a notice of proposed rulemaking (NPRM) that would provide exemptions from the regulatory access to care requirements within the Medicaid program. Specifically, the NPRM would exempt states with high rates of comprehensive Medicaid managed care from analyzing data and monitoring access in fee-for-service delivery systems. Additionally, the NPRM would provide similar exemptions to all states when they make nominal rate reductions to fee-for-service payment rates.

HIMSS Recap: View CMS Educational Session Slides

The Centers for Medicare & Medicaid Services (CMS) recently participated in the 2018 Healthcare Information and Management Systems Society (HIMSS) Annual Conference & Exhibition in Las Vegas from March 5-9, 2018.CMS has posted the presentations from HIMSS18

IMPACT Act Transfer of Health measures: Public Comment Period- Ends May 3

The Centers for Medicare & Medicaid Services (CMS) has contracted with RTI International and Abt Associates to develop cross-setting post-acute care transfer of health information and care preferences quality measures in alignment with the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). As part of its measure development process, CMS requests interested parties to submit comments on two draft measure specifications:

  • Medication Profile Transferred to Provider
  • Medication Profile Transferred to Patient
The call for public comment period closes on May 3, 2018. View the public comment webpage for more information.

March 6, 2018

CMS NEWS: Trump Administration Announces MyHealthEData Initiative to Put Patients at the Center of the US Healthcare System

Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced a new Trump Administration initiative – MyHealthEData – to empower patients by giving them control of their healthcare data, and allowing it to follow them through their healthcare journey.

To view a fact sheet with more information, visit:CMS Website

March 1, 2018

January 2018 Medicaid & CHIP Eligibility and Enrollment Report

The Centers for Medicare & Medicaid Services (CMS) released the January 2018 monthly report on state Medicaid and Children's Health Insurance Program (CHIP) eligibility and enrollment data.

Patients over Paperwork Newsletter

The February Patients over Paperwork newsletter discusses the new Meaningful Measures Initiative, field visits for feedback from providers, as well as the latest documentation review improvements:

  • Supplier use of bar codes to track Certificates of Medical Necessity
  • Teaching physician verification of student medical record documentation
  • Physician delegation of documentation requirements
  • Skilled nursing facility: Streamlined process for Advanced Beneficiary Notice
Learn more about Patients over Paperwork, and view past editions of this newsletter. Visit the Simplifying Documentation Requirements webpage for previous updates, and find out how to submit an idea.

February 28, 2018

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/prescription-drugs/pharmacy-pricing/index.html. States will have up to 30 days from the March 1, 2018 effective date to implement these updated FULs.

December 2017 Medicaid & CHIP Eligibility and Enrollment Report

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

February 20, 2018

Dementia Care: Person-Centered Care Planning and Practice Recommendations Call — March 20

National Partnership to Improve Dementia Care and Quality Assurance Performance Improvement Tuesday, March 20 from 1:30 to 3 pm ET

Register for Medicare Learning Network events.

During this call, gain insight on the phase two changes for person-centered care planning and discharge planning. Also, learn about the new Alzheimer’s Association Dementia Care Practice Recommendations. Additionally, CMS shares updates on the progress of the National Partnership to Improve Dementia Care in Nursing Homes. A question and answer session follows the presentations.

DMEPOS Information for Pharmacies Fact Sheet — Reminder

A revised DMEPOS Information for Pharmacies Fact Sheet is available. Learn about:

  • Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) accreditation exemption
  • Accreditation requirements for a new pharmacy and change of ownership

February 15, 2018

Beneficiaries in Custody under a Penal Authority Fact Sheet — Reminder

The Beneficiaries in Custody under a Penal Authority Fact Sheet is available. Learn about:

  • Medicare policy, claims processing, and appeals
  • Determining whether a Medicare beneficiary is in custody under a penal statute or rule
  • Social Security Administration policy

CMS Office of the Actuary releases 2017-2026 Projections of National Health Expenditures

National health expenditure growth is expected to average 5.5 percent annually over 2017-2026, according to a report published today as an “Ahead Of Print” by Health Affairs and authored by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS).

February 8, 2018

Medicare Part B Immunization Billing Educational Tool — Reminder

The Medicare Part B Immunization Billing Educational Tool is available. Learn about:

  • Administration and diagnosis codes
  • Vaccine codes and descriptors
  • FAQs
  • February 5, 2018

    Multiple open door forums scheduled for Bundled Payments for Care Improvement Advanced model

    CMS recently announced the launch of a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). In BPCI Advanced, participants will be expected to redesign care delivery to keep Medicare expenditures within a defined budget while maintaining or improving performance on specific quality measures.

    The CMS Innovation Center will be holding a second Open Door Forum to answer questions regarding the BPCI Advanced Model and the Application Process on Thursday, February 15, 2018 from 12 pm – 1 pm EST. This event is open to those who are interested in learning more about the model. Additional information and registration access are now available. The audio file and transcript of the first Open Door Forum held on January 30th is now available.

    AAPM Table Published

    Today, the Centers for Medicare and Medicaid Services (CMS) published a table displaying the Alternative Payment Models (APMs) that CMS operates. In the table CMS identifies which of those APMs CMS has determined to be MIPS APMs or Advanced APMs. We will modify this list based on changes in the designs of APMs or the announcement of new APMs.

    Hospice QRP Resource Documents Now Available

    HQRP Fiscal Year 2020 Requirements Fact Sheet Now Available

    This fact sheet outlines specific compliance requirements for Hospice Item Set (HIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS®) for the Fiscal Year 2020 reporting year (data collection period 1/1/18 -12/31/18), to support providers in compliance with HQRP requirements.

    February 1, 2018

    CMS proposes Medicare Advantage and Part D payment and policy updates to provide new benefits for enrollees, new protections to combat opioid crisis

    Today, the Centers for Medicare & Medicaid Services (CMS) released proposed changes for the Medicare health and drug programs in 2019 that increase flexibility in Medicare Advantage that will allow more options and new benefits to Medicare beneficiaries, meeting their unique health needs and improving their quality of life. Furthermore, the proposal includes important new steps to ensure new patient-doctor-plan communication in combatting the opioid crisis.

    fact sheet on the 2019 Advance Notice, Part II, and the Draft Call Letter

    January 25, 2018

    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.

    January 11, 2018

    Medicare-Required SNF PPS Assessments Educational Tool — Revised

    A revised Medicare-Required SNF PPS Assessments Educational Tool is available.

    January 9, 2018

    CMS announces new payment model to improve quality, coordination, and cost-effectiveness for both inpatient and outpatient care

    Today, the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) announced the launch of a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). Under traditional fee-for-service payment, Medicare pays providers for each individual service they perform. Under this bundled payment model, participants can earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality.

    See CMS News Release

    January 4, 2018

    Are You Prepared for a Health Care Emergency?

    HHS offers a comprehensive national knowledge center about emergency preparedness for health care, public health, and disaster clinical practitioners. Sign up to receive monthly Express and quarterly Exchange newsletters from the Office of the Assistant Secretary for Preparedness and Response (ASPR) Technical Resources, Assistance Center, and Information Exchange (TRACIE) that highlight new and trending emergency preparedness resources.

    Dementia Care Call: Audio Recording and Transcript — New

    An audio recording and transcript are available for the December 14 call on the National Partnership to Improve Dementia Care in Nursing Homes and Quality Assurance Performance Improvement (QAPI). Learn how to work with physicians to ensure compliance with the new psychotropic medication prescribing requirements for long-term care facilities. Also, find out how nursing homes are putting the new QAPI requirements into practice.

    December 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 January 1, 2018 effective date to implement these updated FULs.

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