On Thursday, February 16, 2017, the Senate Finance Committee held a hearing to consider the nomination of Seema Verma for Administrator of the Centers for Medicare and Medicaid Services (CMS). The hearing was noticeably less combative than the hearings held for previous nominees, including Tom Price, who was recently sworn in as Secretary of the […]
Read MoreToday, CMS announced a delay in the implementation of a recently-finalized regulation that would have created three new episode payment models for inpatient hospital care, established the Cardiac Rehabilitation Incentive payment model, and also made technical changes to the Comprehensive Care for Joint Replacement (CJR) model. The final regulation, which was released in December 2016 […]
Read MoreOn February 15, 2017, the Department of Health and Human Services (HHS) released a proposed rule that includes several modifications intended to help stabilize the Affordable Care Act (ACA) Marketplace health plans in 2018. The rule includes the following changes: A shift in the annual open enrollment period to encourage more full-year plan enrollments; Required […]
Read MoreOn February 1, 2017, CMS released the CY 2018 draft Call Letter for Medicare Advantage (MA) and Medicare Part D plans. The Call Letter includes requirements and benefit parameters for plan year 2018. CMS announced a proposal to delay two different proposals that would lead to payment cuts for Employer Group Waiver Plans (EQWP), as […]
Read MoreAs another year wraps up, we want to take a moment to wish everyone a wonderful holiday season and a happy and healthy new year. In 2017, we will continue to help our readers navigate the changing healthcare policy and reimbursement landscape. We encourage you to follow our posts here as well as on Twitter […]
Read MoreNew Payment Models Are MIPS Eligible Advanced Alternative Payment Models On December 20, 2016, the Centers for Medicare and Medicaid Services (CMS) released the Advancing Care Coordination through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR) final rule. These new models add to […]
Read MoreIn 2015, CMS implemented a prior authorization process for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items that are frequently used unnecessarily. The agency released an initial master list of 135 DMEPOS items subject to the new requirements on December 30, 2015, which met the following criteria: Are paid off the Medicare DMEPOS fee […]
Read MoreThe Office of the Inspector General (OIG) of the U.S. Department of Health & Human Services (HHS) has released their Fiscal Year 2017 HHS OIG Work Plan. The OIG seeks to identify opportunities to improve various HHS programs and also holds those who do not meet requirements or violate federal laws accountable. Their work encompasses […]
Read MoreThis afternoon, CMS issued a Request for Information (RFI) related to accelerating the provision of home and community-based services (HCBS) to Medicaid beneficiaries. To be sure, this is a noble goal, as providing health and supportive services to individuals in their homes and communities rather than an institutional setting is often not only the cost-effective […]
Read MoreOn Thursday, November 4th, the Medicare Payment Advisory Commission (MedPAC) hosted the next public meeting of their current term. The topics of the meeting varied but heavily featured provider-related topics in Medicare. The meeting agenda and presentations can be found here. Provider Consolidation: The Role of Medicare Policy The first topic at the meeting was […]
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