A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Center for Medicare and Medicaid Innovation

CMS issues regulations on premium payment

Posted on July 24, 2014

The Center for Consumer Information and Insurance Oversight (CCIIO) and the Centers for Medicare & Medicaid Services (CMS) issued Federal guidance which gives individuals a three-month grace period to pay a premium without losing coverage. However, the same guidance states that if individuals choose enroll in a new policy for 2015, insurance companies cannot apply new premiums to outstanding 2014 debt. Some have suggested that this inconsistency could allow consumers to avoid paying their December premiums. However, nothing bars an insurer from making a bona fide effort to collect any unpaid premiums, as the consumer would still owe this amount to the insurer.

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CMS announces 500 practices to participate in the Comprehensive Primary Care Initiative

Posted on August 22, 2012

The Centers for Medicare & Medicaid Services (CMS) Innovation Center announced today the 500 practices in seven regions that will participate in its Comprehensive Primary Care Initiative. According to the CMS website, “the Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients.” The 500 primary care practices participating in the CPC initiative will represent 2,144 providers serving an estimated 313,000 Medicare beneficiaries.

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CMS announces 15 new participants for CMMI’s Advance Payment ACO Model

Posted on July 19, 2012

The Centers for Medicare & Medicaid Services (CMS) announced that 15 new accountable care organizations (ACOs) were selected to participate under the Center for Medicare and Medicaid Innovation’s (CMMI’s) Advance Payment ACO Model. This brings the total number of advance payment ACOs to 20. The initiative is designed for smaller physician practices and rural practitioners who would benefit from additional start-up resources while participating in the Medicare Shared Savings Program (MSSP). Each participating ACO will receive advance payments to help establish care coordination for beneficiaries.

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CPC initiative will provide resources to better coordinate primary care for Medicare patients

Posted on June 7, 2012

The Comprehensive Primary Care (CPC) initiative, a four-year program administered by CMS’s Center for Medicare and Medicaid Innovation (CMMI), is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients.

CMMI announced that about 75 primary care practices in seven markets will be selected to participate in the initiative. Applications are due on July 20 and applicants will be selected based on their ability to enhance and coordinate services for patients.

45 commercial, federal, and state insurers finalized memorandums of understanding yesterday to participate in the demonstration project with CMS.

The resources will help doctors work with patients to ensure they manage care for patients with high health care needs, ensure access to care, delivery preventive care, engage patients and caregivers, and coordinate care across the medical neighborhood.

The CPC initiative will test two models simultaneously: a service delivery model and a payment model.

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HHS announces first 26 Health Care Innovation Awards

Posted on May 8, 2012

Health and Human Services (HHS) Secretary Kathleen Sebelius today announced the first batch of organizations for Health Care Innovation awards. The awards, a provision under the Affordable Care Act (ACA), will support 26 new innovation projects. The goals of the projects are to lower health care costs, improve quality of care, and enhance the provider workforce. The preliminary awardees announced today expect to reduce health spending by $254 million over the next 3 years.

Projects include…

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HHS announces 32 health care organizations to participate in Pioneer ACO Model

Posted on December 19, 2011

Today, the U.S. Department of Health and Human Service (HHS) named 32 health care organizations that will participate in the Pioneer Accountable Care Organization Model. The goal of the new ACO Model is to encourage providers, hospitals, specialists, and caregivers to provide more coordinated care, which could save $1.1 billion over a five year period, HHS projects. The Centers for Medicare & Medicaid Services (CMS) Innovation Center is spearheading this initiative and will reward groups that have formed ACOs based on improvements in health of their Medicare patients and their ability to lower health care costs. Under the Pioneer ACO Model, the 32 selected health care organizations will test the effectiveness of several innovative payment models. The goal of the Pioneer ACO model is to provide better care for beneficiaries, improved coordination with private payers, a reduction Medicare cost growth, and rewards for health care providers that deliver high-quality care. The 32 selected Pioneer ACOs represent urban and rural organizations from various geographic regions of the country, covering 18 states and 860,000 Medicare beneficiaries.

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HHS issues MLR interim final rule

Posted on December 2, 2011

The U.S. Department of Health and Human Services (HHS) has issued an interim final rule (IFR), with public comment, on the medical loss ratio (MLR) requirement under the Affordable Care Act (ACA). Beginning in 2012, the ACA requires that health insurers spend at least 80% (in some cases 85%) of premiums on health care services, or be required to pay rebates to plan members. HHS issued both the rule itself as well as a separate IFR on the rebate requirements, each allowing for public comment.

For more information on medical loss ratios, click here. An update to the previous brief is pending.

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CMS announces new deadlines for Advance Payment Model

Posted on November 30, 2011

The Advance Payment Accountable Care Organization (ACO) Model is an initiative developed by the Centers for Medicare and Medicaid (CMS) Innovation Center designed for organizations participating as ACOs in the Medicare Shared Savings Program (Shared Savings Program). Through the Advance Payment Model, selected participants in the Shared Savings Program will receive advance payments that will be recouped from the shared savings they earn. CMS released a notice today announcing the new application deadline for participation in the Advance Payment Model for certain ACOs. Applications for the performance period beginning on April 1, 2012 will be accepted from January 3, 2012 through February 1, 2012. The period during which applications will be accepted for the performance period beginning on July 1, 2012 will remain identical to the period for the Medicare Shared Savings Program.

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CMS selects 500 FQHCs for Advanced Primary Care Practice demonstration project

Posted on October 24, 2011

The Centers for Medicare and Medicaid Services (CMS) announced today that 500 Federally Qualified Health Centers (FQHCs) have been selected to participate in the Advanced Primary Care Practice demonstration project. These 500 centers will receive $42 million over three years to improve quality and coordination of health care delivery. The project is designed to evaluate the patient-centered medical home model. The goal of the model is to improve patient health and the quality of health care delivery while lowering the cost of of care. HRSA and the Center for Medicare and Medicaid Innovation Center developed the demonstration, which will be conducted from November 1, 2011 through October 31, 2014.

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CMS releases ACO final rule, others agencies weigh-in

Posted on October 20, 2011

The Centers for Medicare and Medicaid Services (CMS) released the much anticipated Accountable Care Organization (ACO) final rule, implementing section 3022 of the Affordable Care Act (ACA), which contains provisions relating to Medicare payments to providers of services and suppliers participating in ACOs under the Medicare Shared Savings Program. The rule on Medicare ACOs relaxes eligibility requirements for doctors and hospitals to participate by halving the number of performance measurements (65 to 33), removing the electronic medical records (EMR) requirement, and eliminating some financial risks. CMS also extended the deadline for ACO applications through 2012. As enticement to rural doctors and physician-owned practices, CMS said it would dedicate $170 million to said providers to start ACOs. Regulators estimate that between 50 and 270 ACOs will be established in the next 3 years, which will affect the care of 4% of Medicare beneficiaries.

Multiple federal agencies also released rules and guidance on fraud & abuse and antitrust issues related to ACOs. The HHS Office of Inspector General (OIG) issued an interim final rule (IFR) on the waiver of certain fraud and abuse provisions and the Department of Justice (DOJ) issued a statement on health care antitrust enforcement policies.

To read more about ACOs, click here.

For the ACO final rule fact sheet, click here.

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