Centers for Medicare & Medicaid Services
CMS releases final rule on Medicare payment systems
Posted on August 2, 2012
The Centers for Medicare & Medicaid Services (CMS) released a final rule yesterday which revises the Medicare hospital inpatient prospective payment systems (IPPS). The rule will increase inpatient hospital Medicare payments by about $2 billion and long-term care hospital payments by about $92 million in fiscal year 2013. The rule sets Medicare reimbursement rates for 440 long-term care hospitals.
The rule also address value-based purchasing under the Affordable Care Act (ACA) and includes provisions to strengthen a variety of quality reporting programs, such as the hospital value-based purchasing program.
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CMS releases FAQs on Medicare Shared Savings Program
Posted on July 30, 2012
The Centers for Medicare & Medicaid Services (CMS) released frequently asked questions (FAQs) regarding the Medicare Shared Savings Program, a program established by the Affordable Care Act (ACA). Specifically, the guidance addresses Accountable Care Organizations (ACOs). ACOs are formed by providers that have agreed to work together to better coordinate patient care.
Information included in the FAQs include general facts regarding ACOs, the ACO participant list form CMS-588 electronic funds transfer, and governing body background.
On July 9, CMS announced 89 new ACOs had been selected to participate in the second wave of the Medicare Shared Savings Program.
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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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Obama administration: no deadline for states to decide whether to participate in Medicaid expansion
Posted on July 15, 2012
Republican governors sent a letter to President Barack Obama on July 10 requesting that he clarify a number of issues regarding the U.S. Supreme Court’s June 28 decision to uphold the Affordable Care Act (ACA).
In response…
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Sebelius announces 89 new ACOs
Posted on July 9, 2012
U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced yesterday that as of July 1, 2012, 89 new Accountable Care Organizations (ACOs) began serving 1.2 million people with Medicare in 40 states and Washington, D.C. ACOs are organizations formed by groups of doctors and other health care providers that have agreed to work together to coordinate care for people with Medicare. These 89 new ACOs have entered into agreements with CMS, taking responsibility for the quality of care they provide to people with Medicare in return for the opportunity to share in savings realized through high-quality, well-coordinated care. Federal savings from this initiative are estimated to be up to $940 million over four years.
The 89 ACOs announced today bring the total number of organizations participating in Medicare shared savings initiatives to 154, including the 32 ACOs participating in the testing of the Pioneer ACO Model by CMS’s Center for Medicare and Medicaid Innovation (Innovation Center) announced last December, and six Physician Group Practice Transition Demonstration organizations that started in January 2011. For 2012, CMS has established 33 quality measures relating to care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care.
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CMS releases notice regarding information collection
Posted on July 5, 2012
As implementation of the Affordable Care Act (ACA) proceeds, the U.S. Department of Health and Human Services continues to release guidances. On Monday, HHS published notices under the Paperwork Reduction Act regarding its intention to collect data on four ACA-related topics, and requested public comment on these data collection efforts.
Such data collection includes…
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CCIIO releases EHB document providing information on benchmark plans
Posted on July 2, 2012
The Centers for Medicare & Medicaid Services’ (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) released a document today which provides information to facilitate States’ selection of the benchmark plans that would serve as the reference plans for the essential health benefits (EHB). This document complements the bulletin on the EHB released on December 16, 2011. Using data from HealthCare.gov, this document provides below an updated list of the three largest small group insurance products ranked by enrollment for each State. In addition, lists of the three largest nationally available Federal Employee Health Benefit Program (FEHBP) plans are also provided.
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CMS seeks comment on Medicaid eligibility calculation
Posted on June 27, 2012
The Centers for Medicare & Medicaid Services (CMS) announced that it is seeking input on methodologies for determining Medicaid eligibility. The new guidelines use a simple income test based on the applicant’s modified adjusted gross income (MAGI), as defined in the Internal Revenue Code (IRC).
The Affordable Care Act (ACA) will expand Medicaid to include…
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CMS releases Medicare-Medicaid enrollee state profile
Posted on June 21, 2012
The Centers for Medicare & Medicaid Services (CMS) recently published the national summary of state profiles for Medicare-Medicaid enrollees. The report found that beneficiaries dually eligible for Medicare and Medicaid had monthly Medicare spending more than twice as high as those with Medicare only. In 2007, Medicare monthly expenditures per person averaged $1,474 for full-benefit duals, who received full Medicaid benefits, compared with $667 for Medicare-only enrollees. Combined expenditures for these Medicare-Medicaid enrollees was $229 billion. For full-benefit duals, 54 percent of total expenditures were Medicare expenditures while 46 percent were Medicaid expenditures. According to the study, the variation may be related to differences in benefits, payment rates, and practice patterns.
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HHS notice asks for input on measuring consumer experience in Exchange health plans
Posted on June 20, 2012
The Centers for Medicare & Medicaid Services (CMS) requested public comment on a survey to enable government to gauge the satisfaction of enrollees in health insurance exchanges. Comments on the survey are due June 29. The Affordable Care Act (ACA) requires the U.S. Department of Health and Human Services (HHS) to establish an enrollee satisfaction survey system for members of “qualified health plans” (QHPs) offered in the exchanges. All health plans offered in the exchanges starting in 2014 must be QHPs that offer the essential health benefits outlined by HHS. HHS intends to have a QHP quality rating system in effect by open enrollment in 2016 for the 2017 coverage year.
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- State Health Insurance Exchange Navigators posted on February 28, 2011
- CMS State Resources FAQ: Medicaid Eligibility Determinations, Medicaid/Exchange Interactions, and §1115 Demonstrations that Use Enrollment Caps posted on May 22, 2013
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- Update: Essential Health Benefits Final Rule posted on March 13, 2013
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