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CMS & HHS Releases - Archived

7/10/19 - HHS To Transform Care Delivery for Patients with Chronic Kidney Disease

Today, delivering on President Trump’s Advancing American Kidney Health Executive Order, the U.S. Department of Health and Human Services (HHS) Secretary Alex Azar and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced five new CMS Center for Medicare and Medicaid Innovation payment models that aim to transform kidney care so that patients with chronic kidney disease have access to high quality, coordinated care. The proposed required End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model would encourage greater use of home dialysis and kidney transplants for Medicare beneficiaries with ESRD in order to preserve or enhance their quality of care while reducing Medicare expenditures, and the Kidney Care First (KCF) and Comprehensive Kidney Care Contracting (CKCC) Models will test new Medicare payment options that aim to improve the quality of care for patients kidney disease.

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CMS Expands Coverage of Ambulatory Blood Pressure Monitoring (ABPM) 

Decision increases access by extending Medicare coverage to additional diagnostic applications

Today the Centers for Medicare & Medicaid Services (CMS) finalized its national coverage policy for Ambulatory Blood Pressure Monitoring (ABPM).  ABPM is a non-invasive diagnostic test that uses a device to track blood pressure over 24-hour cycles, allowing a doctor to assess a patient’s blood pressure during routine daily living, instead of when they are sitting nervously on an examination table.  ABPM may measure blood pressure more accurately and lead to the diagnosis of high blood pressure in patients who would not otherwise have been identified as having the condition.

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Click here to view decision


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4/22/19 – HHS News: HHS to Deliver Value-Based Transformation in Primary Care

The CMS Primary Care Initiative to Empower Patients and Providers to Drive Better Value and Results

Today, U.S. Department of Health and Human Services (HHS) Secretary Alex Azar and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma are announcing the CMS Primary Cares Initiative, a new set of payment models that will transform primary care to deliver better value for patients throughout the healthcare system. Building on the lessons learned from and experiences of the previous models, the CMS Primary Cares Initiative will reduce administrative burdens and empower primary care providers to spend more time caring for patients while reducing overall health care costs. The models were developed by the Innovation Center under the leadership of Adam Boehler and are part of Secretary Azar’s value-based transformation initiative.

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Click here to view a fact sheet on the CMS Primary Care First payment model options

Click here to view a fact sheet on the Direct Contractions payment model options

Click here to view a fact sheet on the CMS Primary Care Initiative

Click here to view the Direct Contracting – Geographic Request for Information

Click here to view Findings at a Glance

Click here to view the report


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2/20/19 – CMS Office of the Actuary Releases 2018-2027 Projections of National Health Expenditures

Growth in National Health Spending over the Next Decade Remains Similar from Last Year’s Projected Average Annual Growth of 5.5 Percent

National health expenditure growth is expected to average 5.5 percent annually from 2018-2027, reaching nearly $6.0 trillion by 2027, according to a report published today by the independent Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS). 

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1/18/19 – HHS is Committed to Protecting Life and Conscience

On the occasion of the 2019 March for Life, HHS Secretary Alex Azar released the following statement regarding the Trump administration’s accomplishments in protecting human life.

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Click here to view Trump Administration Actions to Protect Life and Conscience


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1/18/19 – OCR Finds the State of California Violated Federal Law in Discriminating Against Pregnancy Resource Centers

Today the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) announced that it found that the State of California violated the federal conscience protection laws known as the Weldon - PDF and Coats-Snowe - PDF Amendments. This is the first time since the launch of the new Conscience and Religious Freedom Division a year ago that OCR has found a violation under these laws. This matter arose from complaints filed by Sacramento Life Center, LivingWell Medical Clinic, Pregnancy Center of the North Coast, and Confidence Pregnancy Center alleging that California subjected them to potential fines and discrimination for refusing to post notices referring for abortion.

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Click here to view the California Notice of Violation


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11/13/18 –  CMS Announces New Medicaid Demonstration Opportunity to Expand Mental Health Treatment Services

CMS letter to State Medicaid Directors outlines new opportunities for states to receive payment for residential treatment services

Today, the Centers for Medicare & Medicaid Services (CMS) sent a letter to State Medicaid Directors that outlines both existing and new opportunities for states to design innovative service delivery systems for adults with serious mental illness (SMI) and children with serious emotional disturbance (SED). The letter includes a new opportunity for states to receive authority to pay for short-term residential treatment services in an institution for mental disease (IMD) for these patients. CMS believes these opportunities offer states the flexibility to make significant improvements on access to quality behavioral health care.

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11/08/18 –  CMS Proposes Changes to Streamline and Strengthen Medicaid and CHIP Managed Care Regulations

Proposed Rule Continues Commitment to Promote Flexibility, Strengthen Accountability, and Maintain and Enhance Program Integrity in Medicaid and CHIP

Today, the Centers for Medicare & Medicaid Services (CMS) is proposing significant regulatory revisions to streamline the 2016 managed care regulatory framework. The changes reflect a broader strategy to relieve regulatory burdens; support state flexibility and local leadership; and promote transparency, flexibility, and innovation in care delivery. While the 2016 managed care final rule was a substantial and comprehensive rewrite of the Medicaid and Children’s Health Insurance Program (CHIP) regulatory structure, it included provisions that many states and stakeholders identified as unnecessarily prescriptive and as adding unnecessary costs and administrative burden to state Medicaid programs without contributing to the improvement of health outcomes.

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11/07/18 –  Trump Administration Issues Final Rules Protecting Conscience Rights in Health Insurance

Today, the Departments of Health and Human Services, Treasury, and Labor released two final rules to provide conscience protections for Americans who have a religious or moral objection to health insurance that covers contraception methods. Under the Affordable Care Act, employer-provided health insurance plans are required to cover certain “preventative services” – which were defined through guidance by the Obama Administration as including all contraception methods approved by the Food and Drug Administration, including methods viewed by many as abortifacients, and sterilization procedures.

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11/07/18 –  HHS activates aid for uninsured citizens of the Commonwealth of the Northern Mariana Islands needing medicine after Super Typhoon Yutu

Uninsured citizens of the Commonwealth of the Northern Mariana Islands (CNMI), a U.S. territory, are eligible for no-cost replacements of critical medications lost or damaged by Super Typhoon Yutu. This relief comes from the Emergency Prescription Assistance Program (EPAP), managed by the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR).

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11/07/18 –  Fact Sheet: Final Rules on Religious and Moral Exemptions and Accommodation for Coverage of Certain Preventive Services Under the Affordable Care Act

On November 7, 2018 the Departments of Health and Human Services, Treasury, and Labor (the Departments) announced two final rules, on display at the Federal Register, that provide conscience protections to Americans who have a religious or moral objection to health insurance that covers contraceptive methods, including certain contraceptives that many view as abortifacients, and/or sterilization procedures.

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11/07/18 –  CMS-9922-P: Exchange Program Integrity Proposed Rule

This proposed rule would revise standards relating to oversight of Exchanges established by states, periodic data matching frequency and authority, and the length of a consumer’s authorization for the Exchange to obtain updated tax information. This proposed rule would also propose new requirements for certain issuers related to the collection of a separate payment for the premium portion attributable to coverage forcertain abortion  services. Many of these proposed changes would help strengthen Exchange program integrity.

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11/07/18 –  CMS releases proposed rule to improve the integrity of the Exchange

Proposed rule advocates for additional oversight to protect both the issuer and consumer

The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule, “Patient Protection and Affordable Care Act (PPACA): Exchange Program Integrity.”  This proposal would safeguard taxpayer dollars by ensuring that people are accurately determined eligible for premium subsidies they receive through the Exchange.  In addition, to better align federal regulations with statutory requirements and congressional intent, the rule proposes that issuers must send a separate bill and collect separate payments for the portion of the consumer’s premium attributable to certain abortion services for which public funding is prohibited.

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11/02/18 –  CY 2019 OPPS and ASC Rule Encourages More Choices and Lower Costs for Seniors

On November 2, CMS released a final rule that strengthens the Medicare program by providing seniors more choices and lower cost options in making the best decisions on their care. The policies adopted in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule with comment period will help lay the foundation for a patient-driven healthcare system.

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11/01/18 –  CMS Finalizes Policies to Modernize and Drive Innovation in Durable Medical Equipment (DME) and End-Stage Renal Disease (ESRD) Programs

Administrator Verma: “Today’s rule finalizes market-oriented reforms by simplifying the bidding process to increase patient access to Durable Medical Equipment items and services and incentivizes the development and use of transformative and innovative dialysis therapies.”

Today, the Centers for Medicare & Medicaid Services (CMS) finalized innovative changes to the Medicare payment rules for Durable Medical Equipment Prosthetics, Orthotics, and Supplies (DMEPOS) and the End-Stage Renal Disease (ESRD) programs. The policies aim to increase access to items and services for patients, drive competition and increase affordability.

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11/01/18 –  CMS Finalizes Changes to Advance Innovation, Restore Focus on Patients

Changes to the Medicare Physician Fee Schedule and Quality Payment Program will shift clinicians’ time from completing unnecessary paperwork to providing innovative, high-quality patient care

Today, the Centers for Medicare & Medicaid Services (CMS) finalized bold proposals that address provider burnout and provide clinicians immediate relief from excessive paperwork tied to outdated billing practices. The final 2019 Physician Fee Schedule (PFS) and the Quality Payment Program (QPP) rule released today also modernizes Medicare payment policies to promote access to virtual care, saving Medicare beneficiaries time and money while improving their access to high-quality services, no matter where they live. It makes changes to ease health information exchange through improved interoperability and updates QPP measures to focus on those that are most meaningful to positive outcomes. Today’s rule also updates some policies under Medicare’s accountable care organization (ACO) program that streamline quality measures to reduce burden and encourage better health outcomes, although broader reforms to Medicare’s ACO program were proposed in a separate rule. This rule is projected to save clinicians $87 million in reduced administrative costs in 2019 and $843 million over the next decade.

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10/31/18 – Statement: CMS and AARP Encourage Beneficiaries to Review Coverage this Open Enrollment

Medicare Open Enrollment for 2019 Medicare health and drug plans began on October 15, 2018 and ends December 7, 2018. Beneficiaries have more plans to choose from than ever, with 600 more plans available across the country next year. Starting in 2019, plans have new discretion to offer a broader array of supplemental benefits.

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10/31/18 – 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.

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10/30/18 – HHS Announces the Official Opening of the Health Sector Cybersecurity Coordination Center

On Monday, October 29, the Deputy Secretary of the Department of Health and Human Services (HHS), Eric Hargan, announced the official dedication of the Health Sector Cybersecurity Coordination Center (HC3) at an official opening ceremony in the Hubert H. Humphrey building.  As part of October’s National Cybersecurity Awareness Month, and in coordination with the Administration’s rollout of the National Cyber Strategy, the opening underscores HHS’ commitment to support and improve the health sector’s cybersecurity defenses.

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10/26/18 – CMS Acts to Help with Typhoon Yutu Emergency Response

Agency waivers to take effect in the Northern Mariana Islands

The Centers for Medicare & Medicaid Services (CMS) today announced that the agency has acted to support the Northern Mariana Islands in response to Typhoon Yutu. This week, Health and Human Services Secretary Alex Azar declared a public health emergency (PHE) in the Northern Mariana Islands. With the PHE in effect, CMS has taken several actions to provide immediate relief to those impacted by the typhoon. The actions will include temporarily waiving or modifying certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements; creating special enrollment opportunities for individuals to access healthcare immediately; and taking steps to ensure dialysis patients obtain critical life-saving services.

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10/26/18 – CMS Proposes to Modernize Medicare Advantage, Expand Telehealth Access for Patients

Proposed rule would strengthen the popular system for private health insurance plans to provide Medicare coverage, increase plan flexibility to offer telehealth benefits, and improve coordination for dual-eligible beneficiaries

In a proposed rule issued today, the Centers for Medicare & Medicaid Services (CMS) took action to build upon the Administration’s ongoing efforts to modernize the Medicare Advantage and Part D programs, which provide seniors with Medicare health and prescription drug coverage through private plans. The changes proposed today would allow plans to cover additional telehealth benefits and would make other much-needed updates, including for individuals who are eligible for Medicare Advantage special needs plans.
 

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10/25/18 – HHS Advances Payment Model to Lower Drug Costs for Patients

The International Pricing Index (IPI) Model would lower costs for physician-administered drugs by resetting Medicare payments based on international prices and introducing competition

On Thursday, the U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), announced and sought input on a new “International Pricing Index” (IPI) payment model to reduce what Americans pay for prescription drugs.

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10/23/18 – CMS model addresses opioid misuse among expectant and new mothers

Goals are to improve quality of care, increase access to treatment based on state-specific needs, and reduce expenditures

Today the Centers for Medicare & Medicaid Services (CMS) announced the Maternal Opioid Misuse (MOM) model, an important step in advancing the agency’s multi-pronged strategy to combat the nation’s opioid crisis. The model addresses the need to better align and coordinate care of pregnant and postpartum Medicaid beneficiaries with opioid use disorder (OUD) through state-driven transformation of the delivery system surrounding this vulnerable population. By supporting the coordination of clinical care and the integration of other services critical for health, wellbeing, and recovery, the MOM model has the potential to improve quality of care and reduce expenditures for mothers and infants.
 
 

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10/22/18 – Trump Administration announces State Relief and Empowerment Waivers to give states the flexibility to lower premiums and increase choices for their health insurance markets

States could develop innovative solutions to help their consumers combat skyrocketing premiums and limited plan options

Today, the Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of the Treasury (collectively, the Departments) issued new guidance so states can move their insurance markets away from the one-size-fits-all rules and regulations imposed by the Affordable Care Act (ACA) and increase choice and competition within their insurance markets. The new guidance grants states more flexibility to design alternatives to the ACA and to give Americans more options to get health coverage that better meets their needs. Under this new policy, states will be able to pursue waivers to improve their insurance markets, increase affordable coverage options for their residents, and ensure that people with pre-existing conditions are protected. These waivers are called State Relief and Empowerment Waivers to reflect this new direction and opportunity.

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Click here to view fact sheet


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10/19/18 – CMS Responding to Suspicious Activity in Agent and Broker Exchanges Portal

Earlier this week, CMS staff detected anomalous activity in the Federally Facilitated Exchanges, or FFE’s Direct Enrollment pathway for agents and brokers. The Direct Enrollment pathway, first launched in 2013, allows agents and brokers to assist consumers with applications for coverage in the FFE.

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10/18/18 – HHS Activates Aid for Uninsured Floridians Needing Medicine after Hurricane Michael

Thousands of uninsured Floridians are eligible for no-cost replacements of critical medications lost or damaged by Hurricane Michael. This relief comes from the Emergency Prescription Assistance Program (EPAP), managed by the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR).

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10/18/18 – HHS awards $293 million to expand primary health care workforce

Today, the U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration (HRSA) announced $293 million in awards to primary health care clinicians and students through the National Health Service Corps (NHSC) and Nurse Corps programs.

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10/16/18 - ONC and OCR Bolster the Security Risk Assessment (SRA) Tool with New Features and Improved Functionality

Patients expect not only quality health care to keep them healthy, but also trust that their most sensitive health information will be protected from threats and vulnerabilities that could lead to the compromise of one’s health information.  An enterprise-wide risk analysis is not only a requirement of the HIPAA Security Rule, it is also an important process to help healthcare organizations understand their security posture to prevent costly data breaches.  What is an enterprise-wide risk analysis?  It is a robust review and analysis of the risks to the confidentiality, integrity, and availability of electronic health information -- across all lines of business, in all facilities, and in all locations.

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10/16/18 - Remarks by Administrator Seema Verma at the America’s Health Insurance Plans (AHIP) 2018 National Conference on Medicare

(As prepared for delivery – October 16, 2018)

Thank you. I am honored to be with you and welcome to your nation’s capital.

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10/15/18 - Important New Medicare Card Mailing Update — Wave 7 Begins, Wave 5 Ends

CMS has started mailing new Medicare cards to people with Medicare who live in Wave 7 states and territories including: Kentucky, Louisiana, Michigan, Mississippi, Missouri, Ohio, Puerto Rico, Tennessee, and the Virgin Islands.
 

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10/15/18 - CMS Proposes to Require Manufacturers to Disclose Drug Prices in Television Ads

Proposed rule would further the Trump Administration’s commitment to lower prescription drug prices by requiring companies to list prices for prescription drugs covered in Medicare or Medicaid

As part of the agency’s ongoing efforts to empower patients and lower prescription drug prices, the Centers for Medicare & Medicaid Services proposed today to require that prescription drug manufacturers post the Wholesale Acquisition Cost (WAC) for drugs covered in Medicare or Medicaid in direct-to-consumer television advertisements.
 

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10/15/18 - What You Need to Know about Putting Drug Prices in TV Ads

“If we want to have a real market for drugs, why not have [companies] disclose their prices in the ads, too? Consumers would have much more balanced information, and companies would have a very different set of incentives for setting their prices.” – HHS Secretary Alex Azar

In May 2018, President Trump and Secretary Azar introduced the American Patients First blueprint - PDF to bring down prescription drug prices.

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10/15/18 - Anthem Pays OCR $16 Million in Record HIPAA Settlement Following Largest U.S. Health Data Breach in History

Anthem, Inc. has agreed to pay $16 million to the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) and take substantial corrective action to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules after a series of cyberattacks led to the largest U.S. health data breach in history and exposed the electronic protected health information of almost 79 million people.

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10/15/18 - CMS Administrator Seema Verma Statement on Drug Industry Price Transparency Announcement

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10/15/18 - HHS Secretary Azar Comments on Drug Industry Price Transparency Announcement 

Health and Human Services Secretary Alex Azar issued the following statement regarding pharmaceutical companies’ announcement that they would be providing access to more information on drug prices.
 

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10/12/18 - Readout of Secretary Azar’s Community Pharmacy and Patient Roundtable in Pittsburgh 

Today, Health and Human Services Secretary Alex Azar and Centers for Medicare & Medicaid Services Chief of Staff Paul Mango traveled to Pittsburgh, Pennsylvania to participate in a roundtable discussion at Spartan Pharmacy. The discussion included community pharmacists and their senior patients and covered the legislation recently signed by President Trump banning pharmacy gag clauses.
 

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10/12/18 - CMS announces 2019 Medicare Parts A & B premiums and deductibles

Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2019 premiums, deductibles, and coinsurance amounts for Medicare Parts A and B.

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10/11/18 - HHS Secretary Azar declares public health emergency in Georgia due to Hurricane Michael

Health and Human Services (HHS) Secretary Alex Azar today declared a public health emergency in Georgia due to damage from Hurricane Michael. The declaration follows President Trump’s emergency declaration for the state and gives the HHS Centers for Medicare & Medicaid Services beneficiaries and their healthcare providers and suppliers greater flexibility in meeting emergency health needs.
 

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10/11/18 - CMS Acts to help with Hurricane Michael Emergency Response

Agency waivers to take effect in Georgia

The Centers for Medicare & Medicaid Services (CMS) today announced that the agency has acted to support Georgia in response to Hurricane Michael. Today, Health and Human Services Secretary Alex Azar declared a public health emergency (PHE) in Georgia. With the PHE in effect, CMS has taken several actions to provide immediate relief to those impacted by the hurricane. The actions will include temporarily waiving or modifying certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements; creating special enrollment opportunities for individuals to access healthcare immediately; and taking steps to ensure dialysis patients obtain critical life-saving services.

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10/11/18 - HHS awards $2.34 billion in grants to help Americans access HIV/AIDS care and medication

Today, the U.S. Department of Health and Human Services announced that approximately $2.34 billion in Ryan White HIV/AIDS Program grants were awarded to cities, counties, states, and local community-based organizations in fiscal year (FY) 2018. This funding through the Health Resources and Services Administration (HRSA) supports a comprehensive system of HIV primary medical care, medication, and essential support services to more than half a million people living with HIV in the United States.
 

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10/11/18 - Premiums on the Federally-facilitated Exchanges drop in 2019

Administration’s actions provide some relief from skyrocketing premiums

Today, the Centers for Medicare & Medicaid Services (CMS) announced that the average premium for second lowest cost silver plans (SLCSP) for the 2019 coverage year will drop by 1.5 percent, the first time average premiums have dropped since the implementation of the Federally- facilitated Exchange in 2014. Tennessee being the largest with a 26.2 percent reduction. These premium reductions along with increased issuer participation strongly suggest that the numerous actions taken by the Trump administration to stabilize the market are working.

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10/10/18 - HHS Secretary Azar Praises Results of President Trump’s Leadership on Drug Pricing 

On Wednesday, President Trump signed legislation that bans pharmacy gag clauses, which prevent pharmacists from informing patients when they can pay less out of pocket for a prescription drug, in both private insurance plans and in Medicare prescription drug plans.
 

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10/10/18 - HHS expands corporate partnership to protect against health security threats

A strategic partnership will expand between the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (ASPR) and Johnson & Johnson of New Brunswick, New Jersey.  The expansion will focus on the development of innovative products to combat the potentially deadly health effects of chemical, biological, radiation and nuclear threats, emerging infectious diseases and antimicrobial resistant infections.
 

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10/10/18 - CMS Takes Steps to help with Hurricane Michael Emergency Response

Agency waivers to take effect in Florida

The Centers for Medicare & Medicaid Services (CMS) today announced steps taken by the agency to support Florida in response to Hurricane Michael. Yesterday, Health and Human Services Secretary Alex Azar declared a public health emergency (PHE) in Florida. With the PHE in effect, CMS has taken several actions to provide immediate relief to those impacted by the hurricane. The actions will include temporarily waiving or modifying certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements; creating special enrollment opportunities for individuals to access healthcare immediately; and taking steps to ensure dialysis patients obtain critical life-saving services.
 

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10/10/18 - Medicare provides continued access to high-quality health coverage choices in 2019

CMS releases Star Ratings for 2019 Medicare Advantage and Part D prescription drug plans ahead of Medicare Open Enrollment

Today, the Centers for Medicare & Medicaid Services (CMS) announced that Medicare beneficiaries continue to have access to high-quality health choices for their Medicare coverage as the agency releases the Star Ratings for the 2019 Medicare Advantage and Part D prescription drug plans.
 

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10/09/18 - HHS Secretary Azar declares public health emergency in Florida due to Hurricane Michael

Following President Trump’s emergency declaration for Florida, Health and Human Services Secretary Alex Azar today declared a public health emergency in the state as Hurricane Michael makes landfall. The declaration gives the HHS Centers for Medicare & Medicaid Services beneficiaries and their healthcare providers and suppliers greater flexibility in meeting emergency health needs.
 

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10/09/18 - CMS Announces Participants in New Value-Based Bundled Payment Model

Participation is robust in Administration’s Bundled Payments for Care Improvement-Advanced model, which is designed to improve quality and reduce costs for inpatient & outpatient care

Today, the Centers for Medicare & Medicaid Services (CMS) announced that 1,299 entities have signed agreements with the agency to participate in the Administration’s Bundled Payments for Care Improvement – Advanced (BPCI Advanced) Model.  The participating entities will receive bundled payments for certain episodes of care as an alternative to fee-for-service payments that reward only the volume of care delivered.
 

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10/04/18 - CMS to Strengthen Oversight of Medicare’s Accreditation Organizations

Agency’s website will increase transparency into Accrediting Organization performance, and CMS will streamline and strengthen the validation of Accrediting Organization surveys

Today, the Centers for Medicare & Medicaid Services (CMS) took action to improve quality and safety in healthcare facilities and empower patients with information to make decisions about where to receive care.
 

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10/03/15 - CMS Accelerates Innovation and Promotes Patient Access to Medical Technology 

Reforms to Medicare’s Local Coverage Determination process will increase transparency and patient engagement in order to ensure that Medicare beneficiaries have access to the latest therapies and devices

Today, as part of broader efforts to modernize the Medicare program and bring the latest technologies and innovations to Medicare beneficiaries, the Centers for Medicare & Medicaid Services (CMS) announced changes to the way contractors decide which technologies are covered by publishing a revision to Medicare’s Program Integrity Manual.
 

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8/22/18 – CMS Releases Formal Approach to Ensure Medicaid Demonstrations Remain Budget Neutral

Agency reinforces commitment to transparency and controlling costs; provides new tool

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.

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8/7/18 - CMS empowers patients with more choices and takes action to lower drug prices

Agency is providing flexibility through private sector tools to negotiate lower prescription drug prices on behalf of beneficiaries

Today, the Centers for Medicare & Medicaid Services (CMS) delivered on President Trump’s promise to negotiate better deals for Medicare patients and create competition between drugs used to treat the same conditions, with more than half of the savings required to be passed on directly to patients. This action gives Medicare Advantage plans the option of applying step therapy for physician-administered and other Part B drugs and is an important step within the Administration’s larger agenda to provide patients with more choices when picking a Medicare Advantage plan that best meets their needs.

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Click here to view memo that was sent to Medicare Advantage Plans

Click here to view fact sheet on allowing Medicare Advantage plans the option of applying step therapy for physician-administered and other Part B drugs


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02/01/18 – 2019 Medicare Advantage and Part D Advance Notice Part II and Draft Call Letter

Today, the Centers for Medicare & Medicaid Services (CMS) released Part II of the 2019 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part D Payment Policies (the Advance Notice), and Draft Call Letter. CMS released Part I of the Advance Notice on December 27, 2017. CMS will accept comments on all proposals through Monday, March 5, 2018, before publishing final versions on April 2, 2018. The proposed updates will continue to create more choices for Medicare beneficiaries selecting MA and Part D plans in 2019.

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12/21/16 – Special Edition Open Enrollment Snapshot: November 1 through December Deadline for January 1 Coverage

Through the extended deadline for January 1, 2017 coverage, Americans are demonstrating clear demand for quality, affordable coverage as 6.4 million consumers have signed up for Health Insurance Marketplace plans through HealthCare.gov, an increase of 400,000 plan selections compared to last year at this time. Total plan selections from November 1 through the extended deadline of December 19 include 2.05 million new consumers and 4.31 million returning consumers actively renewing their coverage. Consumers whose coverage will be automatically renewed for January 1 are not yet included in these totals.

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12/21/16 – HHS Selects Eight States for New Demonstration Program to Improve Access to High Quality Behavioral Health Services

The U.S. Department of Health and Human Services today announced the selection of eight states for participation in a two-year Certified Community Behavioral Health Clinic (CCBHC) demonstration program designed to improve behavioral health services in their communities. This demonstration is part of a comprehensive effort to integrate behavioral health with physical health care, increase consistent use of evidence-based practices, and improve access to high quality care for people with mental and substance use disorders.

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12/20/16 – Advancing Care Coordination through Episode Payment Models (Cardiac and Orthopedic Bundled Payment Models) Final Rule(CMS-5519-F) and Medicare ACO Track 1 + Model

On December 20, 2016, the Centers for Medicare & Medicaid Services (CMS) finalized new Innovation Center models that continue the Administration’s progress to shift Medicare payments from rewarding quantity to rewarding quality by creating strong incentives for hospitals to deliver better care to patients at a lower cost. These models will reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery.

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Click here to view more information about the individual cardiac and orthopedic bundled payment models


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12/20/16 – Evaluation of the Comprehensive Primary Care Initiative: Third Annual Report

In October 2012, the Center for Medicare & Medicaid Innovation (CMMI) of the Centers for Medicare & Medicaid Services (CMS) launched the Comprehensive Primary Care (CPC) initiative. This unique collaboration between CMS and other public and private payers— including commercial insurers and Medicaid managed care—aims to improve primary care delivery and achieve better care, smarter spending, and healthier people. CPC also aims to enhance clinician and staff experience. This third annual report focuses on CPC’s third program year (January through December 2015), examining how practices implemented CPC and altered health care delivery during that year, and estimating the impacts on patient experience, cost, service use, and quality-of-care outcomes for attributed Medicare fee-for-service (FFS) beneficiaries over the first 36 months of CPC (October 2012 through September 2015), using the most recent data available.

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12/20/16 – 2017 Interoperability Standards Advisory Released

Key Resource for Clinicians and Developers to Enhance Flow of Electronic Information

The Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) today released the 2017 Interoperability Standards Advisory (ISA). The ISA catalogues key information about standards and implementation specifications – such as whether they are required by any federal programs or how widely used they are – to help enhance information sharing for key clinical data, including medication lists, immunization records, and test results.

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Click here to view the 2017 Interoperability Standards Advisory (ISA)


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12/20/16 – HHS Finalizes New Medicare Alternative Payment Models to Reward Better Care at Lower Cost

Bundled Payments for Cardiac and Orthopedic Care, Small-Practice Accountable Care Organization Opportunities to Continue Health Care System’s Shift Toward Value

Today, the Department of Health & Human Services finalized new Medicare alternative payment models that continue the Administration’s progress in reforming how the health care system pays for care. These new approaches will shift Medicare payments from rewarding quantity to rewarding quality by creating incentives for hospitals and clinicians to work together to avoid complications, avoid preventable hospital readmissions, and speed patient recovery.

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Click here to view the final rule


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12/16/16 – Medicare Health Care Quality Demonstration Announced: Meridian Health System Evaluation Reports Posted

Section 646 of the Medicare Modernization Act (MMA) mandates a 5-year demonstration program under which the Centers for Medicare & Medicaid Services (CMS) will test major changes to improve quality of care while increasing efficiency across an entire health care system. 

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Click here to view the Meridian Health System Care Journey Program Final Evaluation Report

Click here to view the Meridian Health System Care Journey Program Patient and Family Focus Group


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12/16/16 – 2018 Letter to Issuers in the Federally-facilitated Marketplaces

The Centers for Medicare & Medicaid Services (CMS) is releasing this final 2018 Letter to Issuers in the Federally-facilitated Marketplaces (Letter). This Letter provides issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Marketplaces (FFMs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs) with operational and technical guidance to help them successfully participate in any such Marketplace in 2018. Unless otherwise specified, references to the FFMs include the FF-SHOPs.

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12/16/16 – Final Key Dates Calendar for 2017: QHP Certification in the Federally-facilitated Marketplaces; Rate Review; Risk Adjustment and Reinsurance

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12/16/16 – Timing of Submission and Posting of Rate Filing Justifications for the 2017 Filing Year for Single Risk Pool Coverage

The Centers for Medicare & Medicaid Services (CMS) is releasing this bulletin regarding the uniform timeline for submission and public release of information about rate filings for single risk pool coverage, consistent with 45 CFR Part 154. The timelines specified below apply to the rate filings issuers will submit in 2017 (2017 filing year) for single risk pool coverage (including both qualified health plans (QHPs) and non-QHPs) with plan or policy years beginning on or after January 1, 2018.

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12/16/16 – Final HHS Notice of Benefit and Payment Parameters for 2018

The HHS Notice of Benefit and Payment Parameters for 2018 final rule released today establishes standards for issuers and each Health Insurance Marketplace, generally for plan years that begin on or after January 1, 2018. The Marketplaces continue to play an important role in fulfilling one of the Affordable Care Act’s core goals: reducing the number of uninsured Americans by providing access to affordable, quality health insurance. The Marketplace provides health insurance coverage to more than 10 million Americans, and we continue to see a strong demand for the quality, affordable coverage it offers.

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12/16/16 – CMS Finalizes Rules for the Health Insurance Marketplace, Improving Stability

The Centers for Medicare & Medicaid Services (CMS) today issued the Notice of Benefit and Payment Parameters final rule and the final Annual Letter to Issuers for 2018, which will further strengthen the Health Insurance Marketplace that millions of Americans rely on for health coverage. The primary focus of the notice -- risk stabilization -- complements recent announcements that improve the risk pool, including actions to address third party payments of premiums and improve program integrity for special enrollment periods.

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Click here to view a fact sheet on the major provisions of the final rule

Click here to view the final rule


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12/15/16 – Medicare-Medicaid ACO Model Joins Growing Number of State-Based Efforts to Improve Quality of Care, Lower Costs

Today, the Centers for Medicare & Medicaid Services (CMS) announced the Medicare-Medicaid Accountable Care Organization (ACO) Model, a new initiative designed to improve the quality of care and lower costs for beneficiaries who are enrolled in both Medicare and Medicaid.

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12/15/16 – CMS Announces Additional Opportunities for Clinicians under the Quality Payment Program

Today, the Centers for Medicare & Medicaid Services (CMS) announced more new opportunities for clinicians to join Advanced Alternative Payment Models (APMs) to improve care and earn additional incentive payments under the Quality Payment Program, which implements the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Beginning in January and February 2017, CMS will open applications for new rounds of two CMS Innovation Center models for the 2018 performance year – for new practices and payers in the Comprehensive Primary Care Plus (CPC+) model and new participants in the Next Generation Accountable Care Organization (ACO) model. With these new opportunities, CMS expects that by the 2018 performance period, 25 percent of clinicians in the Quality Payment Program would be a part of these advanced models and may be eligible to earn incentive payments.

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12/15/16 – Department of Health and Human Services Awards Over $50 Million for New Health Center Sites

Today, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced over $50 million in funding for 75 health centers in 23 states, Puerto Rico and the Federated State of Micronesia.

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12/14/16 – Biweekly Enrollment Snapshot - Weeks 5 And 6

Nov 27 – Dec 10, 2016

Heading into the final days before the December 15 deadline for January 1 coverage, millions of Americans are coming to HealthCare.gov and signing up for Health Insurance Marketplace plans, demonstrating the strong demand for quality, affordable coverage. As of December 10, over 4 million people had selected plans using HealthCare.gov since Open Enrollment began November 1, including over 1.1 million new consumers and 2.9 million renewing their coverage.  Since December 10, sign-up activity has accelerated. With the December 15 deadline for January 1 coverage approaching, the last two days – Monday, December 12 and Tuesday, December 13 – have been two of the biggest days of any Open Enrollment, with more than 700,000 sign-ups.

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12/14/16 - Long-Term Care Hospital (LTCH) Compare Website

This fact sheet contains information about the Long-Term Care Hospital (LTCH) Compare website that was launched on December 14, 2016. - Section 3004(a) of the Affordable Care Act established the LTCH Quality Reporting Program (QRP) and requires the Secretary of Health and Human Services to establish procedures for making quality data submitted by LTCHs available to the public. This Compare release contains data from approximately 97 percent of all LTCHs.

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12/14/16 - Inpatient Rehabilitation Facility (IRF) Compare Website

This fact sheet contains information about the Inpatient Rehabilitation Facility (IRF) compare website that was launched on December 14, 2016. - Section 3004(b) of the Affordable Care Act established the IRF Quality Reporting Program (QRP) and requires the Secretary of Health and Human Services to establish procedures for making quality data submitted by IRFs available to the public. This Compare release contains data from approximately 87 percent of all IRFs.

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12/14/16 – HHS Issues Final Regulation to Increase Access to Affordable Family Planning and Preventive Services

The U.S. Department of Health and Human Services (HHS) issued a final rule to clarify the regulations for family planning services under Title X of the Public Health Service Act and protect access to family planning services. Title X is the only federal program focused solely on providing family planning and related preventive services.

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12/13/16 – HHS Showcases Industry Progress in Bringing Interoperable Medication Lists to Consumers

New Challenge Also Announced to Create Tool to Generate User-Friendly “Snapshots” of Model Privacy Practices for Digital Health Products

The Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) today, in partnership with leaders in the private sector, as well as patient and consumer advocates, coordinated a live demonstration of consumer-friendly applications (apps) that import data from some of the largest health information technology (IT) vendors in the country to allow individuals to access a consolidated list of their medications from a variety of sources in one place. The demonstration illustrated the promise of Fast Healthcare Interoperability Resources (FHIR)—a set of private sector technical standards developed with the strong support of ONC—and took place at the annual Connected Health Conference hosted by the Personal Connected Health Alliance at National Harbor in Maryland.

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12/13/16 – New Report Details Impact of the Affordable Care Act

Millions of Americans Have Gained Coverage, and Millions More Have Had Their Coverage Substantially Improved

Today, the U.S. Department of Health and Human Services released an extensive compilation of national and state-level data illustrating the substantial improvements in health care for all Americans in the last six years. The uninsured rate has fallen to the lowest level on record, and 20 million Americans have gained coverage thanks to the Affordable Care Act (ACA). But beyond those people who would otherwise be uninsured, millions of Americans with employer, Medicaid, Medicare, or individual market coverage have benefited from new protections as a result of the law.

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12/12/16 – National Patient Safety Efforts Save 125,000 Lives and Nearly $28 Billion in Costs

New Report Shows Hospital-Acquired Conditions Continue to Decline

Drop 21 Percent and 3 Million Fewer Adverse Events Over a Five Year Period –A report released by the U.S. Department of Health and Human Services (HHS) today shows that nationwide efforts to make health care safer are paying off. Thanks in part to provisions of the Affordable Care Act, approximately 125,000 fewer patients died due to hospital-acquired conditions and more than $28 billion in health care costs were saved from 2010 through 2015.  In total, hospital patients experienced more than 3 million fewer hospital-acquired conditions from 2010 through 2015, the result of a 21 percent decline in the rate of these adverse events over that period. Hospital-acquired conditions are conditions that a patient develops while in the hospital being treated for something else. The decline in their incidence aligns with a major goal of the Affordable Care Act to improve the quality of health care.

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12/12/16 – IFC-Conditions for Coverage for End-Stage Renal Disease Facilities

This interim final rule with comment period implements new requirements for Medicare-certified dialysis facilities that make payments of premiums for individual market health plans. These requirements apply to dialysis facilities that make such payments directly, through a parent organization, or through a third party. These requirements are intended to protect patient health and safety; improve patient disclosure and transparency; ensure that health insurance coverage decisions are not inappropriately influenced by the financial interests of dialysis facilities rather than the health and financial interests of patients; and protect patients from mid-year interruptions in coverage.

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12/08/16 – Beneficiary Engagement and Incentives Models: Direct Decision Support Model

The Centers for Medicare & Medicaid Services (CMS) identifies strengthening beneficiary engagement as one of the agency’s goals to help transform our health care system into one that delivers better care, smarter spending, healthier people, and puts individuals at the center. Specifically, the “CMS Quality Strategy envisions health and care that is person-centered, provides incentives for the right outcomes, is sustainable, emphasizes coordinated care and shared decision making, and relies on transparency of quality and cost information.”

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12/08/16 – Beneficiary Engagement and Incentives Models: Shared Decision Making Model

The Centers for Medicare & Medicaid Services (CMS) identifies strengthening beneficiary engagement as one of the agency’s goals to help transform our health care system into one that delivers better care, smarter spending, healthier people, and puts individuals at the center. Specifically, the “CMS Quality Strategy envisions health and care that is person-centered, provides incentives for the right outcomes, is sustainable, emphasizes coordinated care and shared decision making, and relies on transparency of quality and cost information.”

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12/08/16 – Medicare Outpatient Observation Notice (MOON)

Enacted August 6, 2015, the Notice of Observation Treatment and Implication for Care Eligibility Act (NOTICE Act) requires hospitals and Critical Access Hospitals (CAH) to provide notification to individuals receiving observation services as outpatients for more than 24 hours explaining the status of the individual as an outpatient, not an inpatient, and the implications of such status.

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Click here to view the finalized, OMB-approved Medicare Outpatient Observation Notice


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12/02/16 – CMS Releases 2015 National Health Expenditures

In 2015, per-capita health care spending grew by 5.0 percent and overall health spending grew by 5.8 percent, according to a study by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) published today as a Web First by Health Affairs. Those annual rates continue to be below the rates of most years prior to passage of the Affordable Care Act. And, even as millions of people gained coverage, per-enrollee spending growth in private health insurance and Medicare continue to be well below the average in the decade before passage of the Affordable Care Act.

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11/30/16 – Biweekly Enrollment Snapshot

WEEKS 3 AND 4, NOV 13 – 26, 2016 Four weeks into Open Enrollment, millions of Americans continue to visit HealthCare.gov and sign up for Marketplace plans, demonstrating the strong demand for quality, affordable coverage. Over 2.1 million people have selected plans using the HealthCare.gov platform since Open Enrollment began on November 1, including over half a million new consumers and 1.6 million consumers renewing their coverage. Enrollments for these two weeks represent an increase of 167,000 plan selections versus the third and fourth weeks of Open Enrollment last year. In addition, the total number of plan selections at this point exceeds last year by over 97,000, even though this year’s totals include two fewer days. In addition to national data, this snapshot includes state-by-state plan selection estimates for those states using HealthCare.gov.

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11/22/16 – UMass Settles Potential HIPAA Violations Following Malware Infection

The University of Massachusetts Amherst (UMass) has agreed to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules. The settlement includes a corrective action plan and a monetary payment of $650,000, which is reflective of the fact that the University operated at a financial loss in 2015.  

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11/17/16 – CMS Launches New Online Tool to Make Quality Payment Program Easier for Clinicians

Today, the Centers for Medicare & Medicaid Services (CMS) released a tool to share automatically electronic data for the Medicare Quality Payment Program. This new release is the first in a series that will be part of CMS’s ongoing efforts to spur the creation of innovative, customizable tools to reduce burden for clinicians, while also supporting high-quality care for patients.

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11/14/16 – CMS Approves Michigan Plan to Abate Lead Hazards from Flint and Other Impacted Areas in the State with Federal Support

The Centers for Medicare & Medicaid Services (CMS) approved a Michigan State Plan Amendment (SPA) today that uses federal and state funding to expand lead abatement activities in the impacted areas of Flint and other areas in Michigan. This targeted and time-limited effort will complement other federal, state and local efforts to abate lead hazards from the homes and improve the health of Medicaid and Children’s Health Insurance Program (CHIP) eligible residents.

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11/14/16 – Michigan Health Services Initiative

Today the Centers for Medicare & Medicaid Services (CMS) approved a Michigan State Plan Amendment (SPA) for a Title XXI state-designed Health Services Initiative (HSI) for expanded lead abatement activities in the impacted areas of Flint, Michigan and other areas within the state of Michigan. CMS worked closely with Michigan as it developed its plan. The targeted and time-limited HSI will complement other federal, state and local efforts to abate lead hazards from the homes and improve the health of Medicaid and Children’s Health Insurance Program (CHIP) eligible individuals.

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11/14/16 – Update to the Medicare Drug Spending Dashboard

As part of its effort to provide additional information on, and increase transparency with respect to the cost of prescription drugs, CMS is updating the Medicare Drug Spending Dashboard to include information for 2015. This online dashboard presents information for three categories of Medicare prescription drugs for both Part B and Part D: drugs with high spending on a per user basis, drugs with high spending for the program overall, and drugs with high unit cost increases in recent years.

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11/14/16 – Update to the Medicare Drug Spending Dashboard

As part of its effort to provide additional information on, and increase transparency with respect to the cost of prescription drugs, CMS is updating the Medicare Drug Spending Dashboard to include information for 2015. This online dashboard presents information for three categories of Medicare prescription drugs for both Part B and Part D: drugs with high spending on a per user basis, drugs with high spending for the program overall, and drugs with high unit cost increases in recent years.

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11/14/16 – Medicaid Drug Spending Dashboard

Medicaid is a state-federal partnership that provides health insurance to over 73 million beneficiaries and spent approximately $57 billion on prescription drugs in 2015. The Centers for Medicare & Medicaid Services (CMS) released a new online dashboard to look at Medicaid spending on covered outpatient drugs, as part of CMS’ effort to provide additional information on and increase transparency with respect to the cost of prescription drugs. Although the dashboard presents data on a relatively small number of drugs, these drugs represent approximately 41% of Medicaid covered outpatient drug spending in 2015.

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11/10/16 – Quality Payment Program Presentations Available

Learn more about the Quality Payment Program by reviewing two recent presentations.
 
 

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11/10/16 – Draft 2018 Letter to Issuers in the Federally-facilitated Marketplaces

The Centers for Medicare & Medicaid Services (CMS) is releasing this draft 2018 Letter to Issuers in the Federally-facilitated Marketplaces (Letter). This Letter provides issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Marketplaces (FFMs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs) with operational and technical guidance to help them successfully participate in any such Marketplaces in 2018. Unless otherwise specified, references to the FFMs include the FF-SHOPs.

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11/10/16 – Draft Rate Review Timeline Bulletin

The Centers for Medicare & Medicaid Services (CMS) is releasing this draft bulletin for comment on the proposed uniform timeline for submission and public release of information about rate filings for single risk pool coverage, consistent with 45 CFR Part 154.

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11/10/16 – Proposed Key Dates for Calendar Year 2017: QHP Certification in the Federally-facilitated Marketplaces; Rate Reviews; Risk Adjustment and Insurance 

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11/10/16 – 2017 Medicare Parts A & B Premiums and Deductibles Announced

Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2017 premiums for the Medicare inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs.

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11/10/16 – CMS and Indian Health Service Expand Collaboration to Improve Health Care in Hospitals

Efforts Benefit 2.2 Million American Indians and Alaska Natives Eligible for HIS Services – The Centers for Medicare & Medicaid Services (CMS) now includes Indian Health Service (IHS) Hospitals in the nationwide Hospital Improvement and Innovation Networks (HIINs) contract for public and private sector hospitals to reduce adverse events by 20 percent and hospital readmissions by 12 percent. This commitment to American Indian and Alaska Native (AI/AN) health care is part of ongoing CMS and IHS work to address issues in hospitals before they can affect patients.

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11/09/16 - CMS Announces $66.1 Million to Support Zika Prevention & Treatment Services

Today, the Centers for Medicare & Medicaid Services (CMS) announced a funding opportunity providing up to $66.1 million available to support prevention activities and treatment services for health conditions related to the Zika virus. Congress authorized this funding in the Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2017, and Zika Response and Preparedness Act (P.L. 114-223).

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11/04/16 – Michigan Three-Way Contract Update

The newly-executed Michigan MI Health Link three-way contract has posted.

Click here to view the summary of contract changes

Click here to view the updated contract


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11/03/16 – CMS Publishes Proposed Rule on Fire Safety Requirements for Applicable Dialysis Facilities

Today, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule to update Medicare fire protection guidelines for certain dialysis facilities to ensure that patients are protected from fire while receiving treatment in those facilities. CMS strives to promote health and safety for all patients, family, and staff in every provider and supplier setting, and fire safety requirements are an important part of this effort.

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11/02/16 – HHS Announces Phase 1 Winners of the Move Health Data Forward Challenge

Proposals Designed to Help Consumers Share their Personal Health Data Easily and Securely

The Department of Health and Humans Services’ Office of the National Coordinator for Health Information Technology (ONC) today announced the Phase 1 winners of the Move Health Data Forward Challenge. Winners were selected based on their proposals for using application programming interfaces (API) to enable consumers to share their personal health information safely and securely with their health care providers, family members or other caregivers. “As health information technology becomes more accessible, consumers are playing an even greater role in how and when their health information is exchanged or shared,” said Dr. Vindell Washington, national coordinator for health information technology. “The Move Health Data Forward Challenge will help consumers unleash their health data and put it to work.”
 
 

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11/02/16 – Final Policy, Payment, and Quality Provisions in the Medicare Physician Fee Schedule for Calendar Year (CY) 2017

On Wednesday, November 2, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017. CMS finalized a number of new PFS policies that will improve Medicare payment for those services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioral health issues, and cognitive impairment conditions.

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11/02/16 – Medicare Finalizes Substantial Improvements that Focus on Primary Care, Mental Health, and Diabetes Prevention

Medicare Finalizes Policies to Expand the Diabetes Prevention Model

Today, the Centers for Medicare & Medicaid Services (CMS) finalized the 2017 Physician Fee Schedule final rule that recognizes the importance of primary care by improving payment for chronic care management and behavioral health. The rule also finalizes many of the policies to expand the Diabetes Prevention Program model test to eligible Medicare beneficiaries, the Medicare Diabetes Prevention Program (MDPP) expanded model, starting January 1, 2018. This is the first time a prevention model from the CMS Innovation Center will be adopted under the CMS authority to expand successful payment and service delivery models to reach all eligible beneficiaries.

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Click here to view the fact sheet


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11/01/16 – HHS Launches 2017 Open Enrollment, Encourages Americans to Shop for Affordable Coverage on HealthCare.gov

More than 85% of Marketplace Consumers will Qualify for Tax Credits, Most to Find Plans for Less than $75/Month

Today, HHS announced that the Health Insurance Marketplaces are open for business, and Americans can again shop for high-quality, affordable coverage on an open, transparent market. This year, most Marketplace consumers will again have plan options for less than $75 per month, thanks to financial assistance.
 
 

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11/01/16 – CMS Hospital Value-Based Purchasing Program Results for Fiscal Year 2017

The Hospital Value-Based Purchasing (VBP) Program adjusts what Medicare pays hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of care they provide to patients. For fiscal year (FY) 2017, the law requires that the applicable percent reduction, the portion of Medicare payments available to fund the program’s value-based incentive payments, increase from 1.75 to 2 percent of the base operating Medicare Severity Diagnosis-Related Group (MS-DRG) payment amounts for all participating hospitals. We estimate that the total amount available for value-based incentive payments for FY 2017 discharges will be approximately $1.8 billion.

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11/01/16 – CMS Finalizes Hospital Outpatient Prospective Payment System Changes to Better Support Hospitals and Physicians and Improve Patient Care

Today, the Centers for Medicare & Medicaid Services (CMS) finalized updated payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System for calendar year (CY) 2017. These finalized policy changes will improve the quality of care Medicare patients receive by better supporting their physicians and other health care providers and reflect a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people.

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Click here to view the fact sheet


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10/27/16 – CMS Announces Target Markets for Open Enrollment 2017

Local Partnerships and Focused Communication will Help Drive Enrollment

Today, the Centers for Medicare and Medicaid Services (CMS) announced 15 target markets for this year’s Open Enrollment. As in previous years, the target markets will be a particular focus for outreach, travel, and collaborations with local partners, also in addition to other nationwide efforts to step up outreach.

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10/26/16 - Vermont All-Payer ACO Model Joins Growing State-Based Efforts To Deliver Better Health Care, Reduce Costs

The Centers for Medicare & Medicaid Services (CMS) and the state of Vermont jointly announced today the Vermont All-Payer Accountable Care Organization (ACO) Model, a new initiative aimed at accelerating delivery system reform for Vermont residents. The Vermont All-Payer ACO Model aims to transform health care for the entire state and its population. Through the model, the most significant payers throughout the state – Medicare, Medicaid, and commercial health care payers – will incentivize health care value and quality, with a focus on health outcomes, under the same payment structure for the majority of providers throughout the state’s care delivery system. Today, CMS also approved a five-year extension of Vermont’s section 1115(a) Medicaid demonstration, which, in addition to extending the state’s comprehensive demonstration, includes the authorities needed to make Medicaid a full partner in the Vermont All-Payer ACO Model.
 
 

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10/26/16 – Medicare and Medicaid Plans – A Technical Guide to Eligibility and Enrollment Transaction Processing

The Medicare-Medicaid Plan (MMP) Enrollment Technical Guidance (Version 2.7) has posted.  It has been (revised and updated with guidance to incorporate CMS 11/2016 software changes as well as the addition of "enrollment source code" to each Medicare enrollment occurrence and period for States.) 
 
 

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10/25/16 – Appendix 5: Additional State-Specific Enrollment Guidance Requirements for Michigan Medicare-Medicaid plans posted

This document defines Michigan specific Enrollment/Disenrollment Requirements where there are differences from the national Medicare-Medicaid Plan (MMP) Enrollment and Disenrollment Guidance as published by the Centers for Medicare & Medicaid (CMS) on June 14, 2013.

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10/25/16 - CMS Announces Additional Opportunities For Clinicians To Join Innovative Care Approaches Under The Quality Payment Program

Today, the Centers for Medicare & Medicaid Services (CMS) announced new opportunities for clinicians to join Advanced Alternative Payment Models (APMs) developed by the CMS Innovation Center to improve care and potentially earn an incentive payment under the Quality Payment Program created through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Quality Payment Program rewards clinicians with sufficient participation in Advanced APMs that align incentives for high-quality, patient-centered care. By giving more clinicians the opportunity to participate in these models, today’s announcement will extend the benefits of high-quality, coordinated care to more Medicare beneficiaries.

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Click here to view the fact sheet


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10/25/16 – HHS FACT Sheet: Delivery System Reform: Progress and the Future

As the largest health care purchaser in this country, the Department of Health and Human Services is directly responsible for ensuring access to high quality health care services for more than 100 million Americans. This Administration is dedicated to using that role to ensure that all Americans receive better care; that we spend our health care dollars more wisely; and that we have healthier communities, a healthier economy, and ultimately, a healthier country. To accomplish these goals, we are working with State and private partners to drive change throughout the system by find better ways of paying providers, delivering care, and sharing information. We call these efforts delivery system reform, and we are making tremendous strides in advancing high-quality patient care.

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10/25/16 – CMS Announces Additional Opportunities for Clinicians to Join Innovative Care Approaches Under the Quality Payment Program

Today, the Centers for Medicare & Medicaid Services (CMS) announced new opportunities for clinicians to join Advanced Alternative Payment Models (APMs) developed by the CMS Innovation Center to improve care and potentially earn an incentive payment under the Quality Payment Program created through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The Quality Payment Program rewards clinicians with sufficient participation in Advanced APMs that align incentives for high-quality, patient-centered care. By giving more clinicians the opportunity to participate in these models, today’s announcement will extend the benefits of high-quality, coordinated care to more Medicare beneficiaries.

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10/25/16 – HHS Collaborates with Innovative Companies to Encourage Marketplace Enrollment

Outreach will Boost Effort to Reach More Americans than Ever Starting November 1st

Ahead of the fourth Open Enrollment period, the U.S. Department of Health and Human Services today announced a commitment from seventeen companies to support enrollment in the Health Insurance Marketplace. These companies will connect freelance professionals, entrepreneurs, and customers with information and resources to encourage enrollment in affordable coverage throughout the Open Enrollment period beginning November 1 and ending on January 31.

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10/24/16 – More Than 70 Percent of Consumers Can Find Marketplace Plans for Less than $75 Per Month

With Start of Window Shopping, Americans Can Now Check Out Options for 2017 Coverage – With window shopping beginning today, Health Insurance Marketplace consumers can now visit HealthCare.gov to check out their options for 2017 coverage in advance of the start of Open Enrollment on November 1. A new report released today shows that 72 percent of Marketplace consumers in states using HealthCare.gov will be able to find plans with a premium of less than $75 per month and 77 percent will be able to find plans with premiums below $100, taking into account financial assistance. The report also shows that consumers will have options, with an average of 30 health insurance plans to choose from.

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10/21/16 – Hospital Compare is Updated with VA Hospital Performance Data

Today, the Centers for Medicare & Medicaid Services (CMS) is pleased to announce the inclusion of Department of Veterans Affairs (VA) hospital performance data. The VA hospital performance data can be found via a link on Hospital Compare: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalCompare.html. Additional VA hospital data will be added in December with plans for future seamless integration of VA data onto the Hospital Compare website to allow comparison of performance between VA and civilian acute care hospitals.  

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10/19/16 – First Half of 2016 Effectuated Enrollment Snapshot

For the first half of 2016, an average of 10.4 million consumers had effectuated Health Insurance Marketplace coverage – which means those individuals, paid their premiums and had an active policy through one of the Health Insurance Marketplaces nationwide as of that date. [i] Effectuated enrollment is generally lower in January and February, since coverage purchased in the weeks before the final Open Enrollment deadline does not begin until March. June effectuated enrollment was slightly higher than the average for the first half of the year, about 10.5 million. These amounts do not include individuals enrolled in coverage through New York and Minnesota’s Basic Health Programs, which currently enroll about 650,00 people.

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10/18/16 - $294 Million in Primary Care Workforce Awards Help Expand Access to Primary Care

Today, the U.S. Department of Health and Human Services (HHS) announced more than $294 million in awards to primary care clinicians and students through the National Health Service Corps (NHSC)and NURSE Corps Scholarship and Loan Repayment Programs. This funding helps to increase access to primary health care services in the communities that need it most.

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10/18/16 - $2.14 Million HIPAA Settlement Underscores Importance Of Managing Security Risk

St. Joseph Health (SJH) has agreed to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules following the report that files containing electronic protected health information (ePHI) were publicly accessible through internet search engines from 2011 until 2012. SJH, a nonprofit integrated Catholic health care delivery system sponsored by the St. Joseph Health Ministry, will pay a settlement amount of $2,140,500 and adopt a comprehensive corrective action plan. SJH’s range of services includes 14 acute care hospitals, home health agencies, hospice care, outpatient services, skilled nursing facilities, community clinics and physician organizations throughout California and in parts of Texas and New Mexico.

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10/14/16 – HHS Issues Final Rule to Enhance the Reliability, Transparency, Accountability, and Safety of Certified Health Information Technology

Today, the U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) issued a final rule that emphasizes the importance of protecting public health and safety while also strengthening transparency and accountability in the ONC Health IT Certification Program (“Program”).

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10/14/16 – HHS Finalizes Streamlined Medicare Payment System that Rewards Clinicians for Quality Patient Care

MACRA Rule will Accelerate Health Care System’s Shift Toward Value

Today, the Department of Health & Human Services (HHS) finalized a landmark new payment system for Medicare clinicians that will continue the Administration’s progress in reforming how the health care system pays for care. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program, which replaces the flawed Sustainable Growth Rate (SGR), will equip clinicians with the tools and flexibility to provide high-quality, patient-centered care. With clinicians as partners, the Administration is building a system that delivers better care, one in which clinicians work together and have a full understanding of patients’ needs, Medicare pays for what works and spends taxpayer money more wisely, and patients are in the center of their care, resulting in a healthier country.

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Click here to view the executive summary

Click here to view the final rule


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10/13/16 - CMS Announces New Initiative To Increase Clinician Engagement

First step of the initiative is to reduce medical review for certain Advanced Alternative Payment Models

Today, the Centers for Medicare & Medicaid Services (CMS) announced a new initiative to improve the clinician experience with the Medicare program. As we implement delivery system reforms from the Affordable Care Act and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), this new long-term effort aims to reshape the physician experience by reviewing regulations and policies to minimize administrative tasks and seek other input to improve clinician satisfaction. The initiative will be led by senior physicians within CMS who will report to the Office of the Administrator.

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Click here to view the fact sheet


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10/13/16 – CMS Details Outreach Campaign Strategy for Open Enrollment 2017

Better Targeting and New Tactics will Connect with Consumers, Drive Open Enrollment Success

Every year, the Administration gets better and more strategic in our efforts to help millions of Americans enroll in affordable coverage. While the uninsured rate has fallen to the lowest level on record, there are still too many Americans who remain uninsured and experience health and financial hardships resulting from lack of coverage. A key reason people remain uninsured is that they don’t know about the options that exist to help them obtain coverage. Experts continue to find that nearly half of uninsured adults are unaware of the financial assistance available to help pay for health insurance, even though about 85 percent of Marketplace-eligible uninsured Americans could qualify for financial help.  

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10/12/16 – 2017 Star Ratings

One of the Centers for Medicare & Medicaid Services’ (CMS) most important strategic goals is to improve the quality of care and general health status for Medicare beneficiaries. CMS publishes the Part C and D Star Ratings each year to: measure quality in Medicare Advantage (MA) and Prescription Drug Plans (PDPs or Part D plans), assist beneficiaries in finding the best plan for them, and determine MA Quality Bonus Payments. Moreover, the ratings support the efforts of CMS to improve the level of accountability for the care provided by physicians, hospitals, and other providers. Star Ratings are driving improvements in Medicare quality. The information included in this Fact Sheet is evidence of such improvement and is based on the 2017 Star Ratings published on Medicare Plan Finder (MPF) on October 12, 2016.

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Click here to view the final 2017 Call Letter

Click here to view the Medicare Part C & D Star Rating Technical Notes


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10/06/16 – CMS Releases New Date to Increase Transparency on Medicare Hospice Payments and the Third Release of the Market Saturation and Utilization Data Tool

Data Serves as Comprehensive Resource for Information on Payments and Utilization

As part of our efforts to improve care delivery, payments to providers, and the sharing and utilization of information, the Centers for Medicare & Medicaid Services (CMS) today released a privacy-protected public data set, the Hospice Utilization and Payment Public Use File (Hospice PUF), which provides information on services provided to Medicare beneficiaries by hospice providers. CMS also released an update to the Market Saturation and Utilization Data Tool, formerly called the Moratoria Provider Services and Utilization Data Tool. For the first time, this tool will include information on hospice services.

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Click here to view the fact sheet


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10/04/16 – New Analysis Shows 2.5 Million Americans Currently Buying Individual Health Coverage Off-Marketplace May Be Eligible for Affordable Care Act Premium Tax Credits

HHS Encourages Consumers to Evaluate Marketplace Options During Upcoming Open Enrollment

Since the Affordable Care Act became law, millions of Americans gained coverage or found more affordable options thanks to premium tax credits available through the Health Insurance Marketplace. Today, the U.S. Department of Health and Human Services (HHS) released data showing that 2.5 million Americans who currently purchase off-Marketplace individual market coverage may qualify for tax credits if they shop for 2017 coverage through the Marketplace.  Six states (California, Texas, Florida, North Carolina, Illinois, and Pennsylvania) each have more than 100,000 individuals enrolled in off-Marketplace individual market coverage whose incomes may qualify them for Marketplace tax credits.

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Click here to view today's brief


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10/04/16 – HHS Awards Funding to Help Protect Health Sector Against Cyber Threats

The U.S. Department of Health and Human Services (HHS) has awarded cooperative agreements totaling $350,000 to strengthen the ability of health care and public health sector partners to respond to cybersecurity threats. The agreements will foster the development of a more vibrant cyber information sharing ecosystem within the health care and public health sector.

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10/04/16 – CMS Selects Quality Improvement Organization to Support Quality Improvement at Indian Health Service Hospitals

The Centers for Medicare & Medicaid Services (CMS) awarded a new contract to help support best health care practices and other operational improvements for Indian Health Service (IHS) federal government operated hospitals that participate in the Medicare program. HealthInsight, a current Quality Innovation Network – Quality Improvement Organization (QIN-QIO), will partner with IHS hospitals to continuously improve the quality of care for the Medicare patients they serve. These efforts will also benefit other patients receiving care at the same facilities. This award is part of a larger IHS quality initiative supported by the Department of Health and Human Services (HHS) Executive Council on Quality Care led by HHS Acting Deputy Secretary Mary K. Wakefield. With this collaborative strategy, IHS and CMS are working together to achieve and sustain improvements in quality of care.

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10/03/16 – CMS Awards $300,000 to the Greater Flint Health Coalition to Help Reduce the Number of Uninsured Children in Flint, Michigan

The Centers for Medicare & Medicaid Services (CMS) today will award $300,000 to the Greater Flint Health Coalition (GFHC) in an effort to get more eligible children in Flint, Michigan enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) and to help connect children to services. This award is in response to the public health emergency resulting from lead exposure related to the Flint water system.

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10/03/16 – Participants Selected for Part D Enhanced Medication Therapy Management Model

Today, the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (Innovation Center) is announcing the participants in the Part D Enhanced Medication Therapy Management (MTM) model. This Enhanced MTM model offers an opportunity and financial incentives for basic stand-alone Part D Prescription Drug Plans (PDPs) in selected regions to offer innovative MTM programs in lieu of the standard CMS MTM model, aimed at improving the quality of care while also reducing costs. As part of the “better care, smarter spending, healthier people” approach to improving health delivery, CMS will test changes to the Part D program that aim to achieve better alignment of PDP sponsor and government financial interests, while also creating incentives for robust investment and innovation in MTM targeting and interventions. The objectives for this model are for stand-alone PDP sponsors to identify and implement innovative strategies to optimize medication use, improve care coordination, and strengthen system linkages.

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10/03/16 – Medicare Advantage Value-Based Insurance Design Model

The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation is announcing refinements to the design of the second year of the Medicare Advantage Value-Based Insurance Design (MA-VBID) model. The MA-VBID model is an opportunity for Medicare Advantage plans (MA plans), including Medicare Advantage plans offering Part D benefits (MA-PD plans), to offer clinically nuanced benefit packages aimed at improving quality of care while also reducing costs.

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09/30/16 – Financial Alignment Initiative Annual Report: One Care: MassHealth plus Medicare

The First Annual Report on the Massachusetts Capitated model demonstration under the Medicare-Medicaid Financial Alignment Initiative posted

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09/29/16 – Every Income Group Experienced Significant and Similar Drops in Uninsured Rates Under the Affordable Care Act

ACA Led to Widespread Coverage Gains Across Income, Age, Geography, and Race; Expanding Medicaid Significantly Strengthens Gains

Today, the U.S. Department of Health and Human Services released new research analyzing gains in health insurance coverage from 2010-2015 across key demographic categories of Americans: income, age, geography, race and ethnicity. The report finds that ACA coverage gains have been widely shared across groups. For example, the uninsured rate fell by around 40 percent for Americans in all income groups for 2010 through 2015, including individuals with incomes above 400 percent of the federal poverty level (FPL).

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Click here to view today's issue brief

Click here to view the charts from today's brief


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09/29/16 – CMS Finalizes Improvements in Care, Safety, and Consumer Protections for Long-Term Care Facility Residents

Revisions Mark First Major Rewrite of the Conditions of Participation for Long-Term Care Facilities Since 1991

Today, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to make major changes to improve the care and safety of the nearly 1.5 million residents in the more than 15,000 long-term care facilities that participate in the Medicare and Medicaid programs. The policies in this final rule are targeted at reducing unnecessary hospital readmissions and infections, improving the quality of care, and strengthening safety measures for residents in these facilities. These changes are an integral part of CMS’s commitment to transform our health system to deliver better quality care and spend our health care dollars in a smarter way, setting high standards for quality and safety in long-term care facilities.

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09/29/16 – Transforming Clinical Practice Initiative Support and Alignment Networks 2.0

Updated September 2016

Americans deserve a health care system that delivers the right care, at the right time, and at a cost that is reasonable and easy to understand. Such a system will result in fewer unnecessary hospital admissions and readmissions, fewer healthcare-associated infections, reduced patient harm, and will show continuous improvement in quality of care and cost efficiency.

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09/29/16 – CMS Awards $347 Million to Continue Progress Toward a Safer Health Care System

Hospital Improvement and Innovation Networks to Continue Patient Safety Improvement Efforts Started Under the Partnership for Patients Initiative

The Centers for Medicare & Medicaid Services (CMS) awarded $347 million to 16 national, regional, or state hospital associations, Quality Improvement Organizations, and health system organizations to continue efforts in reducing hospital-acquired conditions and readmissions in the Medicare program. The Hospital Improvement and Innovation Network contracts awarded today build upon the collective momentum of the Hospital Engagement Networks and Quality Improvement Organizations to reduce patient harm and readmissions. This announcement is part of a broader effort to transform our health care system into one that works better for the American people and for the Medicare program. The Administration has a vision of a system that delivers better care, spends our dollars in a smarter way, and puts patients in the center of their care to keep them healthy.

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Click here to view the fact sheet


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09/28/16 – HHS Awards $1.5 Million to Improve Information Flow for Patients and Providers

The U.S. Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) today announced seven recipients of two Cooperative Agreement programs to improve the flow of health information.

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09/27/16 – Next Generation ACO Model: Frequently Asked Questions

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09/27/16 – Administration Launches New Campaign to Enroll Young Adults During Open Enrollment

New Outreach Platforms, Better Mobile Experience, and Strong Partners will Help Reach Young Adults

Today, as the White House convenes the Millennial Outreach and Enrollment Summit, the Centers for Medicare and Medicaid Services (CMS) announced additional initiatives to reach young adults during Open Enrollment and help them find affordable coverage through HealthCare.gov. Young adults had the highest uninsured rates before the Affordable Care Act and have seen the sharpest drop in uninsured rates since 2010. Yet millions of young adults remain uninsured, showing that there is more work to do to equip younger Americans with the tools and information they need to access coverage through the Health Insurance Marketplace. Today, we are announcing new strategies, new tools, and new partnerships to reach young people and help them get covered.

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09/26/16 – EHR Contract Guide and Health Playbook Help Clinicians and Hospitals Get the Most Out of Health Information Technology

New Tools Serve as Practical, Easy-To-Understand Resources to Help Health Care Providers Increase Information Flow to Improve Health Care Delivery

The U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) today released two practical, easy-to-understand tools to help health care providers get the most out of their health information technology (health IT), such as electronic health records (EHRs): an EHR contract guide - PDF and a newly expanded Health IT Playbook.

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09/23/16 – HIPAA Settlement Illustrates the Importance of Reviewing and Updating, as Necessary, Business Associate Agreements

Care New England Health System (CNE), on behalf of each of the covered entities under its common ownership or control, has agreed to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules.  The settlement includes a monetary payment of $400,000 and a comprehensive corrective action plan. CNE provides centralized corporate support for its subsidiary affiliated covered entities, which include a number of hospitals and health care providers in Massachusetts and Rhode Island.  These functions include, but are not limited to, finance, human resources, information services and technical support, insurance, compliance and administrative functions.

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9/22/16 – HHS Awards More than $44.5 Million to Expand the Nation’s Behavioral Health Workforce

The U.S. Department of Health and Human Services (HHS) today announced more than $44.5 million in awards to training programs to increase the number of mental health providers and substance abuse counselors across the country.

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Click here for a complete list of fiscal year 2016 BHWET recipients


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09/22/16 – Medicare Advantage Premiums Remain Stable in 2017; Beneficiaries Have Saved Over $23.5 Billion on Prescription Drugs

The Affordable Care Act has made the Medicare Program Stronger for Seniors and People with Disabilities

Today, the Centers for Medicare & Medicaid Services (CMS) announced that 2017 Medicare Advantage premiums will remain stable and more enrollees will have access to higher quality plans while, for the seventh straight year, enrollment is projected to increase to a new all-time high. In addition, CMS released today updated information that shows that millions of seniors and people with disabilities with Medicare continue to enjoy prescription drug discounts and affordable benefits as a result of the Affordable Care Act. Today’s announcement comes as CMS releases the premiums and costs for Medicare health and drug plans for the 2017 calendar year.

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Click here to view the fact sheet


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09/20/16 – CMS Bundled Payments for Care Improvements Initiative Models 2-4: Year 2 Evaluation & Monitoring Annual Report

By The Lewin Group

The Bundled Payments for Care Improvement (BPCI) initiative is designed to test whether linking the payments for all providers involved in delivering an episode of care can reduce Medicare costs while maintaining or improving quality of care. The Centers for Medicare & Medicaid Services (CMS) launched the BPCI initiative under the authority of the Center for Medicare and Medicaid Innovation. BPCI Awardees, which can include hospitals, physician groups, post-acute care (PAC) providers and other entities, entered into agreements with CMS to be held accountable for total Medicare episode payments. Those agreements also specify Awardees’ choices among four payment models, 48 clinical episodes, three episode lengths and waiver options.

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09/15/16 – HHS Awards Over $87 Million for Health Centers’ IT Enhancement

Today, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced more than $87 million in funding for 1,310 health centers in every U.S. state, the District of Columbia, Puerto Rico, the Virgin Islands and the Pacific Basin.

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09/14/16 – New Data Show Major Improvements in Health Care Access, Affordability, and Quality Under the Affordable Care Act

American Families Saving $3600 from Slower Growth in Employer Premiums Since 2010

New studies released this week show Americans are experiencing slower growth in health care premiums, increased access to coverage, and higher quality of care under the Affordable Care Act (ACA).

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09/08/16 – Accountable Health Communities (AHC) Model Track 1 - Awareness

Many of the biggest drivers of health care use and costs are beyond the scope of health care alone. Health-related social needs often are left undetected and unaddressed. Unmet health-related social needs, such as food insecurity and inadequate or unstable housing, may increase the risk of developing chronic conditions, reduce an individual’s ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization.

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09/08/16 – Next Steps for the State Innovation Models Initiative Request for Information

The State Innovation Models (SIM) Initiative was launched in 2013 to test the ability of state governments to use their policy and regulatory levers to accelerate healthcare transformation efforts in their states, with a primary goal to transform over 80 percent of payments to providers into innovative payments and service delivery models. SIM has supported over 38 states, territories, and the District of Columbia in two rounds of awards. The Centers for Medicare & Medicaid Services (CMS) has set ambitious goals for health system transformation, and we recognize that much of this transformation will ultimately occur at the state and community level. Our investment in SIM is a recognition of the important role states play as a locus for change to accelerate transformation, and their unique leverage point to implement models consistent with the proposed Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

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09/08/16 – CMS Finalizes Rule to Bolster Emergency Preparedness of Certain Facilities Participating in Medicare and Medicaid

Today, the Centers for Medicare & Medicaid Services (CMS) finalized a rule to establish consistent emergency preparedness requirements for health care providers participating in Medicare and Medicaid, increase patient safety during emergencies, and establish a more coordinated response to natural and man-made disasters.

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Click here to view the rule


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09/08/16 – Competitive Bidding Program Continues to Maintain Access and Quality While Helping to Save Medicare Millions

The Centers for Medicare & Medicaid Services (CMS) today announced the new single payment amounts and began sending contract offers to successful bidders for Medicare’s Round 1 2017 Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. These new payment amounts and contracts go into effect on January 1, 2017. This program has been an essential tool to help Medicare set appropriate payment rates for DMEPOS items and save money for beneficiaries and taxpayers while ensuring access to quality items.

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09/07/16 – State Innovation Models (SIM) Initiative Evaluation

Model Test Year Two Annual Report

The State Innovation Models (SIM) Initiative within the Center for Medicare and Medicaid Innovation (the Innovation Center) is testing the ability of state governments to accelerate statewide health care system transformation from encounter-based service delivery to care coordination, and from volume-based to value-based payment. The underlying belief is that more coordinated and accountable care is better care and leads to smarter spending and healthier people. Through the SIM Initiative, the Innovation Center recognizes the unique role states can play—as regulators, legislators, conveners, and both suppliers and purchasers of health care services—and calls on states to use a wide array of policy levers, engage a broad range of stakeholders, and build on existing efforts to bring about or accelerate health care system transformation.

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09/06/16 – CMS Awards Consumer Assistance Funding to Support 2017 Health Insurance Marketplace Enrollment

With open enrollment for 2017 only a few weeks away, the Centers for Medicare & Medicaid Services (CMS), announced $63 million in Navigator grant awards to returning and new organizations. These awards will support local in-person assistance to help consumers navigate, shop, and enroll in the wide variety of Marketplace coverage options.

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09/02/16 – 2017 Medicare Electronic Health Record (EHR) Incentive

Program Payment Adjustment for Hospitals

As part of the American Recovery and Reinvestment Act of 2009 (ARRA), Congress established payment adjustments under Medicare for eligible hospitals that are not meaningful users of Certified Electronic Health Record Technology (CEHRT). Eligible hospitals that do not successfully demonstrate meaningful use for an EHR reporting period associated with a payment adjustment year will receive reduced Medicare payments for that year.

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08/30/16 – Washington Financial Alignment Demonstration (HealthPath Washington)

The First Annual Report on the Washington Health Homes Managed Fee-for-Service (MFFS) Demonstration under the Medicare-Medicaid Financial Alignment Initiative posted.

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08/29/16 – CMS Proposes New Standards to Strengthen the Marketplace for 2018

The Centers for Medicare & Medicaid Services (CMS) today issued the proposed annual Notice of Benefit and Payment Parameters for 2018, which proposes additional steps to strengthen the Health Insurance Marketplace. CMS is issuing this rule earlier in the calendar year in order to provide more certainty to the Marketplace as it continues to mature.

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Click here to view the proposed rule.

Click here to view the fact sheet. 


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08/25/16 – Physicians and Health Care Providers Continue to Improve Quality Care, Lower Costs

Affordable Care Act Accountable Care Organization Initiatives Put Patients at the Center of their Care While Generating More than $1.29 Billion in Total Medicare Savings Since 2012

The Centers for Medicare & Medicaid Services (CMS) today announced the 2015 performance year results for the Medicare Shared Savings Program and the Pioneer Accountable Care Organization Model that show physicians, hospitals, and health care providers participating in Accountable Care Organizations continue to make significant improvements in the quality of care for Medicare beneficiaries, while achieving cost savings. Collectively, Medicare Accountable Care Organizations have generated more than $1.29 billion in total Medicare savings since 2012.

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Click here to for a more detailed information on quality and financial results.


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08/25/16 – Medicaid Expansion Lowers Marketplace Premiums by 7 Percent

New Analysis Finds Medicaid Expansion Brings Down Marketplace Rates – Another Benefit on Top of Gains for Low-Income Individuals and State Economies

Today, the U.S. Department of Health and Human Services released a report showing that expanding Medicaid lowers Marketplace premiums by about 7 percent in those states.

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Click here to read the complete report.


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08/24/16 – New Analysis Shows Consumers Will Still Have Affordable Health Coverage Optios Next Year

An Estimated 73 Percent of HealthCare.gov Consumers Could Still Purchase a Plan for Less than $75 per Month, Even if All Rates were to Increase by Double Digits

Since the Affordable Care Act became law, health care prices have risen at the lowest rate in 50 years, and premiums for the 150 million Americans with employer-sponsored insurance have grown at some of the slowest rates on record. Today, a new HHS analysis finds that HealthCare.gov consumers would continue to have affordable coverage options, even if all Marketplace final health insurance premium rates were to increase by double digits next year. In a hypothetical scenario where all rates increase by 25 percent, the vast majority of consumers (73%) would be able to purchase coverage for less than $75 per month, according to today’s report. All Marketplace premiums will be finalized and public in October.

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08/18/16 - CMS Releases New Prescription Drug Cost Data

Second Annual Release Provides Clearer Look Into Medicare Part D Costs And Services

Continuing the commitment to greater data transparency, the Centers for Medicare & Medicare Services (CMS) today released privacy-protected data on the prescription drugs that were paid for under the Medicare Part D Prescription Drug Program in 2014. This is the second release of the data on an annual basis, which shows which prescription drugs were prescribed to Medicare Part D enrollees by physicians and other healthcare professionals.  “With this data release, patients, researchers and providers can access valuable information about the Medicare prescription drug program,” said Niall Brennan, CMS Chief Data Officer. “Today’s release joins a series of actions the Administration is taking to improve transparency around government data, including the cost of prescription drugs.”

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Click here to read the fact sheet

Click here to access the 2014 Medicare Part D Prescriber Data


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08/18/16 - Michigan MMPs: Release of Final Contract Year 2017 State’s Specific Marketing Guidance for Medicare-Medicaid Plans

Attached to this memorandum is the final Contract Year (CY) 2017 State’s specific Marketing Guidance for Medicare-Medicaid Plans (MMPs) operating in the Michigan capitated financial alignment model demonstration. The State’s specific Marketing Guidance has been jointly updated by CMS and Michigan as summarized below and will be applicable to all marketing done for CY 2017 benefits.

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Click here to view the Final CY 2017 Marketing Guidance for Michigan Medicare-Medicaid Plans


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08/18/16 – CMS Examines Inappropriate Steering of People Eligible for Medicare or Medicaid into Marketplace Plans

Concerns Raised About Impact of 3rd Party Premium Provider & Affiliated Organization Payments

The Centers for Medicare & Medicaid Services (CMS) today issued a request for information seeking public comment on concerns that some health care providers and provider-affiliated organizations may be steering people eligible for, or receiving, Medicare and/or Medicaid benefits into Affordable Care Act-compliant individual market plans, including Health Insurance Marketplace plans, for the purpose of obtaining higher reimbursement rates. CMS also sent letters to all Medicare-enrolled dialysis facilities and centers informing them of this announcement.

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Click here to view the request for information

Click here to view the letter to all dialysis providers


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08/11/16 - $10 Million In Grants Targets Community-Based Efforts To Combat Chronic Diseases In The Delta Region

Eight states in the Delta region are receiving a total of $10 million in grant funding in FY 2016 to reduce chronic diseases that disproportionately affect the region. The funds will support collaborative efforts among health care providers to use an evidence-based model to address diabetes, cardiovascular disease, obesity, stroke and behavioral health.

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08/11/16 - $16 Million In Funding To Improve Health Care In Rural America

More than $16 million has been awarded by the Health Resources and Services Administration (HRSA) to improve access to quality health care in rural communities, including funds that will expand use of telehealth technology for veterans and other patients, assist providers with quality improvement activities, and support policy-oriented research to better understand the challenges faced by rural communities.

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08/11/16 – Programs of All-Inclusive Care for the Elderly (PACE) (CMS-4168-P)

The Programs of All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that provides comprehensive medical and social services that enable older adults to live in the community instead of a nursing home or other care facility. More than 34,000 older adults are currently enrolled in about 100 PACE organizations in 31 states, and enrollment in PACE has increased by over 60 percent since 2011. Today, the Centers for Medicare & Medicaid Services (CMS) is proposing a rule to update and modernize the PACE program.

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Click here to view the proposed rule


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08/10/16 - Medicare Advantage Value-Based Insurance Design Model

The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation is announcing refinements to the design of the second year of the Medicare Advantage Value-Based Insurance Design (MA-VBID) model.  The MA-VBID model is an opportunity for Medicare Advantage plans (MA plans), including Medicare Advantage plans offering Part D benefits (MA-PD plans), to offer clinically nuanced benefit packages aimed at improving quality of care while also reducing costs.In the second year of the model, beginning January 1, 2018, CMS will: open the model test to new applicants; conduct the model test in three new states - Alabama, Michigan, and Texas; add rheumatoid arthritis and dementia to the clinical categories for which participants may offer benefits; make adjustments to existing clinical categories; and change the minimum enrollment size for some MA and MA-PD plan participants.

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For more information on the MA-VBID, click here.


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08/10/16 – CMS Updates Nursing Home Five-Star Quality Ratings

New Quality Measures are now Included in the Overall Calculation for Nursing Home Star Ratings

Today, the Centers for Medicare & Medicaid Services (CMS) updated the popular Nursing Home Compare Five-Star Quality Ratings to incorporate new measures, giving families more information at their fingertips to help them make important decisions about care. These new measures look at successful discharges, emergency visits, and re-hospitalizations, and complement other nursing home measures previously announced in April. 

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Click here to read the fact sheet.


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08/09/16 - Affordable Care Act Payment Model Continues To Improve Care, Lower Costs

The Independence at Home Demonstration continues to provide high quality primary care services for chronically ill Medicare beneficiaries in the home setting while saving the Medicare program money, according to a new analysis released today by the Centers for Medicare & Medicaid Services (CMS).  “The Independence at Home Demonstration is a patient-centered model that supports providers in caring for chronically ill patients in their own homes,” said Dr. Patrick Conway, CMS acting deputy administrator and chief medical officer. “These results continue to support what most patients already want – the ability to have high quality care in the home setting”.  The CMS analysis found that, for the second performance year, Independence at Home participants saved Medicare more than $10 million – an average of $1,010 per beneficiary – while delivering higher quality patient care in the home. CMS will award incentive payments of $5.7 million to seven participating practices that succeeded in reducing spending while improving quality.

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Click here to view the fact sheet

Click here to learn more about the Independence at Home Demonstration


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08/04/16 - Medicare Announces Participants In Effort To Improve Access, Quality Of Care In Rural Areas

Today, the Centers for Medicare & Medicaid Services (CMS) announced the participants in the Frontier Community Health Integration Project (FCHIP) Demonstration, an effort to increase access to care for Medicare beneficiaries in areas of the country where access to health services can be limited because of distance from providers. Ten critical access hospitals (CAHs) in Montana, Nevada, and North Dakota will participate in the Demonstration, which begins this August. The FCHIP Demonstration is another example of how the Administration is working to ensure that Americans receive better care, we spend our health care dollars more wisely, and we have healthier people.

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Click here to view the fact sheet


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08/04/16 – Advocate Health Care Settles Potential HIPAA Penalties for $5.55 Million

Advocate Health Care Network (Advocate) has agreed to a settlement with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR), for multiple potential violations of the Health Insurance Portability and Accountability Act (HIPAA) involving electronic protected health information (ePHI). Advocate has agreed to pay a settlement amount of $5.55 million and adopt a corrective action plan.  This significant settlement, the largest to-date against a single entity, is a result of the extent and duration of the alleged noncompliance (dating back to the inception of the Security Rule in some instances), the involvement of the State Attorney General in a corresponding investigation, and the large number of individuals whose information was affected by Advocate, one of the largest health systems in the country.

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Click here to view the resolution agreement and corrective action plan.


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08/04/16 – HHS Awards More Than $8.6 Million for Health Centers to Improve Care Coordination and Become Patient-Centered Medical Homes

Today, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced more than $8.6 million in funding for 246 health centers in 41 states, the District of Columbia, the Federation of Micronesia and the Northern Mariana Islands. The awards will help to improve quality of care and patients’ and providers’ experience of care through the Patient-Centered Medical Home (PCMH) health care delivery model.

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Click here to view a list of the award recipients.


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08/04/16 – Frontier Community Health Integration Project (FCHIP) Demonstration

Ten CAHs are participating in the Frontier Community Health Integration Project (FCHIP) Demonstration, which aims to test new models of health care delivery in the most sparsely populated rural counties with the goal of improving health outcomes and reducing Medicare expenditures.  The Centers for Medicare & Medicaid Services (CMS) received applications representing critical access hospitals (CAHs) in Montana, Nevada, and North Dakota (though eligible to apply, CAHs in Alaska and Wyoming did not apply).  This Demonstration is for three years and it began on August 1, 2016.

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08/03/16 - Suggested Approaches for Strengthening and Stabilizing the Medicaid Home Care Workforce

This informational bulletin highlights steps available to states, providers, and others to strengthen the home care workforce, the term used in this document to encompass individuals furnishing HCBS, consistent with advancing goals of beneficiary autonomy and self-direction of needed services. CMS and states are taking important steps to support increased access to high-quality home and community based care. These steps are helping to remedy a longstanding imbalance between institutional and home and community-based care: data for fiscal year 2014 showed that 53 percent of total Medicaid long-term services and supports (LTSS) expenditures were spent on home and community-based services (HCBS), a marked change from 2009 when only 45 percent of LTSS expenditures were on HCBS.

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08/02/16 – Hospital Inpatient Perspective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Final Rule Policy and Payment Changes for Fiscal Year (FY) 2017

Today, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to update fiscal year (FY) 2017 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The final rule, which would apply to approximately 3,330 acute care hospitals and approximately 430 LTCHs, would affect discharges occurring on or after October 1, 2016.

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08/01/16 – CMS Announces Next Phase in Largest-Ever Initiative to Improve Primary Care in America

Today, the Centers for Medicare & Medicaid Services (CMS) opened the application period for practices to participate in the new nation-wide primary care model, Comprehensive Primary Care Plus (CPC+). CPC+ is a five-year primary care medical home model beginning January 2017 that will enable primary care practices to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care. CPC+ is an opportunity for practices of diverse sizes, structures, and ownership who are interested in qualifying for the incentive payment for Advanced Alternative Payment Models through the proposed Quality Payment Program. CMS estimates that up to 5,000 primary care practices serving an estimated 3.5 million beneficiaries could participate in the model.

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Click here to view the fact sheet


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07/29/16 – Final Fiscal Year 2017 Payment and Policy Changes for Medicare Skilled Nursing Facilities (CMS-1645-F)

On July 29, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining fiscal year (FY) 2017 Medicare payment policies and rates for the Skilled Nursing Facility Prospective Payment System (SNF PPS), the SNF Quality Reporting Program (SNF QRP), and the SNF Value-Based Purchasing (SNF VBP) Program.

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07/29/16 – Final Fiscal Year 2017 Payment and Policy Changes for the Medicare Hospice Benefit (CMS-1652-F)

On July 29, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining fiscal year (FY) 2017 Medicare payment rates and wage index and the Hospice Quality Reporting Program (QRP) for hospices serving Medicare beneficiaries.

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07/29/16 – Final Fiscal Year 2017 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities (CMS-1647-F)

On July 29, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining fiscal year (FY) 2017 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP).

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07/29/16 – CMS Extends, Expands Fraud-Fighting Enrollment Moratoria Efforts in Six States

New Demonstration Enhances Agency’s  Enrollment and Investigative Options

Today, the Centers for Medicare & Medicaid Services (CMS) announced an extension and statewide expansion of fraud-fighting temporary provider enrollment moratoria efforts in six states, along with a new related demonstration project to allow for certain exceptions to the moratoria and heightened screening requirements for new providers.  CMS also announced it is immediately lifting the current temporary moratoria on all Medicare Part B, Medicaid, and Children’s Health Insurance Program (CHIP) emergency ground ambulance suppliers.

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07/29/16 – Medicare Projects Relatively Stable Average Prescription Drug Premiums in 2017

Today, Medicare announced that the average basic premium for a Medicare Part D prescription drug plan in 2017 is projected to remain relatively stable at an estimated $34 per month. This represents an increase of approximately $1.50 over the actual average premium of $32.56 in 2016.

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07/27/16 – First Release of the Overall Hospital Quality Star Rating on Hospital Compare

Today, we are updating the star ratings on the Hospital Compare website to help millions of patients and their families learn about the quality of hospitals, compare facilities in their area side-by-side, and ask important questions about care quality when visiting a hospital or other health care provider. Today’s update comes after substantive discussions with hospitals and other stakeholders to review the Overall Hospital Quality Star Rating’s methodology.

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07/25/16 - Important Next Step towards a Better, Smarter, Healthier Medicare: New Payment Models and Rewards for Better Care at Lower Cost

Today, the Department of Health & Human Services proposed new models that continue the Administration’s progress to shift Medicare payments from quantity to quality by creating strong incentives for hospitals to deliver better care to patients at a lower cost. These models would reward hospitals that work together with physicians and other providers to avoid complications, prevent hospital readmissions, and speed recovery.

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Click here to read the fact sheet

Click here to read the proposed rule

Click here for more information on the Cardiac Bundled Payment Models

Click here for more information on the Cardiac Rehabilitation Incentive Payment Model

Click here for more information on the Comprehensive Care for Joint Replacment Model


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07/25/16 – HHS Issues Funding Opportunities for Information Sharing and Analysis Organization for Health and Public Health Sector

Funding Will Strengthen Efforts to Combat Cyber Threats

The U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) and Assistant Secretary for Preparedness and Response (ASPR) today announced two cooperative agreement funding opportunities for an Information Sharing and Analysis Organization (ISAO) for the Healthcare and Public Health sector.

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07/25/16 – CMS Approves Arizona’s Plan to Re-Open CHIP Program

Today, the Centers for Medicare & Medicaid Services (CMS) announced that it has approved Arizona’s plan to allow new enrollment in the Children’s Health Insurance Program (CHIP) after enrollment was frozen for several years. Now all states provide CHIP coverage to eligible children.

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07/21/16 - Data Brief: Evaluation of National Distributions of Overall Hospital Quality Star Ratings

Hospital Compare is a consumer-oriented website that provides information on how well hospitals provide care to their patients. This information can help consumers make informed decisions about their health care. The Centers for Medicare & Medicaid Services (CMS) has been posting quarterly hospital quality star ratings based on patients’ experience of care on the Hospital Compare website since April 16, 2015.  To continue our efforts to make quality of care information more readily available, we developed an Overall Hospital Quality Star Rating (Star Rating) that reflects comprehensive quality information about the care provided at our nation’s hospitals.

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07/21/16 - Medicare Announces Participants For A New Initiative To Prevent Heart Attacks And Strokes

Today, the Centers for Medicare & Medicaid Services (CMS) announced 516 awardees in 47 states, Puerto Rico, and the District of Columbia to help reduce the risks for heart attacks and strokes among millions of Medicare fee-for-service beneficiaries. The health care practitioners participating in the Million Hearts® Cardiovascular Disease Risk Reduction Model will work to decrease cardiovascular disease risk by assessing an individual patient’s risk for heart attack or stroke and applying prevention interventions.

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Click here to view the fact sheet


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07/21/16 - HHS Awards More Than $36 Million For Health Center Adoption Of Health Information Technology

Today, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced more than $36 million in funding for 50 Health Center Controlled Networks (HCCNs) in 41 states and Puerto Rico. This increase in health information technology support will impact over 1,020 participating health center organizations in all 50 states and Puerto Rico.  HCCNs improve access to care, enhance quality of care and achieve cost efficiencies through the redesign of practices to integrate services, optimize patient outcomes, or negotiate managed care contracts on behalf of participating health centers. 

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07/20/16 – HRSA Awards More Than $149 Million to Grow the Nation’s Primary Care Workforce and Expand Health Professions Training

The Health Resources and Services Administration (HRSA) announced more than $149 million in new awards through 12 workforce programs to prepare the next generation of skilled, diverse primary care providers to serve communities in need across the country.

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07/19/16 – FFM and FF-SHOP Enrollment Manual

This manual provides operational policy and guidance on key topics related to eligibility and enrollment activities within the FFM and FF-SHOP, as well as within the SBM-FP, which use the federal platform for eligibility and enrollment platforms. For ease of reference, this document will use the terms “FFM” and “FF-SHOP” to refer to all individual market Marketplaces and SHOPs that rely on the federal eligibility and enrollment platforms.

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07/18/16 – ONC Announces Phase 1 Winners of Consumer Health Data Aggregator and Provider User Experience Challenges

Challenges Designed to Foster Private Sector Innovation to Enable Consumers and Providers to Easily and Securely Access and Share Electronic Health Information

Today the Office of the National Coordinator for Health Information Technology (ONC) announced the Phase 1 winners of two application (app) challenges to make electronic health information easier to access and use for both consumers and providers. Applicants were challenged to use the Fast Healthcare Interoperability Resources (FHIR®) standard and open application programming interfaces (APIs), which are modern resources that make it easier to retrieve and share information superseding what currently exist in most EHRs. The two challenges, the Consumer Health Data Aggregator Challenge and the Provider User Experience Challenge, were announced by Dr. Karen DeSalvo, national coordinator for health information technology, at the Health Information Management Systems Society (HIMSS) annual conference on March 1, 2016.

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07/18/16 – Widespread HIPAA Vulnerabilities Result in $2.7 Million Settlement with Oregon Health & Science University

Oregon Health & Science University (OHSU) has agreed to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules following an investigation by the U.S. Department of Health and Human Services Office for Civil Rights (OCR) that found widespread and diverse problems at OHSU, which will be addressed through a comprehensive three-year corrective action plan.  The settlement includes a monetary payment by OHSU to the Department for $2,700,000.  

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Click here to view the Resolution Agreement and Corrective Action Plan


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07/13/16 – 2015-2025 Projections of National Health Expenditures Data Released

Total health care spending growth is expected to average 5.8 percent annually over 2015-2025, according to a report published today as a ‘Web First’ by Health Affairs and authored by the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary (OACT). Projected national health spending growth remains lower than the average over previous two decades before 2008 (nearly 8 percent).

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07/12/16 – Median Marketplace Deductible Only $850

Marketplace Enrollees are in Plans with Lower Deductibles, More Covered Health Services than Commonly Understood

Consumers enrolled in a 2016 Health Insurance Marketplace plan have moderate deductibles and access to a number of covered health services before reaching the deductible, according to a new analysis released today by the Centers for Medicare & Medicaid Services (CMS). The median individual deductible is $850 for Healthcare.gov Marketplace policies, and consumers’ plans have an average of seven covered services before the deductible.

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Click here to view the full report


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07/07/16 – Medicare Proposes Substantial Improvements to Paying for Care Coordination and Planning, Primary Care, and Mental Health in Doctor Payment Rule

Medicare Also Expands the Diabetes Prevention Program

Today, the Centers for Medicare & Medicaid Services (CMS) proposed changes to the Physician Fee Schedule to transform how Medicare pays for primary care through a new focus on care management and behavioral health designed to recognize the importance of the primary care work physicians perform. The rule also proposes policies to expand the Diabetes Prevention Program within Medicare starting January 1, 2018. This is the first time a preventive service model from the CMS Innovation Center would be expanded into the Medicare program.

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Click here to view the fact sheet

Click here to view a fact sheet on the Medicare Diabetes Prevention Program Expansion


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07/06/16 - HHS Announces New Actions To Combat Opioid Epidemic

U.S. Health and Human Services (HHS) Secretary Sylvia M. Burwell today announced several new actions the department is taking to combat the nation’s opioid epidemic. The actions include expanding access to buprenorphine, a medication to treat opioid use disorder, a proposal to eliminate any potential financial incentive for doctors to prescribe opioids based on patient experience survey questions, and a requirement for Indian Health Service prescribers and pharmacists to check state Prescription Drug Monitoring Program (PDMP) databases before prescribing or dispensing opioids for pain. In addition, the department is launching more than a dozen new scientific studies on opioid misuse and pain treatment and soliciting feedback to improve and expand prescriber education and training programs.

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07/06/16 - CMS Proposes Hospital Outpatient Prospective Payment System Changes to Better Support Physicians and Improve Patient Care

Today, the Centers for Medicare and Medicaid Services (CMS) proposed updated payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. Several of the proposed policy changes would improve the quality of care Medicare patients receive by better supporting their physicians and other health care providers. These proposals are based on feedback from stakeholders, including beneficiary and patient advocates, as well as health care providers, including hospitals, ambulatory surgical centers and the physician community.

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Click here to view the fact sheet.


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07/01/16 - CMS Finalizes Rule Giving Providers and Employers Improved Access to Information for Better Patient Care

MACRA provides expanded opportunity for the use of Medicare and private sector claims data to drive higher quality, lower cost care - The Centers for Medicare & Medicaid Services (CMS) today finalized new rules that will enrich the Qualified Entity Program by expanding access to analyses and data that will help providers, employers, and others make more informed decisions about care delivery and quality improvement. The new rules, as required by the Medicare Access and CHIP Reauthorization Act (MACRA), allow organizations approved as qualified entities to confidentially share or sell analyses of Medicare and private sector claims data to providers, employers, and other groups who can use the data to support improved care. In addition, qualified entities may provide or sell claims data to providers and suppliers, such as doctors, nurses, and skilled nursing facilities among others.

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06/30/16 - CMS’ Open Payments Program Posts 2015 Financial Data 

Health care industry manufacturers reported $7.52 billion in payments and ownership and investment interests to physicians and teaching hospitals in 2015 - Today, the Centers for Medicare & Medicaid Services (CMS) published 2015 Open Payments data, along with newly submitted and updated payment records for the 2013 and 2014 reporting periods, at https://openpaymentsdata.cms.gov/.  The Open Payments program (sometimes called the “Sunshine Act”) requires that transfers of value by manufacturers of drugs, devices, biologicals, and medical supplies that are paid to physicians and teaching hospitals will be published on a public website.

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06/30/16 - March 31, 2016 Effectuated Enrollment Snapshot

On March 31, 2016, about 11.1 million consumers had effectuated Health Insurance Marketplace coverage – which means those individuals, paid their premiums and had an active policy as of that date.i HHS continues to project effectuated enrollment of about 10 million people for the end of 2016.  Of the approximately 11.1 million consumers nationwide with effectuated Marketplace enrollments at the end of March 2016, about 85 percent, or about 9.4 million consumers, were receiving an advance payment of the premium tax credit (APTC) to make their premiums more affordable throughout the year. The average APTC for those enrollees who qualified for the financial assistance was $291 per month.

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06/29/16 – HHS Announces Physician Groups Selected for an Initiative Promoting Better Cancer Care

HHS Oncology Care Model Attracts Almost Twice the Expected Number of Physician Group Practices

The U.S. Department of Health and Human Services (HHS) today announced that it has selected nearly 200 physician group practices and 17 health insurance companies to participate in a care delivery model that supports and encourages higher quality and more coordinated cancer care. The Medicare arm of the Oncology Care Model includes more than 3,200 oncologists and will cover approximately 155,000 Medicare beneficiaries nationwide. The Oncology Care Model begins on July 1, 2016 and runs through June 30, 2021.

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Click here to view the fact sheet


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06/28/16 – Financial Alignment Initiative Enrollment, Age and Health Risk Assessment as of June 2016

The Centers for Medicare & Medicaid Services (CMS) launched the Financial Alignment Initiative in 2011 to begin addressing the financial misalignment between Medicare and Medicaid that often presents a barrier to coordinated care for enrollees. The Financial Alignment Initiative aims to better align the financing of these two programs and integrate primary, acute, behavioral health and long-term services and supports in a more easily navigable, simplified system for enrollees. The Initiative has two models, the capitated model and managed fee-for-service model, both of which are serving beneficiaries in states throughout the country. This document provides a snapshot of enrollment, age, and health risk assessment (HRA) experience to date for the capitated financial alignment model.

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06/27/16 – CMS Announces Proposed Payment Changes for Medicare Home Health Agencies for 2017 (CMS-1648-P)

Today, the Centers for Medicare & Medicaid Services (CMS) announced proposed changes to the Medicare home health prospective payment system (HH PPS) for calendar year (CY) 2017 that would foster greater efficiency, flexibility, payment accuracy, and improved quality. Approximately 3.4 million beneficiaries received home health services from approximately 11,400 home health agencies, costing Medicare approximately $17.8 billion in 2015.

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Click here to view the proposed rule


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06/24/16 – CMS Proposed Updates to Policies and Payment Rates for ESRD PPS, QIP, Coverage and Payment for Acute Kidney Injury, DMEPOS Competitive Bidding Program and Fee Schedule, and Comprehensive ESRD Care Model (CMS 1651-P)

On June 24, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2017.  This rule also proposes new quality measures to improve the quality of care by dialysis facilities treating patients with end-stage renal disease.

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Click here to view the proposed rule


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06/23/16 – New Members Named to Serve on Federal Health Information Technology Policy and Standards Committees

Today, U.S. Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell named eight new members of the Health Information Technology Standards Committee (HITSC) and one new member to the Health Information Technology Policy Committee (HITPC). The HITSC is charged with recommending standards, implementation specifications, and certification criteria for the electronic exchange and use of health information.  The HITPC is charged with recommending policies for the development and adoption of a nationwide health information technology (health IT) infrastructure, including standards for the exchange and use of health information.

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06/23/16 – Adjustments to Fee Schedule Amounts for Certain DMEPOS Using Information from the Competitive Bidding Program

The Centers for Medicare & Medicaid Services (CMS) announces the release of the July 2016 Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule amounts.

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Click here to view the fee schedule


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06/22/16 – Moratoria Provider Services and Utilization Data Tool (Updated form February 22, 2016)

The Centers for Medicare & Medicaid Services (CMS) has developed a Moratoria Provider Services 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. The data provide information on the number of Medicare providers servicing a geographic region and the number of Medicare beneficiaries who use a health service area. In addition to the Ambulance (Emergency & Non-Emergency) and Home Health service areas that were included in the initial release, the second release also includes subdivided ambulance claims data (Ambulance (Emergency) and Ambulance (Non-Emergency)), as well as claims data for Independent Diagnostic Testing Facilities (IDTFs) Part A and Part B and Skilled Nursing Facilities (SNFs). IDTF and SNF have been added because these are areas that have been discussed as possible expansions for moratoria, though there is no intended implication that the areas will, in fact, be chosen in the future as moratoria areas. For the Ambulance and Home Health service areas, moratoria regions at the state and county level are clearly indicated. The data can also be used to reveal the degree to which use of these services is related to the number of providers servicing a geographic region. Provider services and utilization data by geographic regions are easily compared using the interactive maps. The tool is available through the CMS website at: https://data.cms.gov/moratoria-data.  Future releases may include comparable information on additional health service areas.

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Click here to view the tool


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06/22/16 – Medicare Trustees Report Shows Continued Slow Cost Growth

Today, the Medicare Trustees projected that the trust fund financing Medicare’s hospital insurance coverage will remain fully funded until 2028, 11 years longer than they projected in 2009 before the passage of the Affordable Care Act.

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Click here to view the 2015 Medicare Trustees Report


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06/21/16 – Strengthening the Marketplace by Covering Young Adults

Deploying New Targeting Strategies and Partnerships to Reach Young Adults and Others Who Are Still Uninsured

With millions of Americans insured through the Health Insurance Marketplaces, it's clear that Marketplace coverage is a product consumers want and need as well as an important business for insurers – with several major issuers expanding their Marketplace presence. At the U.S. Department of Health and Human Services (HHS), we are constantly monitoring the health of the Marketplace and are always looking to make improvements that benefit both consumers and issuers. Over the past several months, HHS has taken a series of actions to strengthen the Marketplace risk pool, and ensure a strong Marketplace for the long term. As part of our continued commitment to the long-term strength of the Marketplace, earlier this month, HHS made announcements regarding additional efforts to strengthen the Marketplace risk pool and new work with insurers and state Departments of Insurance to improve coverage options.

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06/20/16 – HHS Announces Major Initiative to Help Small Practices Prepare for the Quality Payment Program

Over the last few weeks, the Department of Health and Human Services (HHS) has made several important announcements related to the Quality Payment Program, which has been proposed to implement the new, bipartisan law changing how Medicare pays clinicians, known as the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA. Today, we are announcing $20 million to fund on-the-ground training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer.

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06/20/16 – Proposed Changes to the Payment Error Rate and Measurement and Medicaid Eligibility Quality Control Programs in Response to the Affordable Care Act (CMS-6068-P)

On June 20, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a notice of proposed rulemaking outlining proposed changes to the Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) programs to implement provisions in the Affordable Care Act’s changes to the way states adjudicate eligibility for Medicaid and the Children’s Health Insurance Program (CHIP). The proposed rule addresses the new eligibility provisions of the Affordable Care Act and makes other general improvements to the PERM and MEQC programs. The proposed rule also includes policies that, if implemented, would reduce state burden and increase the focus on the continuous reduction of improper payment rates. Comments on this proposed rule are due by August 22, 2016.

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06/17/16 – Medicare Will Use Private Payor Prices to Set Payment Rates for Clinical Diagnostic Laboratory Tests Starting in 2018

Today, the Centers for Medicare & Medicaid Services (CMS) released a final rule implementing Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA), requiring laboratories performing clinical diagnostic laboratory tests to report the amounts paid by private insurers for laboratory tests. Medicare will use these private insurer rates to calculate Medicare payment rates for laboratory tests paid under the Clinical Laboratory Fee Schedule (CLFS) beginning January 1, 2018. The final rule includes provisions to ease administrative burdens for physician office laboratories and smaller independent laboratories.   

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Click here to view the final rule

Click here to view the fact sheet on the final rule


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06/15/16 – CMS Announces $22 Million in Affordable Care Act Funding for State Insurance Departments

Awards will Help States Enforce Affordable Care Act Consumer Protections

Today, the Centers for Medicare & Medicaid Services (CMS) announced the availability of $22 million in funding to state insurance regulators to use for issuer compliance with Affordable Care Act key consumer protections. This award opportunity enables states to seek funding for activities related to planning and implementing select federal market reforms and consumer protections including:  essential health benefits, preventive services, parity in mental health and substance use disorder benefits, appeals processes, and bringing down the cost of health care coverage (also known as medical loss ratio provision).

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06/13/16 – CMS Proposes Rule to Improve Health Equity and Care in Hospitals

The Centers for Medicare & Medicaid Services (CMS) today proposed new standards to improve the quality of care and advance health equity in our nation’s hospitals. The proposal applies to the 6,228 hospitals and critical access hospitals that participate in Medicare or Medicaid.

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Click here to view the fact sheet


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06/10/16 – CMS Announces $32 Million to Increase Number of Children with Quality, Affordable Health Coverage

Today, the Centers for Medicare & Medicaid Services (CMS) announced it will provide $32 million in awards to help 38 community organizations in 27 states enroll eligible children in Medicaid and the Children’s Health Insurance Program (CHIP) as part of the Connecting Kids to Coverage campaign. These awards, provided by the bipartisan MACRA legislation, are designed to build on the historic progress already made increasing the number of children who have health coverage.

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06/10/16 – Affordable Care Act Dramatically Improved Health Insurance Coverage for People Living in Rural Areas

Today, the U.S. Department of Health and Human Services released an analysis of how the Affordable Care Act has benefited rural America. The findings, which examine independent studies and other data, show that health coverage in rural counties increased by 8.0 percentage points between late 2013 and early 2015, and the share of rural Americans unable to afford needed care dropped by almost six percentage points.

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Click here to view the full report


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06/10/16 – Transforming Clinical Practice Initiative Support and Alignment Networks 2.0

Americans deserve a health care system that delivers the right care, at the right time, and at a cost that is reasonable and easy to understand. Such a system will result in fewer unnecessary hospital admissions and readmissions, fewer healthcare-associated infections, reduced patient harm, and will show continuous improvement in quality of care and cost efficiency.

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06/08/16 – Strengthening the Marketplace – Actions to Improve the Risk Pool

With millions of Americans insured through the Health Insurance Marketplaces, it's clear that Marketplace coverage is a product consumers want and need and an important business for insurers, with several major issuers expanding their Marketplace presence.  At the Department of Health and Human Services (HHS), we are constantly monitoring the health of the Marketplace and are always looking to make improvements that benefit both consumers and issuers. Over the past several months, HHS has taken a series of actions to strengthen the Marketplace risk pool, limit upward pressure on rates, and ensure a strong Marketplace for the long term. We believe those actions are bringing positive results. As part of our continued commitment to the long-term strength of the Marketplace, we are announcing new measures to ensure that the Marketplace continues to provide affordable coverage for millions of Americans.  

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06/08/16 - Pre-Claim Review Demonstration of Home Health Services (CMS-6069-N)

Home Health Agency (HHA) services are a critical part of the health care continuum and are instrumental in helping a patient with Medicare benefits recover after an illness or injury.  The Medicare home health benefit allows beneficiaries who are deemed homebound to receive certain medically necessary services in their homes, which is a preferred setting for many beneficiaries.  Today, the Centers for Medicare & Medicaid Services (CMS) is taking important new steps to provide timely and appropriate home health services to Medicare beneficiaries, while protecting the Medicare Trust Funds and taxpayer funds from fraud and improper payments.  By implementing a new pre-claim review demonstration in five states -- Illinois, Florida, Texas, Michigan, and Massachusetts -- CMS will help make sure that home health services are medically necessary without delaying or disrupting patient care or access.  The pre-claim review demonstration will begin in Illinois no earlier than August 1, 2016, and the remaining states will phase in during 2016 and 2017.
 

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06/06/16 – Medicare Makes Enhancements to the Shared Savings Program to Strengthen Incentives for Quality Care

The Centers for Medicare & Medicaid Services (CMS) today released a final rule improving how Medicare pays Accountable Care Organizations in the Medicare Shared Savings Program for delivering better patient care. Medicare is moving away from paying for each service a physician provides towards a system that rewards physicians for coordinating with each other. Accountable Care Organizations are a major part of that transition, rewarding providers that deliver high-quality, efficient, and coordinated care for patients.

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Click here to view fact sheet


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06/06/16 - Temporary Pause of QIO Short Stay Reviews

On May 4, 2016, the Centers for Medicare & Medicaid Services (CMS) temporarily paused the Beneficiary and Family Centered Care (BFCC) Quality Improvement Organizations’ (QIOs) performance of initial patient status reviews to determine the appropriateness of Part A payment for short stay inpatient hospital claims. CMS took this action in an effort to promote consistent application of the medical review of patient status for short hospital stays.

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06/03/16 – Update Report on the National Partnership to Improve Dementia Care in Nursing Homes

In 2011, The Office of the Inspector General (OIG) of the Department of Health and Human Services released a report underscoring the high use of atypical antipsychotic medications for “off-label” indications among nursing home residents. According to this report, 83 percent of atypical antipsychotic drug claims were for elderly nursing home residents who had not been diagnosed with a condition for which antipsychotic medications were approved by the Food and Drug Administration (FDA).

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06/03/16 – Nursing Home Enforcement Reports

Through December 31, 2014

The Nursing Home Enforcement Reports in this document cover years 2006-2014. They provide general information regarding enforcement actions taken by the Centers for Medicare & Medicaid Services (CMS) Regional Offices or State Survey Agencies when a nursing home is not in compliance with Medicare and/or Medicaid requirements at 42 C.F.R Part 483. Enforcement actions refer to remedies, described below, that CMS imposed against noncompliant nursing homes.

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06/02/16 – ONC Unveils New Videos Empowering Patients to Learn Their Rights Under HIPAA

During Annual Meeting, ONC Also Announces New Patient Engagement Playbook for Providers

As part of the final day of the 2016 Office of the National Coordinator for Health Information Technology (ONC) Annual Meeting taking place at the Walter E. Washington Convention Center in Washington, D.C., ONC today unveiled a series of consumer-oriented videos about the rights patients have to access their health information, as well as a Patient Engagement Playbook for Providers designed to help clinicians and office staff better engage patients through the use of health IT. This final day of the meeting is focused on empowering individuals to become better partners in their health and care.

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06/01/16 – HHS Begins Listing New Transparency Information for Certified Health Information Technology

Plain Language Disclosures, Upgraded Website to Make the Health IT Market Work Better

Today, the U.S. Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology (ONC) began listing more detailed and easier-to-understand information about certified health information technology (health IT). Via an upgraded website, purchasers of health IT can access information about costs and limitations they may encounter when implementing and using certified health IT products. The disclosure of this information is required by ONC’s recent 2015 Edition final rule, which includes several provisions to increase transparency and accountability in the health IT marketplace and to assist purchasers to better compare and select products that meet their needs.

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05/31/16 – New Survey Shows Nearly All U.S. Hospitals Using Certified Health IT to Manage Patient Care

According to data from a new survey released today at the Office of the National Coordinator for Health Information Technology’s (ONC) 2016 Annual Meeting in Washington, D.C., nearly all of the nation’s hospitals have adopted certified electronic health records (EHRs).

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Click here to view data brief, Adoption of Electronic Health Record Systems among U.S. Non-Federal Acute Care Hospitals: 2008-2015

Click here to view data brief, Interoperability among U.S. Non-Federal Acute Care Hospitals in 2015


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05/25/16 – Medicaid and CHIP Application, Eligibility Determination, and Enrollment Data

Through the Medicaid and CHIP Performance Indicator Project, states provide data to CMS on a range of indicators related to key application, eligibility, and enrollment processes within the state Medicaid and Children’s Health Insurance Programs.  This data provides important information to CMS on state program operations, and allows CMS to share data publicly on state program performance.  For example, the graph below shows the difference in Medicaid and CHIP enrollment growth for expansion and non-expansion states, compared to the period before the first Marketplace Open Enrollment Period and related Medicaid program changes in October 2013. Additional information about the data CMS collects for the Performance Indicator Project is available here.

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5/20/16 - Fiscal Year (FY) 2016 to FY 2017 Nursing Home Action Plan

The Survey and Certification Program Nursing Home Action Plan guides CMS’ efforts to continue to improve nursing home safety and quality. The Plan outlines five inter-related and coordinated approaches – or principles of action – for nursing home quality, ultimately aligning with CMS’ main goals.

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05/17/16 – Statement by Secretary Burwell on the National Health Interview Survey

Today’s report is further proof that our country has made undeniable and historic strides thanks to the Affordable Care Act. The uninsured rate fell to 9.1 percent in 2015, making it the first year in our nation’s history that fewer than 1 in 10 Americans lacked health insurance, and the report documents the progress we’ve made expanding coverage across the country. Meanwhile, premiums for employer coverage, Medicare spending, and health care prices have risen at exceptionally slow rates. Our country ought to be proud of how far we’ve come and where we’re going.

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05/17/16 – Monitoring Data Shows Adequacy of New Payment Amounts for DMEPOS in Non-Competitively Bid Areas

Results Suggest No Negative Impact on Beneficiary Access in Urban and Rural Areas

Starting in 2011, section 1834(a)(1)(F) of the Social Security Act (the Act) required CMS to use competitive bidding to set payment amounts for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) for certain areas in the country.  As implementation of the DMEPOS competitive bidding program has rolled out in areas across the country, CMS has been using real-time data monitoring to ensure that Medicare beneficiaries continue to receive the medical equipment they need.  This data monitoring tracks access to items and services and a number of clinical outcome measures such as mortality, hospitalizations, and emergency room visits.  By all measures, the DMEPOS competitive bidding program has been a great success for beneficiaries and the taxpayers.  

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05/13/16 – HHS Finalizes Rule to Improve Health Equity Under the Affordable Care Act

Final Rule Prohibits Discrimination Based on Race, Color, National Origin, Sex, Age or Disability, Enhances Language Assistance for Individuals with Limited English Proficiency, and Protects Individuals with Disabilities

The Department of Health and Human Services (HHS) today issued a final rule to advance health equity and reduce health care disparities. Under the rule, individuals are protected from discrimination in health care on the basis of race, color, national origin, age, disability and sex, including discrimination based on pregnancy, gender identity and sex stereotyping. In addition to implementing Section 1557’s prohibition on sex discrimination, the final rule also enhances language assistance for people with limited English proficiency and helps to ensure effective communication for individuals with disabilities. The protections in the final rule and Section 1557 regarding individuals’ rights and the responsibilities of many health insurers, hospitals, and health plans administered by or receiving federal funds from HHS build on existing federal civil rights laws to advance protections for underserved, underinsured, and often excluded populations.

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05/09/16 – HHS Announces Challenge to Redesign the Medical Bill for Patients

Speaking at the annual Health Datapalooza conference today, Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell announced a challenge to encourage health care organizations, designers, developers, digital tech companies and other innovators to design a medical bill that’s simpler, cleaner, and easier for patients to understand, and to improve patients’ experience of the overall medical billing process. The "A Bill You Can Understand" design and innovation challenge is intended to solicit new approaches and draw national attention to a common complaint with the health care system: that medical billing is a source of confusion for patients and families.

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05/06/16 – Medicare Advantage Value-Based Insurance Design Model Announced 

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Click here to view the Draft Communication Guidance


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05/06/16 – Special Enrollment Periods for the Health Insurance Marketplace

Special Enrollment Periods and the Consumer Operated and Oriented Plan Program

HHS is taking new steps to strengthen the integrity of special enrollment periods (SEPs) and to simplify rules for the Consumer Operated and Oriented Plan (CO-OP) program to allow them to more easily raise capital.  These changes were instituted in order to improve stability in the Health Insurance marketplace and help consumers’ access to quality, affordable coverage.

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05/05/16 – Updates to Data Initiatives Increase Transparency of the Medicare Program

Data Serves as a Rich Resource on Part B Costs, Services, and Trends

As entrepreneurs, investors, data scientists, researchers, policy experts, government employees, and others prepare to gather for the seventh annual Health Datapalooza conference in Washington, D.C., the Centers for Medicare & Medicare Services (CMS) is releasing updated data to increase transparency in the Medicare program.  Today CMS is posting the third annual release of the Physician and Other Supplier Utilization and Payment public use data.  In addition, CMS is announcing the availability of more timely data for researchers.

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05/04/16 – HHS Awards over $260 Million to Health Centers Nationwide to Build and Renovate Facilities to Serve More Patients

Today, HHS Secretary Sylvia M. Burwell announced over $260 million in funding to 290 health centers in 45 states, the District of Columbia, and Puerto Rico for facility renovation, expansion, or construction. Health centers will use this funding to increase their patient capacity and to provide additional comprehensive primary and preventive health services to medically underserved populations.

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Click here to view a list of the award winners


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05/03/16 – CMS Publishes Final Rule on Fire Safety Requirements for Certain Health Care Facilities

Today, the Centers for Medicare & Medicaid Services (CMS) announced a final rule (https://www.federalregister.gov/public-inspection) to update health care facilities’ fire protection guidelines to improve protections for all Medicare beneficiaries in facilities from fire.

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04/28/16 – New Medicaid Guidance Improves Access to Health Care for Justice-Involved Americans Reentering their Communities

Today, the U.S. Department of Health and Human Services (HHS) strengthened access to health care for individuals transitioning from incarceration back to their communities. New Medicaid guidance released today updates decades-old policy and clarifies that individuals who are currently on probation, parole or in home confinement are not considered inmates of a public institution. It also extends coverage to Medicaid-eligible individuals living in community halfway houses where they have freedom of movement, improving access to care for as many as 96,000 individuals in Medicaid expansion states over the course of the year. 

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Click here to view the report


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04/28/16 – Financial Alignment Initiatives Early Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey Results 

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04/28/16 – CMS Awards Contracts for the DMEPOS Competitive Bidding Program Round 2 Recompete and National Mail-Order Recompete

The Centers for Medicare & Medicaid Services (CMS) today announced the Round 2 Recompete and national mail-order recompete contract suppliers for Medicare’s Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.  This program has been in effect since 2011 and is an essential tool to help Medicare set appropriate payment rates for DMEPOS items, save money for beneficiaries and taxpayers, and ensure access to quality items.

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04/27/16 – Administration Takes First Step to Implement Legislation Modernizing how Medicare Pays Physicians for Quality

The Department of Health and Human Services today issued a proposal to align and modernize how Medicare payments are tied to the cost and quality of patient care for hundreds of thousands of doctors and other clinicians. The Notice of Proposed Rulemaking is a first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This legislation – supported by a bipartisan majority and stakeholders such as patient groups and medical associations – ended more than a decade of last-minute fixes and potential payment cliffs for Medicare doctors and clinicians, while making numerous improvements to America’s health care system.

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04/27/16 – Accountable Health Communities Model Updates: Frequently Asked Questions Updated 

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04/27/16 – CMS Adds New Quality Measures to Nursing Home Compare

Largest Addition of Quality Measures to Nursing Home Companies Since 2003

Today, the Centers for Medicare & Medicaid Services (CMS) added six new quality measures to its consumer-based Nursing Home Compare website (https://www.medicare.gov/nursinghomecompare/search.html). Three of these six new quality measures are based on Medicare-claims data submitted by hospitals, which is significant because this is the first time CMS is including quality measures that are not based solely on data that are self-reported by nursing homes. These three quality measures measure the rate of rehospitalization, emergency room use, and community discharge among nursing home residents.

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Click here to view the fact sheet


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04/25/16 – HHS Issues Major Rule Modernizing Medicaid Management

Final Rule Advances Delivery System Reform, Strengthens Quality and Consumer Protections, Promotes Accountability, and Aligns Medicaid Managed Care with Other Health Insurance Coverage Programs

Today, the Department of Health and Human Services (HHS) issued a final rule on managed care in Medicaid and the Children’s Health Insurance Program (CHIP). The rule, which is the first overhaul of Medicaid and CHIP managed care regulations in more than a decade, advances the Administration’s efforts to transform the health care system to deliver better care, smarter spending, and healthier people.  It supports state delivery system reform efforts, strengthens the consumer experience and key consumer protections, strengthens program integrity by improving accountability and transparency, and aligns key rules with those of other health coverage programs.

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Click here to view the final rule


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04/21/16 – Proposed Fiscal Year 2017 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities (CMS-1647-P)

On April 21, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining proposed fiscal year (FY) 2017 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP). The FY 2017 proposals are summarized below.

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04/21/16 – Proposed Fiscal Year 2017 Payment and Policy Changes for Medicare Skilled Nursing Facilities

On April 21, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule [CMS-1645-P] outlining proposed Fiscal Year (FY) 2017 Medicare payment rates and quality programs for skilled nursing facilities (SNFs). The FY 2017 proposals and other issues discussed in the proposed rule are summarized below.

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04/21/16 – CMS Proposes Updates to the Wage Index and Payment Rates for the Medicare Hospice Benefit

On April 21, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1652-P) that would update fiscal year (FY) 2017 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries.

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04/19/16 – Statement from Assistant Secretary for Aging Kathy Greenlee on Older Americans Act Reauthorization Signed into Law

President Obama signed the Older Americans Act Reauthorization Act of 2016 into law today, reaffirming our nation’s commitment to the health and well-being of older adults. Last July, the President called on Congress to reauthorize this important legislation as part of his remarks at the White House Conference on Aging.

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04/19/16 – CMS Releases Medicare Advantage Quality Data for Racial and Ethnic Minorities

Data is First of Annual Releases on Disparities in Medicare Advantage Plans

Today, the Centers for Medicare & Medicaid Services (CMS) Office of Minority Health released data detailing the quality of care received by people with Medicare Advantage by racial or ethnic group.

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Click here to view the data and summary report


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04/18/16 – Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Proposed Rule Issues for Fiscal Year (FY) 2017

On April 18, 2016 the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update fiscal year (FY) 2017 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The proposed rule, which would apply to approximately 3,330 acute care hospitals and approximately 430 LTCHs, would affect discharges occurring on or after October 1, 2016.

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Click here to view the final rule


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04/18/16 – Bundled Payments for Care Improvement Initiative (BPCI) (Updated from August 13, 2015)

The Bundled Payments for Care Improvement initiative (BPCI) is comprised of four broadly defined models of care, which link payments for multiple services beneficiaries receive during an episode of care. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for episodes of care. These models may lead to higher quality and more coordinated care at a lower cost to Medicare.

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04/11/16 – CMS Launches Largest-Ever Multi-Payer Initiative to Improve Primary Care in America

New Affordable Care Act Initiative, Designed to Improve Quality and Cost, Gives Doctors and Patients More Control Over Health Care Delivery

The Centers for Medicare & Medicaid Services (CMS) today announced its largest-ever initiative to transform and improve how primary care is delivered and paid for in America. The effort, the Comprehensive Primary Care Plus (CPC+) model, will be implemented in up to 20 regions and can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve. The initiative is designed to provide doctors the freedom to care for their patients the way they think will deliver the best outcomes and to pay them for achieving results and improving care.

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Click here to view the fact sheet


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4/8/16 - Applicability of CY 2017 Final Call Letter Provisions to Medicare-Medicaid Plans

This memorandum provides additional guidance regarding the applicability to MedicareMedicaid Plans (MMPs) of the provisions of the Contract Year (CY) 2017 Final Call Letter issued on April 4, 2016. In the chart below, we specify whether a particular provision in the CY 2017 Final Call Letter is: (1) not applicable to MMPs; (2) applicable to MMPs; (3) partly applicable to MMPs; or (4) informational only. For some provisions, comments are provided as further background.

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4/6/16 - Departments Finalize New Version of the Summary of Benefits and Coverage

Helping Consumers Better Understand their Health Coverage

Today, the Department of Health and Human Services (HHS), the Department of Labor (DOL) and the Department of the Treasury announced key enhancements to the Summary of Benefits and Coverage (SBC) template and Uniform Glossary.  The improvements include an additional coverage example and language and terms to improve consumers’ understanding of their health coverage.  Under the Affordable Care Act, issuers and health plans are required to provide a brief summary of what the plan covers and the cost sharing responsibility of the consumer, in order to help individuals make more informed choices among health plan options and better understand their coverage.  Plans and issuers are also required to provide a comprehensive uniform glossary of commonly used health coverage and medical terms.  
 

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04/04/16 – CMS Finalizes 2017 Payment and Policy Updates for Medicare Health and Drug Plans

The Centers for Medicare & Medicaid Services (CMS) today released the final Medicare Advantage and Part D Prescription Drug Program changes for 2017 that seek to provide stable payments to plans, and make improvements to the program for plans that provide high quality care to the most vulnerable enrollees.

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Click here to view a general fact sheet on the 2017 Rate Announcement and Call Letter

Click here to view the full 2017 Rate Announcement and Call Letter


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04/04/16 – The Medicare-Medicaid Plan (MMP) Provider and Pharmacy Directory Monitoring Memo

The purpose of this memorandum is to summarize the results of a recent monitoring study of Medicare-Medicaid Plan (MMP) CY 2016 Provider and Pharmacy Directories.

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03/31/16 – Final Rule Extends New Religious Liberty Protections to Beneficiaries of Federally-Funded Social Service Programs

Today, the U.S. Department of Health and Human Services, along with other federal agencies, published a final rule that will provide new religious liberty protections for beneficiaries of federally funded social service programs, while also adding new protections for the ability of religious providers to compete for government funds on the same basis as any other private organization. The regulations – which are being published after public notice and comment – formally implements Executive Order 13559.

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Click here to view the final rule


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03/29/16 – 2017 Letter to Issuers in the Federally-Facilitated Marketplaces

The Centers for Medicare & Medicaid Services (CMS) is releasing this final 2017 Letter to Issuers in the Federally-facilitated Marketplaces (Letter). This Letter provides issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Marketplaces (FFMs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs) with operational and technical guidance to help them successfully participate in any such Marketplace in 2017. Unless otherwise specified, references to the FFMs include the FF-SHOPs. 

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03/29/16 – Final 2017 HHS Notice of Benefit and Payment Parameters 

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03/29/16 – Key Dates for Calendar Year 2016: QHP Certification in the Federally-Facilitated Marketplaces; Rate Review; Risk Adjustment and Reinsurance 

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03/29/16 – Bulletin: Timing of Submission and Posting of Rate Filing Justifications for the 2016 Filing Year for Single Risk Pool Coverage

The Centers for Medicare & Medicaid Services (CMS) is releasing this bulletin on the uniform timeline for submission and posting of information about rate filings for single risk pool coverage, consistent with the amendments to the rate review regulations at 45 CFR Part 154 in the HHS Notice of Benefit and Payment Parameters for 2017 Final Rule2.  Specifically, this bulletin establishes the uniform deadline under 45 CFR 154.220(b) for health insurance issuers to submit the Rate Filing Justification for proposed rates for single risk pool coverage in the individual and small group markets. It also establishes the uniform posting deadline under 45 CFR 154.301(b)(1)(i) for a State with an Effective Rate Review Program to provide public access to information regarding proposed rate increases that are subject to review.

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03/29/16 – CMS Finalizes Mental Health and Substance Use Disorder Parity Rule for Medicaid and CHIP

Final Rule Strengthens Access to Mental Health and Substance Use Disorder Benefits for Low-Income Americans

In conjunction with the President’s visit to the National Rx Drug Abuse and Heroin Summit, the Centers for Medicare & Medicaid Services (CMS) today finalized a rule to strengthen access to mental health and substance use services for people with Medicaid or Children’s Health Insurance Program (CHIP) coverage, aligning with protections already required of private health plans. The Mental Health Parity and Addiction Equity Act of 2008 generally requires that health insurance plans treat mental health and substance use disorder benefits on equal footing as medical and surgical benefits.

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Click here to view the final rule


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03/28/16 – New Report Shows Medicaid Expansion can Improve Behavioral Health Care Access

Nearly 2 Million Low-Income Uninsured People with a Substance Use Disorder or a Mental Illness Lived in States that had not yet Expanded Medicaid in 2014

Today, the U.S. Department of Health and Human Services released a report showing that states can greatly improve access to behavioral health services for residents by expanding Medicaid under the Affordable Care Act. Substance use disorders and mental illness are prevalent and serious public health problems in American communities. According to today’s report, in 2014, the most recent year for which data is available, an estimated 1.9 million uninsured people with a mental illness or substance use disorder lived in states that have not yet expanded Medicaid under the Affordable Care Act and had incomes that could qualify them for coverage. The report finds that people with behavioral health needs made up a substantial share of all low-income uninsured individuals in these states: nearly 30 percent. While some of these individuals had access to some source of health insurance in 2014, many will gain access to coverage only if their states expand Medicaid, and others would gain access to more affordable coverage.

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Click here to view the full report


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03/25/16 – Release of 2015 Nursing Home Data Compendium

The 11th edition of the Centers for Medicare & Medicaid Services (CMS) Nursing Home Data Compendium contains figures and tables presenting data on all Medicare and Medicaid-certified nursing homes in the United States as well as the residents in these nursing homes. A series of graphs and maps highlights some of the most interesting data, while detailed data are available in accompanying tables. The data compendium is divided into three sections. Section 1 presents information on nursing home characteristics; Section 2 focuses on nursing home survey results; and Section 3 presents information on the demographic, functional and clinical characteristics of nursing home residents.
 
 

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03/24/16 – 2017 QHP Application

The 2017 Qualified Health Plan (QHP) Application is available to issuers applying for certification to participate in the Federally-facilitated Marketplaces. Click on the links below to access detailed application instructions, templates, justifications and supporting documents, and tools for issuers. Please read the application instructions carefully before beginning the application process.

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03/24/16 – CMS Launches New Effort to Improve Care for Nursing Facility Residents

New Payment Model Test for Nursing Facility Care Aims to Reduce Avoidable Hospitalizations – The Centers for Medicare & Medicaid Services (CMS) today announced it will test whether a new payment model for nursing facilities and practitioners will further reduce avoidable hospitalizations, lower combined Medicare and Medicaid spending, and improve the quality of care received by nursing facility residents.

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03/23/16 – Statement from Assistant Secretary for Aging Kathy Greenlee on House Passage of the Older Americans Act Reauthorization

We are excited to see the Older Americans Act on the verge of reauthorization, and we applaud the House for this important step.

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03/23/16 – Independent Experts Confirm that Diabetes Prevention Model Supported by the Affordable Care Act Saves Money and Improves Health

First Ever Preventive Service Model Eligible for Expansion Under Medicare Holds Promise for Employers, Private Insurers and Patients

Today, the Department of Health and Human Services announced a significant step forward in building a health care system that works better, spends dollars smarter, and keeps people healthy. Secretary Sylvia M. Burwell announced that the independent Office of the Actuary in the Centers for Medicare & Medicaid Services (CMS) certified that expansion of the Diabetes Prevention Program, a model funded by the Affordable Care Act, would reduce net Medicare spending. The expansion was also determined to improve the quality of patient care without limiting coverage or benefits. This is the first time that a preventive service model from the CMS Innovation Center has become eligible for expansion into the Medicare program.

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Click here to view the CMS Office of the Actuary Certification of the Diabetes Prevention Program


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03/23/16 – Diabetes Prevention Program Independent Evaluation Report Summary

The Centers for Medicare & Medicaid Services (CMS) Innovation Center awarded the National Council of Young Men’s Christian Associations of the United States of America (Y-USA) more than $11.8 million under Round 1 of the Health Care Innovation Awards to test the Diabetes Prevention Program’s impact on Medicare beneficiaries.

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Click here to view the full report


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03/23/16 – Diabetes Prevention Program Independent Evaluation Report Summary

The Centers for Medicare & Medicaid Services (CMS) Innovation Center awarded the National Council of Young Men’s Christian Associations of the United States of America (Y-USA) more than $11.8 million under Round 1 of the Health Care Innovation Awards to test the Diabetes Prevention Program’s impact on Medicare beneficiaries.

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Click here to view the full report


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03/22/16 – Medicare Spent $473 Billion Less from 2009 through 2014 Compared to Previous Spending Trends

Affordable Care Act Continues to Deliver Better, Smarter Spending and Healthier People

The Department of Health and Human Services (HHS) announced today that Medicare spent $473.1 billion less on personal health care expenditures between 2009 and 2014 than would have been spent if the 2000-2008 average growth rate had continued through 2014.  In addition, if trends continue through 2015, that amount could grow to a projected $648.6 billion.  To put this in perspective, those savings are greater than all of Medicare’s spending for personal health care expenditures in 2015.

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Click here to view the full report


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03/17/16 – Improper Disclosure of Research Participants’ Protected Health Information Results in $3.9 Million HIPAA Settlement

Feinstein Institute for Medical Research agreed to pay the U.S. Department of Health and Human Services, Office for Civil Rights (OCR) $3.9 million to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules and will undertake a substantial corrective action plan to bring its operations into compliance.  This case demonstrates OCR’s commitment to promoting the privacy and security protections so critical to build and maintain trust in health research.  Feinstein is a biomedical research institute that is organized as a New York not-for-profit corporation and is sponsored by Northwell Health, Inc., formerly known as North Shore Long Island Jewish Health System, a large health system headquartered in Manhasset, New York that is comprised of twenty one hospitals and over 450 patient facilities and physician practices.

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Click here to view the resolution agreement and corrective action plan


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03/17/16 – CMS Releases Interactive Mapping Medicare Disparities Tool

Today, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) released a new interactive map to increase understanding of geographic disparities in chronic disease among Medicare beneficiaries. The Mapping Medicare Disparities (MMD) Tool identifies disparities in health outcomes, utilization, and spending by race and ethnicity and geographic location.  Understanding geographic differences in disparities is important to informing policy decisions and efficiently targeting populations and geographies for interventions.

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Click here to access the tool


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03/16/16 – $1.55 Million Settlement Underscores the Importance of Executing HIPAA Business Associate Agreements

North Memorial Health Care of Minnesota has agreed to pay $1,550,000 to settle charges that it potentially violated the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules by failing to enter into a business associate agreement with a major contractor and failing to institute an organization-wide risk analysis to address the risks and vulnerabilities to its patient information. North Memorial is a comprehensive, not-for-profit health care system in Minnesota that serves the Twin Cities and surrounding communities.

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Click here to view the resolution agreement and corrective action plan


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03/11/16 – Medicare Advantage Quality Bonus Payment Model – Final Evaluation Report

The Centers for Medicare & Medicaid Services (CMS) launched the three-year Medicare Advantage (MA) Quality Bonus Payment (QBP) Demonstration (“QBP demo”), which extended quality bonus payments established in the Affordable Care Act of 2010 to 3- and 3.5-Star contracts in addition to contracts with Ratings of 4 Stars or higher and accelerated the phase-in of higher bonus payments to all levels of Star Ratings in payment years 2012 through 2014. The primary goal of this evaluation is to examine whether a causal relationship between the bonus payments and improved quality exists throughout the Ratings continuum. Towards this aim, we compare quality Ratings, enrollment, and benefit data for contracts in Star Ratings years 2009 through 2012 (derived from quality data collected prior to the announcement of the demonstration) to contracts in Star Ratings years 2013 through 2015 (derived from quality data collected after the announcement of the demonstration). Evaluating the causal impact of the QBP demo on quality is constrained by several factors, including the absence of an appropriate counterfactual, concurrent policy changes affecting MA plan payments and quality Ratings, and nonequivalence in Star Ratings measures over time. As a result, we provide descriptions of the payments made as a result of the QBP demo, contemporaneous changes in Star Ratings, enrollment, and benefits, but we cannot identify the unique contribution of the QBP demo from the effects of other factors the observed changes.
 

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03/11/16 – December 31, 2015 Effectuated Enrollment Snapshot

On December 31, 2015, about 8.8 million consumers had effectuated Health Insurance Marketplace coverage – which means those individuals paid their premiums and had an active policy at the end of December.  Of the approximately 8.8 million consumers nationwide with effectuated Marketplace enrollments at the end of December 2015, about 84 percent, or about 7.4 million consumers, were receiving an advance payment of the premium tax credit (APTC) to make their premiums more affordable throughout the year. The average APTC for those enrollees who qualified for the financial assistance was $272 per month.

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03/11/16 – Next Generation ACO Model Updated: Request for Applications and Letter of Intent Frequently Asked Questions Documents Posted

Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program (Shared Savings Program), the Next Generation ACO Model offers a new opportunity in accountable care—one that sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care.

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Click here to view 2017 Request for Application

Click here to view Letter of Intent (LOI) Frequently Asked Questions


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03/11/16 – HHS Awards $94 Million to Health Centers to Help Treat the Prescription Opioid Abuse and Heroin Epidemic in America

Today, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced $94 million in Affordable Care Act funding to 271 health centers in 45 states, the District of Columbia, and Puerto Rico to improve and expand the delivery of substance abuse services in health centers, with a specific focus on treatment of opioid use disorders in underserved populations.

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Click here to view a list of the award winners


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03/09/16 – Medicare Skilled Nursing Facility (SNF) Transparency Data (CY2013)

The Centers for Medicare & Medicaid Services (CMS) released a new dataset, the Skilled Nursing Facility Utilization and Payment Public Use File (SNF PUF).  This data set, which is part of CMS’s Medicare Provider Utilization and Payment Data sets, details information on services provided to Medicare beneficiaries by skilled nursing facilities.  The new data include information on 15,055 skilled nursing facilities, over 2.5 million stays, and almost $27 billion in Medicare payments for 2013.  The data is posted on the CMS website at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/SNF.html

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Click here to view the data


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03/09/16 – CMS Releases Skilled Nursing Facility Utilization and Payment Data

Data Serve as Comprehensive Resource for Information on Skilled Nursing Facility Costs and Services

As part of our efforts to increase the transparency of federal health programs, the Centers for Medicare & Medicaid Services (CMS) today released a public data set that provides information on services provided to Medicare beneficiaries by skilled nursing facilities (SNFs).  The Skilled Nursing Facility Utilization and Payment Public Use File (SNF PUF) contains information on utilization, payments, and submitted charges organized by provider, state, and resource utilization group (RUG).  The data include information on 15,055 skilled nursing facilities, over 2.5 million stays, and almost $27 billion in Medicare payments for 2013. The data set does not contain any individually identifiable information about Medicare beneficiaries.

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03/08/16 – CMS Proposes to Test New Medicare Part B Prescription Drug Models to Improve Quality of Care and Deliver Better Value for Medicare Beneficiaries

Next Step to Address Access, and Innovation in Prescription Drugs

Today, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule to test new models to improve how Medicare Part B pays for prescription drugs and supports physicians and other clinicians in delivering higher quality care. CMS values public input and comments as part of the rulemaking process, and looks forward to continuing to work with stakeholders through the rulemaking process to maximize the value and learning from the proposed tests.

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Click here to view a fact sheet with more information about the proposed rule

Click here to view a fact sheet with more information about what Medicare beneficiaries need to know about the proposed model

Click here to view the proposed rule

Click here to view additional information on the proposed rule


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03/03/16 – HHS Approves Major Medicaid Expansion for Flint

Today, the U.S. Department of Health and Human Services announced that the Centers for Medicare & Medicaid Services (CMS) has approved the State of Michigan’s 1115 demonstration to extend Medicaid coverage and services to Flint residents impacted by the lead exposure. In recognition of the public health crisis in Flint, it is a top priority for the Administration and for the Department to ensure that all children and pregnant women exposed to lead in their water in Flint have access to the services they need.  Approximately 15,000 additional children and pregnant women will be eligible for Medicaid coverage and 30,000 current Medicaid beneficiaries in the area will be eligible for expanded services under this new waiver agreement.

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03/03/16 – HHS Reaches Goal of Tying 30 Percent of Medicare Payments to Quality Ahead of Schedule

A Major Milestone in the Effort to Improve Quality and Pay Providers for What Works

Thanks to tools provided by the Affordable Care Act, an estimated 30 percent of Medicare payments are now tied to alternative payment models that reward the quality of care over quantity of services provided to beneficiaries, HHS announced today.  Today’s announcement means that over 10 million Medicare patients are getting improved quality of care by having more time with their doctors and better coordinated care – nearly a year ahead of schedule.

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03/03/16 – 20 Million People Have Gained Health Insurance Coverage Because of the Affordable Care Act, New Estimates Show

More than 6 Million Uninsured Young Adults Have Gained Health Insurance Coverage Since 2010

A new report released today finds that the provisions of the Affordable Care Act have resulted in an estimated 20 million people gaining health insurance coverage between the passage of the law in 2010 and early 2016—an historic reduction in the uninsured.    Those provisions include Medicaid expansion, Health Insurance Marketplace coverage, and changes in private insurance that allow young adults to stay on their parent’s health insurance plans and require plans to cover people with pre-existing health conditions.

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03/03/16 – Overview of Select Alternative Payment Models

The Centers for Medicare & Medicaid Services (CMS) has deployed multiple alternative payment models that increasingly tie Medicare payments to value, meaning the quality and efficiency of the care delivered.  In total, as of January 1, 2016, CMS has identified 10 alternative payment models that contribute to progress towards goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value. Those include:

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03/03/16 – Better Care. Smarter Spending. Healthier People: Improving Quality and Paying for What Works

In January 2015, the Administration announced its goals to help drive Medicare and the health care system at large towards rewarding the quality of care as opposed to the quantity of care provided to beneficiaries. The goals include tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements, by the end of 2016 and tying 50 percent of payments to these models by the end of 2018.

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03/02/16 – HHS Expands Head Start in Flint

The U.S. Department of Health and Human Services today announced that Head Start and Early Head Start services will expand immediately in Flint, Michigan to help children and families exposed to lead in the city’s water supply. The expansion was made possible through one-time emergency funds of $3.6 million and is one of several steps HHS is taking as the agency designated to lead the federal response and recovery effort in Flint.

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03/02/16 – Medicare-Medicaid Coordination Office

Fiscal Year 2015 Report to Congress

Section 2602 of the Patient Protection and Affordable Care Act, hereinafter referred to as the Affordable Care Act, created the Federal Coordinated Health Care Office (“Medicare‐Medicaid Coordination Office” hereinafter “the Office” or “MMCO”). The purpose of MMCO is to bring together Medicare and Medicaid in order to more effectively integrate benefits, and improve the coordination between the Federal Government and states to enhance access to quality services for individuals who are enrolled in both programs (Medicare-Medicaid enrollees, sometimes referred to as “dual eligibles”). The Affordable Care Act sets forth goals and responsibilities for the Office, including the annual submission of a Report to Congress.
 

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03/01/16 – ONC Launches New Challenges to Spur Innovation for Market-Ready, User-Friendly Health Technology Apps for Consumers and Providers

The Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) announced today a three-part strategy to spur the development of market-ready, user-friendly software applications (apps) for consumers and health care providers.

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03/01/16 – HHS Announces Proposed Rule to Support the Reliability, Transparency, Accountability, and Safety of Certified Health IT

ONC Health IT Certification Program: Enhanced Oversight and Accountability Proposed Rule

The U.S. Department of Health and Human Services and the Office of the National Coordinator for Health Information Technology (ONC) today proposed a new rule that would further enhance the safety, reliability, transparency, and accountability of certified health IT for users. The “ONC Health IT Certification Program: Enhanced Oversight and Accountability” proposed rulemaking  would modify the ONC Health IT Certification Program to reflect the widespread adoption of certified electronic health records and the rapid pace of innovation in the health IT market.

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02/29/16 – HHS Announces Major Commitments from Healthcare Industry to make Electronic Health Records Work Better for Patients and Providers

Health Information Technology Developers that Provide 90 Percent of Electronic Health Records Use by U.S. Hospitals and Five Largest Healthcare Systems Agree to Implement Three Commitments to Improve the Flow of Health Information

Today, U.S. Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell announced that companies that provide 90 percent of electronic health records used by U.S. hospitals, the nation’s five largest private healthcare systems, and more than a dozen leading professional associations and stakeholder groups have pledged to implement three core commitments that will improve the flow of health information to consumers and healthcare providers. Secretary Burwell made the announcement at the Health Information Management Systems Society conference attended by more than 40,000 health IT professionals, clinicians, executives, and vendors from around the world. The three commitments are:

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Click here to view the fact sheet


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02/29/16 – The Financial Alignment Initiative Enrollment, Age and Health Risk Assessment as of February 2016

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02/29/16 – Final HHS Notice of Benefit and Payment Parameters for 2017

The final HHS Notice of Benefit and Payment Parameters for 2017 released today sets standards for issuers and Health Insurance Marketplaces for plan years beginning on or after January 1, 2017. It generally includes payment parameters that will apply to the 2017 benefit year, establishes new standards to improve consumers’ Marketplace experience, promotes continuity and stability in the Marketplaces, and ensures coverage is affordable and accessible.

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02/29/16 – CMS Finalizes Improvements for the 2017 Health Insurance Marketplace

Today, the Centers for Medicare & Medicaid Services (CMS) issued the final annual Notice of Benefit and Payment Parameters for the 2017 coverage year, along with related guidance documents, as part of our ongoing efforts to promote healthy and stable markets that works for consumers and for insurers.

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Click here to view the fact sheet

Click here to view the final Annual Letter to Issuers

Click here to view a bulletin on the Rate Filing Justifications for the 2016 Filing Year for Single Risk Pool Compliant Coverage

Click here to view a set of Frequently Asked Questions (FAQs) related to the Moratorium on the Health Insurance Provider Fee

Click here to view guidance addressing the transitional policy for plans that have been continuously renewed since 2014

Click here to view the final Notice of Benefit and Payment Parameters for 2017 rule


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02/26/16 – The Health Care Fraud and Abuse Control Program Protects Consumers and Taxpayers by Combating Health Care Fraud

The Affordable Care Act has helped the Government Fight Fraud, Strengthen Health Insurance Programs, Protect Consumers, and Save Taxpayer Dollars

The Obama Administration is committed to reducing fraud, waste, and abuse across the government.  Since 2010, the U.S. Department of Health & Human Services, Office of Inspector General (HHS OIG), the Centers for Medicare & Medicaid Services (CMS), and the U.S. Department of Justice (DOJ) have been using powerful, new anti-fraud tools to protect Medicare and Medicaid by shifting from a “pay and chase” approach toward fraud prevention. Through the groundbreaking Healthcare Fraud Prevention Partnership, stronger relationships have been built between the government and the private sector to help protect all consumers.

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02/25/16 – Program Integrity Enhancements to the Provider Enrollment Process (CMS-6058-P)

This proposed rule is part of CMS’s ongoing and continuous effort to prevent questionable providers and suppliers from entering the Medicare program and enhance our ability to promptly identify and act on instances of improper behavior.

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02/24/16 – Fact Sheet: Special Enrollment Confirmation Process

Special enrollment periods (SEPs) are an important way to make sure that people who lose health insurance during the year or who experience major life changes like getting married or having a child have the opportunity to enroll in coverage through the Health Insurance Marketplaces outside of the annual Open Enrollment period. SEPs are a longstanding feature of employer insurance, and without them many people would lack options to maintain continuous coverage. But it’s equally important to avoid SEPs being misused or abused.

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02/22/16 – CMS Publishes Medicare Fee-for-Service Provider & Supplier Lists

Posting of Ambulance, Home Health Utilization Data Follows Recent Provider and Supplier Moratoria Extension

As part of our efforts to improve care delivery, data sharing, and transparency, the Centers for Medicare & Medicaid Services (CMS) is releasing two public data sets regarding the availability and use of services provided to Medicare beneficiaries by ground ambulance suppliers and home health agencies, as well as a list of Medicare fee-for-service (FFS) providers and suppliers currently approved to bill Medicare. The data sets are accessible at https://data.cms.gov

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Click here to view more information on the recent temporary enrollment moratoria extension

Click here to view the Ambulance and Home Health Agency data set and a related fact sheet

Click here to view the Public Provider Enrollment data set and a related fact sheet


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02/22/16 – Strengthening Provider and Supplier Enrollment Screening

The Affordable Care Act (ACA) provided tools to enhance the Centers for Medicare & Medicaid Services’ (CMS) ability to screen providers and suppliers upon enrollment and identify those that may be at risk for committing fraud, including the use of risk-based screening of providers and suppliers. In addition to implementing the tools provided by the ACA, CMS is strengthening strategies designed to reinforce provider screening activities by increasing site visits to Medicare-enrolled providers and suppliers, enhancing and improving information technology (IT) systems, and implementing continuous data monitoring practices to help make sure practice location data is accurate and in compliance with enrollment requirements.

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02/19/16 – CMS Proposes 2017 Payment and Policy Updates for Medicare Health and Drug Plans

The Centers for Medicare & Medicaid Services (CMS) today released proposed changes for the Medicare Advantage and Part D Prescription Drug Programs in 2017 that will, if finalized, provide stable and fair payments to plans, and makes unprecedented improvements to the program for plans that provide high quality care to the most vulnerable enrollees.

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Click here to view the fact sheet

Click here to view the full 2017 Advance Notice


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02/18/16 – HHS Awards $500,000 in Funding to Flint Health Centers

U.S. Department of Health and Human Services Secretary Sylvia M. Burwell today announced $500,000 in funding to help two area health centers increase and expand activities in response to the lead contamination of Flint’s water.

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02/16/16 – Accountable Health Communities Model Updated: Frequently Asked Questions Posted 

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02/16/16 – Webinar: Accountable Health Communities Model – State Medicaid Agency Roles

This Accountable Health Communities Model webinar was held on Wednesday, February 10, 2016 from 3:00 – 4:00pm EST. The webinar focused on the anticipated role of state Medicaid agencies in the model.

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02/16/16 – CMS and Major Commercial Health Plans, in Concert with Physician Groups and Other Stakeholders, Announce Alignment and Simplification of Quality Measures

First Set of Core Measures, Used as Basis for Quality-Based Payments, were Developed by New Broad Collaborative of Health Care System Participants

Today, the Centers for Medicare & Medicaid Services (CMS) and America’s Health Insurance Plans (AHIP), as part of a broad Core Quality Measures Collaborative of health care system participants, released seven sets of clinical quality measures (https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/Core-Measures.html).  These measures support multi-payer alignment, for the first time, on core measures primarily for physician quality programs. This work is informing CMS’s implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) through its measure development plan and required rulemaking, and is part of CMS’s commitment to ensuring programs work for providers while keeping the focus on improved quality of care for patients.

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Click here to view the fact sheet

Click here to view the AHIP, Collaborative Announcement


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02/11/16 – Medicare Reporting and Returning of Self-Identified Overpayments

CMS 6037-F Final Rule

The Centers for Medicare & Medicaid Services (CMS) has published a final rule that requires Medicare Parts A and B health care providers and suppliers to report and return overpayments by the later of the date that is 60 days after the date an overpayment was identified, or the due date of any corresponding cost report, if applicable.  A separate final rule was published in the May 23, 2014 Federal Register (79 FR 29844) that addresses Medicare Parts C and D overpayments.

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02/08/16 – More than 10 Million People with Medicare Have Saved Over $20 Billion on Prescription Drugs Since 2010

39 Million Medicare Beneficiaries Utilized Free Preventative Services in 2015

The Department of Health and Human Services released today new information that shows that millions of seniors and people with disabilities with Medicare continue to save on prescription drugs and see improved benefits in 2015 as a result of the Affordable Care Act.

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02/05/16 – HHS Proposes Changes to the Rules Governing the Confidentiality of Substance Use Disorder Records

Proposed Changes Would Facilitate Health Information Exchange to Support Delivery System Reform While Protecting the Privacy of Patients Seeking Treatment for a Substance Use Disorder

U.S. Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell today announced proposed revisions to the Confidentiality of Alcohol and Drug Abuse Patient Records regulations, 42 CFR Part 2. The goal of the proposed changes, which will be published in the Federal Register on February 9, 2016, is to facilitate information exchange within new health care models while addressing the legitimate privacy concerns of patients seeking treatment for a substance use disorder.

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02/04/16 – Health Insurance Marketplace Open Enrollment Snapshot – Week 13

January 24, 2016 – February 1, 2016

On January 31, Open Enrollment for 2016 coverage ended, with about 12.7 million plan selections through the Health Insurance Marketplaces. Of the 12.7 million consumers enrolling in Marketplace coverage, over 9.6 million came through the HealthCare.gov platform and 3.1 million selected a plan through State-based Marketplaces. It is also worth noting that nearly 400,000 people signed up for New York’s new Basic Health Program, along with about 33,000 people who signed up for Minnesota’s Basic Health Program, during this Open Enrollment. Basic Health Programs are state based programs supported by the Affordable Care Act that provide health insurance coverage to low income individuals who would generally otherwise be eligible for qualified health plans. In fact, about 300,000 of the New York Basic Health Program enrollees for 2016 are people who enrolled in Marketplace coverage for 2015 and were included in last year’s Marketplace total plan selections.

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02/04/16 – FACT SHEET: About 12.7 Million People Nationwide are Signed Up for Coverage During Open Enrollment

On January 31, Open Enrollment for 2016 coverage ended, with about 12.7 million consumers selecting plans or being automatically re-enrolled across all states, either through the HealthCare.gov platform or a State-based Marketplace, HHS Secretary Sylvia M. Burwell announced today. This does not include about 400,000 people who signed up on the New York and Minnesota Marketplaces for coverage through the Basic Health Program during this Open Enrollment. (Basic Health Programs are state-based programs supported by the Affordable Care Act that provide health insurance coverage to low income individuals who would generally otherwise be eligible for qualified health plans.)

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01/29/16 – New Proposal to Give Providers and Employers Access to Information to Drive Quality and Patient Care Improvement

MACRA Provides Expanded Opportunity for the Use of Medicare and Private Sector Claims Data to Drive Higher Quality, Lower Cost Care – The Centers for Medicare & Medicaid Services (CMS) today proposed rules that will expand access to analyses and data that will help providers, employers, and others make more informed decisions about care delivery. The new rules, as required by the Medicare Access and CHIP Reauthorization Act (MACRA), will allow organizations approved as qualified entities to confidentially share or sell analyses of Medicare and private sector claims data to providers, employers, and other groups who can use the data to support improved care. In addition, qualified entities will be allowed to provide or sell claims data to providers. The rule also includes strict privacy and security requirements for all entities receiving Medicare analyses or data, as well as new annual reporting requirements.

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01/28/16 – CMS Announces Proposed Improvements to Medicare Shared Savings Program

Plan Strengthens Incentives for ACOs to Improve Performance

The Centers for Medicare & Medicaid Services (CMS) today released a proposed rule to update the methodology used to measure the performance of Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (Shared Savings Program).  Today’s proposal builds on the momentum of growth in the Shared Savings Program and charts a path for long-term sustainability by improving the long-term incentives for ACOs as they continue to provide efficient, high quality health care to Medicare beneficiaries.

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Click here to view the fact sheet


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01/28/16 – CMS Releases First Ever Home Health Patient Experience of Care Star Ratings

Comparison Ratings that Help Patients Compare and Choose Among Home Health Agencies

Today, the Centers for Medicare & Medicaid Services (CMS) introduced the first patient experience of care star ratings on Home Health Compare (https://www.medicare.gov/homehealthcompare/search.html). Known as Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) Survey star ratings, these measures evaluate patients’ experiences with home health agencies.

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Click here to view Home Health Compare


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01/27/16 – Health Insurance Marketplace Open Enrollment Snapshot – Week 12

January 17, 2016 – January 23, 2016

With the final January 31 deadline just days away, about 8.9 million consumers have signed-up for health coverage through the HealthCare.gov platform or had their coverage automatically renewed. This week’s snapshot includes weekly and cumulative data for enrollment through HealthCare.gov, a breakdown of cumulative data for 38 states using the HealthCare.gov platform, and cumulative data for local markets. 

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01/26/16 – CMS Releases Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries

Today, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH), released a new Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries.

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01/22/16 – Accountable Health Communities Model - Frequently Asked Questions

The Accountable Health Communities (AHC) Model is a new model under the U.S. Department of Health and Human Services (HHS), Centers for Medicare & Medicaid Services (CMS) Innovation Center that examines whether systematically identifying and attempting to address health-related social needs of Medicare and Medicaid beneficiaries through referral and community navigation services can impact health care costs, reduce inpatient and outpatient health care utilization, and improve health care quality and delivery.

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01/21/16 – Eight in 10 Marketplace Customers in HealthCare.gov States Qualify for a Tax Credit with an Average Value of Nearly $300 per Month

People who Reenrolled Saved $43 per Month on Average by Shopping and Switching Plans – According to a new report released today, more than 8 in 10 people (83 percent) who selected or were automatically enrolled in a 2016 plan through the Marketplace qualify for a tax credit with an average value of $294 per month, or about 72 percent of the pre-tax credit premium.

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Click here to view the full report


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01/21/16 – Covered Outpatient Drugs Final Rule with Comment (CMS-2345-FC) – Fact Sheet

Today, the Centers for Medicare & Medicaid Services (CMS) released the Covered Outpatient Drugs final rule with comment that addresses key areas of Medicaid drug reimbursement and changes made to the Medicaid Drug Rebate Program by the Affordable Care Act. This final rule assists states and the federal government in managing drug costs, establishes the long term framework for implementation of the Medicaid drug rebate program, and creates a more fair reimbursement system for Medicaid programs and pharmacies.

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01/21/16 – CMS Finalizes ACA Rule to Save Taxpayers Billions by Improving Medicaid Prescription Drug Rebates and Reimbursements

In order to effectively implement provisions of the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) finalized a rule today detailing reforms to the rebate and reimbursement systems for Medicaid prescription drugs, which will save federal and state governments an estimated $2.7 billion over five years.

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01/20/16 – Health Insurance Marketplace Open Enrollment Snapshot – Week 11

January 10, 2016 – January 16, 2016

Since Open Enrollment began on November 1, about 8.8 million consumers signed-up for health coverage through the HealthCare.gov platform or had their coverage automatically renewed. This week’s snapshot includes weekly and cumulative data for enrollment through HealthCare.gov, a breakdown of cumulative data for 38 states using the HealthCare.gov platform, and cumulative data for local markets.

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01/13/16 - Health Insurance Marketplace Open Enrollment Snapshot - Week 10 - January 3, 2016 - January 9, 2016

Since Open Enrollment began on November 1, nearly 8.7 million consumers signed-up for health coverage through the HealthCare.gov platform or had their coverage automatically renewed. This week’s snapshot includes weekly and cumulative data for enrollment through HealthCare.gov, a breakdown of cumulative data for 38 states using the HealthCare.gov platform, and for the first time this Open Enrollment, cumulative data for certain local areas.

 

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01/11/16 – CMS Welcomes New Medicare Shared Savings Program (Shared Savings Program) Participants

On January 11, 2016, the Centers for Medicare & Medicaid Services (CMS) announced the selection of 100 new Accountable Care Organizations (ACOs) and 147 renewing ACOs that are joining or continuing their participation in the Medicare Shared Savings Program (Shared Savings Program) for the 2016 performance year, providing Medicare beneficiaries with access to high-quality, coordinated care across the United States. That brings the total of Shared Savings Program ACOs to 434 serving over 7.7 million Medicare fee-for-service beneficiaries.

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01/11/16 – Next Generation Accountable Care Organization Model (NGACO Model)

The Centers for Medicare & Medicaid Services (CMS) has launched a new accountable care organization (ACO) model called the Next Generation ACO Model (NGACO Model). The twenty-one ACOs participating in the NGACO Model in 2016 have significant experience coordinating care for populations of patients through initiatives, including, but not limited to, the Medicare Shared Savings Program and the Pioneer ACO Model. Building on experience from the Pioneer ACO Model and the Medicare Shared Savings Program, through this new model, CMS will partner with ACOs that are experienced in coordinating care for populations of patients and whose provider groups are ready to assume higher levels of financial risk and reward. This is in accordance with the Administration’s goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to alternative payment models, such as ACOs, by the end of 2016 -- and 50 percent by the end of 2018.

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01/06/16 – Health Insurance Marketplace Open Enrollment Snapshot – Week 9

December 27, 2015 – January 2, 2016

Since Open Enrollment began on November 1, about 8.6 million consumers signed-up for health coverage through the HealthCare.gov platform or had their coverage automatically renewed. The Week 9 snapshot includes the New Year’s holiday.

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01/06/16 – Accountable Health Communities (AHC) Model Fact Sheet

Many of the biggest drivers of health and health care costs are beyond the scope of health care alone. Health-related social needs often are left undetected and unaddressed. Unmet health-related social needs, such as food insecurity and inadequate or unstable housing, may increase the risk of developing chronic conditions, reduce an individuals’ ability to manage these conditions, increase health care costs, and lead to avoidable health care utilization.

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01/05/16 – First Ever CMS Innovation Center Pilot Project to Test Improving Patients’ Health by Addressing their Social Needs

$157 Million in Funding will Bridge Clinical Care with Social Services

The Department of Health and Human Services today announced a new funding opportunity of up to $157 million to test whether screening beneficiaries for health-related social needs and associated referrals to and navigation of community-based services will improve quality and affordability in Medicare and Medicaid. Many of these social issues, such as housing instability, hunger, and interpersonal violence, affect individuals’ health, yet they may not be detected or addressed during typical health care-related visits. Over time, these unmet needs may increase the risk of developing chronic conditions and reduce an individual’s ability to manage these conditions, resulting in increased health care utilization and costs.

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12/30/15 – Health Insurance Marketplace Open Enrollment Snapshot – Week 8

December 20 – December 26, 2015

Since Open Enrollment began on November 1, more than 8.5 million consumers signed-up for health coverage through the HealthCare.gov platform or had their coverage automatically renewed. Of the about 6 million Marketplace consumers whose coverage was renewed, about 3.6 million actively renewed and 2.4 million consumers were automatically renewed.

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12/29/15 – CMS Finalizes Rule Creating Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics and Supplies Items

The Centers for Medicare & Medicaid Services (CMS) today issued a final rule that would establish a prior authorization process for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items that are frequently subject to unnecessary utilization. This prior authorization process will help ensure that certain DMEPOS items are provided consistent with Medicare coverage, coding, and payment rules.  CMS believes the final rule will prevent unnecessary utilization while safeguarding beneficiaries’ access to medically necessary care.  

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Click here to view the final rule


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12/23/15 – Draft 2017 Letter to Issuers in the Federally-facilitated Marketplaces

The Centers for Medicare & Medicaid Services (CMS) is releasing this draft 2017 Letter to Issuersto Issuers in the Federally-facilitated Marketplaces (Letter). This Letter provides issuers seeking to
offerto offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Marketplaces (FFMs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs) with operational and technical guidance to help them successfully participate in those MarketplacesSM1 in 2017. Unless otherwise specified, references to the FFMs include the FF-SHOPs.
 

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12/23/15 – Stipends or Non-Monetary Incentives for MMP Enrollees Who Are MMP Advisory Committee Members

This memorandum provides additional clarification to Medicare-Medicaid Plans (MMPs) regarding stipends and non-monetary incentives for enrollees who are members of MMP advisory committees.

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12/22/15 – Health Insurance Marketplace Open Enrollment Snapshot - Week 7

December 13 – December 19, 2015

Since Open Enrollment began on November 1, more than 8.2 million consumers signed up for health coverage through the HealthCare.gov platform or had their coverage automatically renewed – with millions more selecting plans through State-based Marketplaces. Last year at this time, about 6.4 million had signed up for coverage or been automatically renewed by December 19, 2014. Since November 1, about 2.4 million new consumers signed up for Marketplace coverage, over one-third higher than the number of new consumers that signed up by the deadline for January 1 coverage last year. Between December 13 and December 19, more than 4 million people selected plans or had their coverage automatically renewed. High consumer demand as we neared the enrollment deadline for January 1 coverage, as well as the automatic renewal process, contributed to this overall total.

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12/22/15 – September 30, 2015 Effectuated Enrollment Snapshot

On September 30, 2015, about 9.3 million consumers had effectuated Health Insurance Marketplace coverage – which means those individuals paid their premiums and had an active policy at the end of September.[i] HHS’s effectuated enrollment projection continues to be 9.1 million people for the end of 2015.

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12/22/15 – Open Enrollment Trends: Selected HealthCare.gov Statistics Prior to the January 1, 2016 Coverage Deadline, December 22, 2015

Since Open Enrollment began on November 1, millions of Americans have learned about the financial help available and selected quality plans through the Marketplace for 2016. While six weeks remain before the final deadline, early consumer behavior and enrollment trends are beginning to surface. The following charts provide a preliminary analysis of plan selections ahead of the deadline for January 1 coverage through the HealthCare.gov platform.

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12/21/15 – Medicare Drug Spending Dashboard – Fact Sheet

Prescription drugs are a major contributor to improving patient health as well as a major driver of health care spending. Spending on prescription drugs in the U.S. grew by 12 percent in 2014, faster than in any year since 2002. The Centers for Medicare & Medicaid Services (CMS) is one of the largest purchasers of prescription drugs in the US.

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12/18/15 – Medicare Fee-for-Service Utilization and Payment Data Available for Home Health Agencies

Data Serves as Comprehensive Resource for Information on Home Health Agencies Costs and Services

As part of our efforts to improve care delivery, payments to providers, and the sharing and utilization of information, the Centers for Medicare & Medicaid Services (CMS) today released a public data set that provides information on services provided to Medicare beneficiaries by home health agencies.  The Home Health Agency Utilization and Payment Public Use File (Home Health Agency PUF) contains information on utilization, payments, and submitted charges organized by provider, state and home health resource group.

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Click here to view the fact sheet


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12/16/15 - Health Insurance Marketplace Open Enrollment Snapshot - Week 6: December 6, 2015 - December 12, 2015

More than 1.3 million consumers signed-up for health coverage through the HealthCare.gov platform between December 6 and December 12, the last full week before the deadline for January 1 coverage, bringing the total number of plan selections made since Open Enrollment began on November 1 to 4.17 million consumers.  Approximately 500,000 were new consumers, for a cumulative total of about 1.5 million new consumers since the beginning of Open Enrollment. “The unprecedented demand over the last several days continues to show that coverage through HealthCare.gov is something millions of Americans want and need,” said Department of Health and Human Services Secretary Sylvia Burwell.

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12/16/15 – HHS Collaborating with National Grocery and Retail Stores to Promote Open Enrollment

Today, with only one day left until the December 15th deadline for coverage beginning January 1, 2016, the Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell announced a collaboration with national grocery and retail stores, connecting millions of consumers to affordable health coverage. H-E-B, Kroger, Meijer, Southeastern Grocers and Walmart play an important role in helping individuals across the country find a health insurance plan to meet their health care and budget needs. Secretary Burwell is in San Antonio today visiting a local H-E-B grocery store where enrollment assisters are on hand to support education and outreach efforts.

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12/14/15 – Revised CY 2015 Core Reporting Requirements for Medicare-Medicaid Plans

The purpose of this memorandum is to announce the release of the revised Calendar Year 2015 Medicare-Medicaid Capitated Financial Alignment Model Reporting Requirements. MedicareMedicaid Plans (MMPs) should follow these revised requirements for all future submissions of 2015 measure data. Please see below for a description of the substantive changes that were made as compared to the prior version of the CY 2015 requirements. Note that the majority of the changes were communicated to MMPs previously via separate guidance.

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Click here to read the updated reporting requirements


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12/14/15 – HHS Collaborating with National Grocery and Retail Stores to Promote Open Enrollment

Today, with only one day left until the December 15th deadline for coverage beginning January 1, 2016, the Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell announced a collaboration with national grocery and retail stores, connecting millions of consumers to affordable health coverage. H-E-B, Kroger, Meijer, Southeastern Grocers and Walmart play an important role in helping individuals across the country find a health insurance plan to meet their health care and budget needs. Secretary Burwell is in San Antonio today visiting a local H-E-B grocery store where enrollment assisters are on hand to support education and outreach efforts.

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12/14/15 – $750,000 HIPAA Settlement Underscores the Need for Organization-Wide Risk Analysis

The University of Washington Medicine (UWM) has agreed to settle charges that it potentially violated the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule by failing to implement policies and procedures to prevent, detect, contain, and correct security violations.  UWM is an affiliated covered entity, which includes designated health care components and other entities under the control of the University of Washington, including University of Washington Medical Center, the primary teaching hospital of the University of Washington School of Medicine.  Affiliated covered entities must have in place appropriate policies and processes to assure HIPAA compliance with respect to each of the entities that are part of the affiliated group.  The settlement includes a monetary payment of $750,000, a corrective action plan, and annual reports on the organization’s compliance efforts.

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12/12/15 – HHS Partners with More than 20 Faith Organizations to Promote Enrollment in the Health Insurance Marketplace

As the December 15th deadline for coverage starting January 1st approaches, the Department of Health and Human Services (HHS) today announced a collaboration with more than 20 faith-based organizations nationwide, with a combined reach of more than five million people to support outreach and enrollment efforts for the 2016 Open Enrollment. HHS partners are continuing their work to make sure consumers have access to the health information they need to get covered.

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12/11/15 – Medicare-Medicaid Plan (MMP) Advisory Committee Stipends and Non-Monetary Incentives

The memorandum provides clarification to Medicare-Medicaid Plans (MMPs) regarding stipends and non-monetary incentives for enrollees who are members of MMP advisory committees. 

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12/11/15 – FACT SHEET: HHS and Treasury Issue Additional Guidance on 1332 Waivers

On December 11, 2015, the Department of Health and Human Services and the Department of the Treasury posted guidance in the Federal Register for states interested in seeking a State Innovation Waiver under section 1332 of the Affordable Care Act.  The guidance provides states with flexibility to pursue innovative waiver proposals while preserving the important protections of the Affordable Care Act, consistent with the statutory language.  The guidance explains how the Secretaries will evaluate waiver applications, so that states have the information they need as they consider a waiver application.  The Departments welcome comments on all aspects of the guidance and look forward to continuing to work with states and other stakeholders.

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12/11/15 – New Consumer Decision Support Features Now Available at HealthCare.gov

As consumers count down to the December 15 enrollment deadline for January 1 coverage, the Centers for Medicare & Medicaid Services (CMS) announced today that new HealthCare.gov consumer decision support features piloted earlier this enrollment season will now be fully deployed to all visitors.  The new Out of Pocket Cost calculator, Doctor and Facility Lookup, and Prescription Drug Lookup features will help consumers to more easily search for the plan that best meets their budget and health needs.

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12/10/15 – Medicare-Medicaid Capitated Financial Alignment Model Quality Withholding Technical Notes (DY 1): Michigan-Specific Measures

The measures in this attachment are quality withhold measures for all Medicare-Medicaid Plans (MMPs) in the MI Health Link demonstration for Demonstration Year 1 (DY 1). These state-specific measures directly supplement the Medicare-Medicaid Capitated Financial Alignment Model CMS Core Quality Withhold Technical Notes for DY 1, which can be found at the following address: http://www.cms.gov/MedicareMedicaid-Coordination/Medicare-and-Medicaid-Coordination/MedicareMedicaidCoordinationOffice/FinancialAlignmentInitiative/Downloads/DY1QualityWithholdGuidance060614.pdf. 
 

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12/10/15 – Fiscal Year (FY) 2016 Results for the CMS Hospital-Acquired Conditions (HAC) Reduction Program

Section 3008 of the Patient Protection and Affordable Care Act (ACA) established the Hospital-Acquired Condition (HAC) Reduction Program to provide an incentive for applicable hospitals to reduce HACs. Effective beginning Fiscal Year (FY) 2015 (discharges beginning on October 1, 2014), the HAC Reduction Program requires the Secretary of the Department of Health and Human Services to adjust payments to applicable hospitals that rank in the worst-performing quartile of all subsection (d) non-Maryland hospitals with respect to risk-adjusted HAC quality measures. These hospitals will have their payments reduced to 99 percent of what would otherwise have been paid for such discharges.

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12/10/15 – CMS Expands Quality Data on Physician Compare and Hospital Compare to Help Consumers Choose Health Care Providers

Updates Provide More Quality Metrics for Health Care Professionals and Group Practices

The Centers for Medicare & Medicaid Services (CMS) is committed to providing current quality performance data that is useful to the consumer. Today, data has been refreshed on both the Physician Compare and Hospital Compare websites to improve these consumer online tools.

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12/9/15 – Health Insurance Marketplace Open Enrollment Snapshot – Week 5 – November 29 – December 5

Heading into the final days before the December 15 deadline for January 1 coverage, more than 1 million new consumers signed-up for health coverage through the HealthCare.gov platform and about 1.8 million have returned to the Marketplace to renew their coverage for 2016. As expected, consumer interest in health coverage is increasing as we approach the December 15 deadline with over 800,000 people selecting plans during the fifth week of Open Enrollment. In total, 2.84 million consumers have made plan selections since November 1.

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12/8/15 – HHS Partners with LGBT Organizations to Promote Open Enrollment Activities during LBGT Week of Action

With the December 15 deadline for coverage starting in January 2016 fast approaching, the Department of Health and Human Services (HHS) today announced partnerships with key national organizations to support LGBT outreach and enrollment efforts during 2016 Open Enrollment. As part of LGBT Week of Action from Dec. 7 – 11, Out2Enroll and other organizations will hold enrollment activities and provide in-person assistance across the country. Additionally, partners will leverage social media campaigns to ask their members and affiliates to sign up for an affordable health plan for 2016 through the Health Insurance Marketplace.

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12/2/15 – Health Insurance Marketplace Open Enrollment Snapshot – Week 4

November 22 – November 28, 2015

Four weeks into Open Enrollment and consumers continue to show a strong interest in exploring their health care options and signing up for coverage. In the fourth week of Open Enrollment, almost 395,000 people selected plans using the HealthCare.gov platform, totaling over two million plan selections since November 1. In addition to national data, the Week 4 snapshot includes state-by-state plan selection estimates for those states using HealthCare.gov.
 

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12/2/15 – CMS Releases 2014 National Health Expenditures

Aggregate Health Expenditures Increase as Millions Gain Coverage and Prescription Drug Costs Increase; Spending Growth Remains Below Rates Seen Prior to the Affordable Care Act

In 2014, per-capita health care spending grew by 4.5 percent and overall health spending grew by 5.3 percent, a study by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) published today as a Web First by Health Affairs. Those rates are below most years prior to passage of the Affordable Care Act. In addition, consumer out-of-pocket spending grew by only 1.3 percent in 2014, as compared to 2.4 percent growth in 2013, reflecting the increased number of individuals with health coverage.

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12/1/15 – National Patient Safety Efforts to Save 87,000 Lives and Nearly $20 Billion in Costs

Report Shows Hospital-Acquired Conditions Decline by 17 Percent Over a Four-Year Period

A report released by the Department of Health and Human Services (HHS) today shows that thanks in part to provisions of the Affordable Care Act, an estimated 87,000 fewer patients died in hospitals and nearly $20 billion in health care costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2014. Preliminary estimates show that, in total, hospital patients experienced 2.1 million fewer hospital-acquired conditions from 2010 to 2014, a 17 percent decline over that period. This aligns with HHS’ aim to encourage better care, smarter spending, and healthier people.

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Click here to view the report


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11/30/15 – Triple-S Management Corporation Settles HHS Charges by Agreeing to $3.5 Million HIPAA Settlement

Triple-S Management Corporation (“TRIPLE-S”), on behalf of its wholly owned subsidiaries, Triple-S Salud Inc., Triple-C Inc. and Triple-S Advantage Inc. , formerly known as American Health Medicare Inc.,  has agreed to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules with the U.S. Department of Health and Human Services, Office for Civil Rights (OCR).  TRIPLE-S will pay $3.5 million and will adopt a robust corrective action plan to correct deficiencies in its HIPAA compliance program, an effort it has already begun.

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11/27/15 - Focused Dementia Care Survey Tools

The Centers for Medicare & Medicaid Services (CMS) completed a pilot project in 2014 to examine the process for prescribing antipsychotic medications and assess compliance with other federal requirements related to dementia care practices in nursing homes. Additionally, it was initiated to gain new insights about surveyor knowledge and skills and ways that the current survey process may be streamlined to more efficiently and accurately identify and cite deficient practice.

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11/25/15 – HIPAA Settlement Reinforces Lessons for Users of Medical Devices

Lahey Hospital and Medical Center (Lahey)  has agreed to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules with the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR).  Lahey will pay $850,000 and will adopt a robust corrective action plan to correct deficiencies in its HIPAA compliance program.  Lahey is a nonprofit teaching hospital affiliated with Tufts Medical School, providing primary and specialty care in Burlington, Massachusetts.
 
 

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11/25/15 – Health Insurance Marketplace Open Enrollment Snapshot Week 3: November 15 – November 21, 2015

During the third week of Open Enrollment, consumers continued to explore their health insurance options by reaching out to a call center representative at 1-800-318-2596, attending enrollment events in their local communities, or visiting HealthCare.gov or CuidadoDeSalud.gov. There are about three weeks remaining ahead of the December 15 deadline.

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11/23/15 – Initial Phase in of Adjustments to Fee Schedule Amounts for Certain DMEPOS Using Information from the Competitive Bidding Program

On November 23, 2015, the Centers for Medicare & Medicaid Services (CMS) announced the release of the 2016 Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) fee schedule amounts.  The DMEPOS and Parenteral and Enteral Nutrition (PEN) public use files contain the 2016 fee schedule amounts for certain items that were adjusted based on information from the DMEPOS Competitive Bidding Program in accordance with sections 1834(a)(1)(F) and 1842(s)(3)(B) of the Social Security Act.  The following is information associated with this change.

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11/20/15 – Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017

This proposed rule sets forth payment parameters and provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost sharing parameters and costsharing reductions; and user fees for Federally-facilitated Exchanges. It also provides additional standards for the annual open enrollment period for the individual market for the 2017 benefit year; essential health benefits; cost-sharing requirements; qualified health plans; updated standards for Exchange consumer assistance programs; network adequacy; patient safety standards; the Small Business Health Options Program; stand-alone dental plans; acceptance of third-party payments by qualified health plans; the definitions of large employer and small employer; fair health insurance premiums; guaranteed availability; student health insurance coverage; the rate review program; the medical loss ratio program; eligibility and enrollment; exemptions and appeals; and other related topics.
 

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11/20/15 – CMS Proposes Improvements for the 2017 Marketplace

The Centers for Medicare & Medicaid Services (CMS) today issued the proposed annual Notice of Benefit and Payment Parameters for 2017, governing participation in the Health Insurance Marketplaces. The proposed rule seeks comment on proposals that will provide continued choice and competition for consumers, and a vibrant and growing market for affordable, quality health plans.  The proposed rule seeks to improve the consumer experience, both when individuals shop for health insurance and when they use it.

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11/19/15 – Risk Corridors Payment and Charge Amounts for Benefit Year 2014

Section 1342 of the Affordable Care Act directs the Secretary of the Department of Health and Human Services (HHS) to establish a temporary risk corridors program that provides issuers of qualified health plans (QHPs) in the individual and small group markets additional protection against uncertainty in claims costs during the first three years of the Marketplace. The program, which was modeled after a similar program implemented as part of the Medicare Part D prescription drug benefit program, encourages issuers to keep their rates stable as they adjust to the new health insurance reforms in the early years of the Marketplaces.
 

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11/19/15 – Health Care Law Results in $2.4 Billion in Consumer Rebates on Premiums Since 2011

The Centers for Medicare & Medicaid Services (CMS) released a new report today showing that consumers have received more than $2.4 billion premium rebates since 2011 because the Affordable Care Act requires that health insurance companies spend at least 80 percent of premium dollars on health care.  For 2014 alone, over 5.5 million consumers received nearly $470 million in rebates, for an average of $129 per family. Those rebates are in addition to improvements in quality and affordability savings consumers have received as the share of insurance companies in compliance with the requirements has increased.

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Click here to view the Medical Loss Ratio Report


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11/18/15 – Health Insurance Marketplace Open Enrollment Snapshot

Week 2: November 8 – November 14, 2015

The second week of Open Enrollment for Marketplace coverage saw millions more Americans exploring their health insurance options by calling the call center, attending enrollment events, or visiting HealthCare.gov or CuidadoDeSalud.gov.

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11/16/15 – CMS Finalizes Bundled Payment Initiative for Hip and Knee Replacements

Model Supports Quality and Care Improvements for Patients’ Transition from Surgery to Recovery

In 2014, more than 400,000 Medicare beneficiaries received a hip or knee replacement, costing more than $7 billion for the hospitalizations alone. Despite the high volume of these surgeries, quality and costs of care for these hip and knee replacement surgeries still vary greatly among providers. For instance, the rate of complications, like infections or implant failures, after surgery can be more than three times higher for procedures performed at some hospitals than others. And the average total Medicare expenditure for surgery, hospitalization, and recovery ranges from $16,500 to $33,000 across geographic areas.
 
 
 

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11/16/15 – CMS Announces $32 Million to Help Get Eligible Children Enrolled in Health Coverage

Medicaid and CHIP Continue to Drive Down Uninsurance Among Children

The Centers for Medicare & Medicaid Services today announced $32 million in available funds to support efforts to reach out to families with children eligible for Medicaid and the Children’s Health Insurance Program (CHIP) and help get them covered.  The funds will support activities aimed at alerting families to the availability of free or low-cost health coverage under Medicaid and CHIP, identifying children likely to be eligible, and assisting families with the application and renewal process.  Medicaid and CHIP provide comprehensive coverage to the nation’s most vulnerable children.

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11/12/15 – Medicare A/B Payment to Medicare-Medicaid Plans Participating in the Financial Alignment Initiative for Contract Year 2016

As follow up to the CMS Request for Information Proposed Changes to the CMS-HCC Risk Adjustment Model for Payment Year 2017 released on October 28, 2015, and available at https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk-Adjustors.html (under the “Downloads” section at the bottom of the page see the document Proposed Changes to the CMS-HCC Risk Adjustment Model for Payment Year 2017), this notice provides information to Medicare-Medicaid Plans (MMPs) regarding rate updates to the Medicare A/B payments to MMPs participating in the capitated financial alignment model during Contract Year (CY) 2016.

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11/12/15 – Medicare Advantage Value-Based Insurance Design Model

As part of the Health Plan Innovation Initiatives, the Medicare Advantage Value-Based Insurance Design (VBID) Model is an opportunity for Medicare Advantage plans to offer supplemental benefits or reduced cost sharing to enrollees with Centers for Medicare & Medicaid Services (CMS)-specified chronic conditions, focused on the services that are of highest clinical value to them. The model will test whether this can improve health outcomes and lower expenditures for Medicare Advantage enrollees.
 

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11/12/15 – Health Insurance Marketplace Open Enrollment Snapshot

Week 1: November 1 – November 7, 2015

In the first week of Open Enrollment for 2016 Health Insurance Marketplace coverage, millions of people found in-person assistance in their local community, spoke with a call center representative or visited HealthCare.gov or CuidadoDeSalud.gov to review their coverage options, learn about what financial assistance is available, or to sign up or re-enroll in a plan that best meets their needs.

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11/10/15 – 2016 Medicare Parts A & B Premiums and Deductibles Announced

Today, the Centers for Medicare & Medicaid Services (CMS) announced the 2016 premiums and deductibles for the Medicare inpatient hospital (Part A) and physician and outpatient hospital services (Part B) programs.
 
 

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11/10/15 – 2016 Medicare Part B Premium State-by-State Savings

States have programs that pay some or all of dual eligible beneficiaries’ premiums and cost sharing for certain people who have Medicare and a limited income. The Bipartisan Budget Act of 2015 mitigated the Part B premium increase for these beneficiaries, who are not held harmless, to $121.80 (as compared to the $159.30 premium estimated in the 2015 Medicare Trustees Report). The Centers for Medicare & Medicaid Services Office of the Actuary estimates that states will save $1.8 billion as a result of this premium mitigation.

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11/10/15 – Part D Enhanced Medication Therapy Management Tool

The Part D Enhanced Medication Therapy Management (MTM) model will test whether providing Part D sponsors with additional payment incentives and regulatory flexibilities will engender enhancements in the MTM program, leading to improved therapeutic outcomes, while reducing net Medicare expenditures. The model is an opportunity for stand-alone basic Part D plans to right-size their investments in MTM services, identify and implement innovative strategies to optimize medication use, improve care coordination, and strengthen system linkages.

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11/6/15 – 2016 FFM Web-broker List

The Centers for Medicare & Medicaid Services (CMS) is making the Web-broker Federally-facilitated Marketplace (FFM) Registration Completion List (“Web-broker List”) available to the public pursuant to Section 1312(e) of the Affordable Care Act and 45 C.F.R. §155.220, and Routine Use No. 11 of the System of Records Notice required by the Privacy Act of 1974 (5 U.S.C. §552a), titled, “Health Insurance Exchanges (HIX) Program” (No. 09-70-0560), published at 78 Fed. Reg. 8,538 (February 6, 2013), as amended and published at 78 Fed. Reg. 32,256 (May 29, 2013), and at 78 Fed. Reg. 63,211 (October 23, 2013).

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11/5/15 – CMS and New York State Partner to Coordinate Care for Medicare-Medicaid Enrollees with Intellectual and Developmental Diabilities

On November 5, 2015, the Centers for Medicare & Medicaid Services (CMS) announced that CMS is partnering with the New York State Department of Health (NYSDOH) and the Office for People with Developmental Disabilities (OPWDD) to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience.

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11/3/15 – HealthCare.gov Pilots New Doctor Lookup Feature

Beginning today, HealthCare.gov is piloting a new beta feature that allows consumers to search plans by their preferred provider or health facility. Some consumers will be part of a pilot that allows them to use the beta Doctor Lookup feature as they compare their coverage options in window shopping or when selecting a plan.

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11/3/15 – Medicare Part D Overutilization Monitoring System (OMS) Summary

As part of a multifaceted response to address the growing problem of overuse and abuse of opioid analgesics (“opioids”) in the Part D program, the Centers for Medicare & Medicaid Services (CMS) adopted a policy in 2013 for Medicare Part D plan sponsors to implement enhanced drug utilization review. CMS is seeing real results from these efforts. From 2011 through 2014, there was a 26% decrease or 7,500 fewer Medicare Part D beneficiaries identified as potential opioid overutilizers. This represents a 39% decrease in the share of beneficiaries using opioids who are identified as potential opioid overutilizers.

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11/3/15 – New Medicare Part D Opioid Drug Mapping Tool Available

Interactive Online Mapping Tool Allows Public to Search Medicare Part D Opioid Prescription Claims Data at the State, County, and ZIP Code Levels

Today, the Centers for Medicare & Medicaid Services (CMS) released an interactive online mapping tool (http://go.cms.gov/opioidheatmap) which shows geographic comparisons at the state, county, and ZIP code levels of de-identified Medicare Part D opioid prescription claims – prescriptions written and then submitted to be filled – within the United States. This new mapping tool allows the user to see both the number and percentage of opioid claims at the local level and better understand how this critical issue impacts communities nationwide.

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Click here to view the tool


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10/30/15 – Consumers will Continue to Find Affordable Options in the Health Insurance Marketplace in 2016

For Returning Consumers, More Than 7 in 10 Can Find Plans for $75 a Month in Premiums or Less; More Than 8 in 10 Could Save an Average of $610 Annually in Premiums Before Tax Credits by Shopping

A new report detailing affordability and plan choice in the Health Insurance Marketplace finds that with applicable tax credits, more than 7 in 10 current Marketplace enrollees could find plans for $75 a month in premiums or less, and almost 8 in 10 could find plans for $100 a month in premiums or less.

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Click here to view the report


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10/30/15 – CMS Finalizes 2016 Medicare Payment Rules for Physicians, Hospitals & Other Providers

The Centers for Medicare & Medicaid Services (CMS) issued final rules this week detailing how the agency will pay for services provided to beneficiaries in Medicare by physicians and other health care professionals in 2016 that reflects the administration’s commitment to quality, value, and patient-centered care. Payment rules for the 2016 calendar year for End-Stage Renal Disease Prospective Payment System, the Hospital Outpatient Prospective Payment System, Home Health Prospective Payment System, and the Physician Fee Schedule were all finalized this week.

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Click here to view the fact sheet

Click here to view the CMS Finalizes Hospital Outpatient and Ambulatory Surgical Center Policy and Payment Changes, Including Changes to the Two-Midnight Rule and Quality Reporting for 2016 fact sheet

Click here to view the fact sheet on Quality Reporting for 2016

Click here to view the fact sheet on the Two-Midnight Rule


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10/29/15 - Discharge Planning Proposed Rule Focuses on Patient Preferences

Today, the Centers for Medicare & Medicaid Services (CMS) proposed to revise the discharge planning requirements that hospitals, including long-term care hospitals and inpatient rehabilitation facilities, critical access hospitals, and home health agencies, must meet in order to participate in the Medicare and Medicaid programs. The proposed changes would modernize the discharge planning requirements by: bringing them into closer alignment with current practice; helping to improve patient quality of care and outcomes; and reducing avoidable complications, adverse events, and readmissions.

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10/29/15 – Michigan MMPs: Release of Final Contract Year 2016 Marketing Guidance for Medicare-Medicaid Plans

Attached to this memorandum is the final Contract Year (CY) 2016 marketing guidance for Medicare-Medicaid Plans (MMPs) operating in the Michigan Capitated Financial Alignment Demonstration. This guidance has been jointly updated by CMS and Michigan as summarized below and will be applicable to all marketing done for CY 2016 benefits.

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Click here to view the CY 2016 Marketing Guidance for Michigan Medicare-Medicaid Plans


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10/29/15 – CMS Announces Payment Changes for Medicare Home Health Agencies for 2016

The Centers for Medicare & Medicaid Services (CMS) today announced changes to the Medicare home health prospective payment system (HH PPS) for calendar year (CY) 2016 that will foster greater efficiency, payment accuracy, and improved quality of care. Approximately 3.5 million beneficiaries received home health services from 11,900 HHAs, costing Medicare $17.9 billion in 2014.  

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10/29/15 – CMS Updates Policies and Payment Rates for End-Stage Renal Disease for CY 2016 and Changes to the ESRD Quality Incentive Program

Finalized Payment System

On October 29, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2016.

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10/29/15 – ICD-10 Transition Moved Forward

On October 1, 2015 health systems across the country transitioned to the International Classification of Diseases, 10th Revision – ICD-10. This change will enable providers to capture more details about the health status of their patients to improve patient care and public health surveillance.

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10/29/15 – CMS Strengthens Access to Essential Health Services for Medicaid Beneficiaries

Meaningful access to health care services is crucial for the 72 million Americans who rely on the Medicaid program for coverage. As our nation  moves towards better sharing and utilizing of information to improve health access, treatment, and outcomes, it is critical for us to work together to ensure continued access to preventive, primary, and specialty service that are needed to maintain the health and well-being of our most vulnerable populations.

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10/28/15 – Switching Plans Resulted in Significant Savings for Marketplace Consumers

Full-Year Enrollees Saved Nearly $400 on Premiums after Tax Credits for the Same Level of Coverage in 2015

Health and Human Services Secretary Sylvia M. Burwell announced today the findings of a new report that shows that consumers who reenrolled in the Health Insurance Marketplace last year and who switched to a plan with the same level of coverage saved nearly $33 per month after tax credits, or almost $400 annually, relative to what they would have paid had they remained in the same plan as in 2014.  Those who also switched issuers within the same level of coverage were able to save $41 per month, or over $490 annually after tax credits.

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Click here to view the full report


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10/28/15 – Michigan MMPs: Revision to Final Contract Year 2016 Marketing Guidance

This memorandum updates the Final Contract Year 2016 Marketing Guidance for Michigan Medicare-Medicaid Plans (MMPs), originally issued on July 31, 2015, which inadvertently excluded the requirement that the disclaimer on the availability of non-English translations in section 50.4 must be included in English, Arabic, and Spanish. Specifically, section 50.4 of the guidance is revised as follows:
 

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10/26/15 – Medicare Advantage Value-Based Insurance Design Model

As part of the Health Plan Innovation Initiatives, the Medicare Advantage Value-Based Insurance Design (VBID) Model is an opportunity for Medicare Advantage plans to offer supplemental benefits or reduced cost sharing to enrollees with Centers for Medicare & Medicaid Services (CMS)-specified chronic conditions, focused on the services that are of highest clinical value to them. The model will test whether this can improve health outcomes and lower expenditures for Medicare Advantage enrollees.

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10/26/15 – 2016 Marketplace Affordability Snapshot

The next Open Enrollment period for the Health Insurance Marketplace begins on November 1, 2015 for coverage starting on January 1, 2016. According to an HHS analysis, about 8 out of 10 returning consumers will be able to buy a plan with premiums less than $100 dollars a month after tax credits; and about 7 out of 10 will have a plan available for less than $75 a month. Highlights of the 2016 Marketplace Affordability Snapshot include:

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10/26/15 – Fiscal Year (FY) 2016 Results for the CMS Hospital Value-Based Purchasing Program

The Hospital Value-Based Purchasing (VBP) Program adjusts what CM pays hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of care they give patients.  For FY 2016, the law requires that the applicable percent reduction, the portion of Medicare payments available to fund the program’s value-based incentive payments, go up from 1.50 to 1.75 percent of the base operating Medicare Severity diagnosis-related group (MS-DRG) payment amounts to all participating hospitals.  We estimate that the total amount available for value-based incentive payments in FY 2016 will be approximately $1.5 billion.

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Click here to view the FY 2016 value-based incentive payment adjustment factors


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10/23/15 – FACT SHEET: Improving the Consumer Experience at HealthCare.gov

Open Enrollment is just around the corner, and we’re ready to welcome consumers back to HealthCare.gov. Over the last few months, our team has been hard at work, applying lessons learned and taking steps to make enrollment quicker and smoother for both returning and new customers. Ahead of Open Enrollment 2016, new features were added to HealthCare.gov based on consumer feedback about previous experiences with the site and the type of additional information they want in order to pick the right plan. Over the next several weeks, we’ll be rolling out additional features to provide consumers with even more information about their plan choices.

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10/21/15 – Basic Health Program Funding Methodology Proposed Notice Fact Sheet

The Centers for Medicare & Medicaid Services (CMS) today issued a proposed notice establishing the methodology for determining federal funding for the Basic Health Program (BHP) in program years 2017 and 2018. The BHP provides states with the option to establish a health benefits coverage program for low-income individuals as an alternative to Health Insurance Marketplace coverage under the Affordable Care Act. This proposed notice is substantially the same as the final notice for program year 2016.

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10/20/15 – HHS Secretary Burwell Announces New Members of Advisory Council on Alzheimer’s Research, Care, and Services

HHS Secretary Sylvia M. Burwell today announced six new members to serve on the Advisory Council on Alzheimer's Research, Care, and Services. The Council was established in 2011 and convenes quarterly to continue development and progress on the National Plan to Address Alzheimer’s Disease by HHS, Veterans Affairs, the Department of Defense, and the National Science Foundation to address the disease. The new members will replace the members whose terms had expired and those that retired in September and will advise the secretary on federal programs that affect people with Alzheimer's disease and related dementias, and they will serve overlapping four-year terms.

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10/20/15 – Financial Alignment Initiative Enrollment, Age and Health Risk Assessment as of October 2015 Posted

The Centers for Medicare & Medicaid Services (CMS) launched the Financial Alignment Initiative in 2011 to begin addressing the financial misalignment between Medicare and Medicaid that often presents a barrier to coordinated care for enrollees. The Financial Alignment Initiative aims to better align the financing of these two programs and integrate primary, acute, behavioral health and long-term services and supports in a more easily navigable, simplified system for enrollees. The Initiative has two models, the capitated model and managed fee-for-service model, both of which are serving beneficiaries in states throughout the country. This document provides a snapshot of enrollment, age, and health risk assessment (HRA) experience to date for the capitated financial alignment model.
 

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10/19/15 – HHS Awards Up to $22.9 Million in Planning Grants for Certified Community Behavioral Health Clinics

Funding Supports Planning Efforts to Certify Community Behavioral Health Clinics in States Across the Nation

The Substance Abuse and Mental Health Services Administration (SAMHSA), in conjunction with the Centers for Medicare & Medicaid Services (CMS) and the Assistant Secretary of Planning and Evaluation (ASPE), today awarded a total of $22.9 million to support states throughout the nation in their efforts to improve behavioral health of their citizens by providing community-based mental and substance use disorder treatment.

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10/15/15 – 10 Million People Expected to Have Marketplace Coverage at End of 2016

HHS Aims to Sign Up More Than 1 Out of Every 4 Uninsured Consumers Eligible for Coverage

U.S. Health and Human Services (HHS) Secretary Sylvia M. Burwell announced today that she expects 10 million individuals to be enrolled in coverage through the Health Insurance Marketplaces and paying their premiums – so-called effectuated coverage – at the close of 2016.  As part of that goal, HHS believes more than 1 out of every 4 uninsured Marketplace-eligible consumers will select plans during Open Enrollment.

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Click here to view Survey Data

Click here to view ASPE brief on the number of individuals who might have effectuated Marketplace coverage at the end of 2016

Click here to view the ASPE brief on the QHP-eligible uninsured site


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10/14/15 – HHS Awards More Than $240 Million to Expand the Primary Care Workforce and Connect Health Care Professionals to Undeserved Communities

Health and Human Services (HHS) Secretary Sylvia Burwell today announced the award of more than $240 million in the National Health Service Corps (NHSC) and NURSE Corps scholarship and loan repayment programs to increase access to primary health care in communities that need it most. The awards will recruit over 4,000 medical students and providers.

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10/8/15 – New Medicare Utilization and Payment Data Available for Medical Equipment, Supplies

Data Serves as Comprehensive Resource for Information on Durable Medical Equipment Costs and Services

As part of the Administration’s efforts to make our healthcare system more transparent, affordable, and accountable, the Centers for Medicare & Medicaid Services (CMS) has posted a new data set as part of the Provider Utilization and Payment files. This data set, called Referring Provider Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Public Use File (PUF), provides information on physicians and other healthcare professionals who referred DMEPOS products and services, such as wheelchairs, walkers, and diabetes supplies for Medicare beneficiaries.

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Click here to view the data set

Click here to view the fact sheet


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10/7/15 – CMS Launches New ACO Dialysis Model

Affordable Care Act Model Designed to Improve Care for Beneficiaries with Kidney Failure While Reducing Costs

More than 600,000 Americans have end-stage renal disease (ESRD), also known as kidney failure, and require life sustaining dialysis treatments several times per week. These individuals typically have many health problems, are at higher risk of hospital readmissions, and suffer from fragmented care. In 2012, ESRD beneficiaries comprised 1.1% of the Medicare population and accounted for an estimated 5.6% of total Medicare spending.
 

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10/6/15 – HHS Publishes a Roadmap to Advance Health Information Sharing and Transform Care

ONC Issues Interoperability Roadmap Defining Critical Actions to Enable a Learning Health System

The Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) today released the final Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap (Roadmap).

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10/6/15 – HHS Issues Rules to Advance Electronic Health Records with Added Simplicity and Flexibility

Public Comment Period Offers Forum to Gather Additional Feedback and Inform Future Policies

The Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) today released final rules that simplify requirements and add new flexibilities for providers to make electronic health information available when and where it matters most and for health care providers and consumers to be able to readily, safely, and securely exchange that information. The final rule for 2015 Edition Health IT Certification Criteria (2015 Edition) and final rule with comment period for the Medicare and Medicaid Electronic Health Records (EHRs) Incentive Programs will help continue to move the health care industry away from a paper-based system, where a doctor’s handwriting needed to be interpreted and patient files could be misplaced.

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Click here to view the fact sheet

Click here to view more information on ONC's editions of certification criteria

Click here to see the CMS rule

Click here to see the ONC rule


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10/6/15 – CMS Fact Sheet: EHR Incentive Programs in 2015 and Beyond

The Centers for Medicare & Medicaid Services (CMS) released final rules that simplify requirements and add new flexibilities for providers to make, electronic health information available when and where it matters most and for health care providers and consumers to be able to readily, safely, and securely exchange that information. The final rules for 2015 Edition Health IT Certification Criteria (2015 Edition) and final rules with comment period for the Medicare and Medicaid Electronic Health Records (EHRs) Incentive Programs will help continue to move the health care industry from a paper-based system, where a doctor’s hand-writing had to be interpreted and patient files could be misplaced.

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10/5/15 – The Medicare-Medicaid Plan (MMP) Enrollment Technical Guidance Version 2.4 Posted

The MMP technical guide has been updated with version 2.4 to reflect the CMS November 2015 Software changes, as documented in the final CMS HPMS notice, dated August 28, 2015. The Infocrossing edit changes will be implemented on the November 2015 CMS Plan Data Due date which will occur on Friday November 6th, 2015. The actual implementation time will be right after 08:00 P.M. Eastern Time.
 

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10/1/15 – Risk Corridors Payment Proration Rate for 2014

Section 1342 of the Affordable Care Act directs the Secretary of the Department of Health and Human Services (HHS) to establish a temporary risk corridors program that provides issuers of qualified health plans (QHPs) in the individual and small group markets additional protection against uncertainty in claims costs during the first three years of the Marketplace. This program, which was modeled after a similar program used in the Medicare prescription drug benefit, encourages issuers to keep their rates stable as they adjust to the new health insurance reforms in the early years of the Marketplaces.

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10/1/15 – The Three Rs: An Overview

The Affordable Care Act (ACA) recognized that there would be uncertainty in the early years of the Marketplace for insurance companies as they tried to set premiums for a new group of people and implemented a higher standard of coverage – for example, no longer being able to deny coverage or charge more because of someone’s pre-existing conditions.

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9/29/15 – HHS Announces $685 Million to Support Clinicians Delivering High Quality, Patient-Centered Care

Health and Human Services Secretary Sylvia M. Burwell today announced $685 million in awards to 39 national and regional health care networks and supporting organizations to help equip more than 140,000 clinicians with the tools and support needed to improve quality of care, increase patients’ access to information, and reduce costs. The Transforming Clinical Practice Initiative is one of the largest federal investments designed to support doctors and other clinicians in all 50 states through collaborative and peer-based learning networks.

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Click here to view the Fact Sheet


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9/28/15 – CMS Announces Part D Enhanced Medication Therapy Management Model

Model’s Goal is to Improve Care, Reduce Costs in Medicare

Today, the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) announced a model to test strategies to improve medication use among Medicare beneficiaries enrolled in Part D. Medication therapy management, when implemented effectively, can improve health care and outcomes for patients and has the potential to lower overall health care costs.

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Click here to view the Fact Sheet

Click here for more information about the Enhanced MTM model test


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9/25/15 – CMS Awards $110 Million in Affordable Care Act Funding to Continue Improvements in Patient Safety

Hospital Engagement Networks Will Continue Patient Safety Improvement Efforts in Hospitals

Today, the Centers for Medicare & Medicaid Services (CMS) awarded $110 million in Affordable Care Act funding to 17 national, regional, or state hospital associations and health system organizations to continue efforts in reducing preventable hospital-acquired conditions and readmissions. Through the Partnership for Patients initiative – a nationwide public-private collaboration that began in 2011 to reduce preventable hospital-acquired conditions by 40 percent and 30-day readmissions by 20 percent – the second round of the Hospital Engagement Networks will continue to work to improve patient care in the hospital setting.  

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Click here to view the Fact Sheet


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9/25/15 – CMS Proposes New Medicare Clinical Diagnostic Laboratory Tests Fee Schedule

Proposed Initiative Would Begin Data Collection Process to Set New Payment Rates

The Centers for Medicare & Medicaid Services (CMS) today announced its next step in implementing the Protecting Access to Medicare Act of 2014 (PAMA), requiring clinical laboratories to report on private insurance payment amounts and volumes for lab tests. This data will be used to determine Medicare’s payment for lab tests beginning January 1, 2017.

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Click here to view the Fact Sheet


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9/22/15 – Secretary Burwell Previews Third Open Enrollment

New Analysis Shows 17.6 Million Have Gained Coverage as Affordable Care Act Provisions Have Taken Effect; About 10.5 Million Uninsured Individuals are Eligible for Marketplace Coverage

In a speech at the Howard University College of Medicine today, U.S. Secretary of Health and Human Services Sylvia M. Burwell reflected on the progress of the first five years of the Affordable Care Act and provided a look at the upcoming Open Enrollment period. In her speech, the Secretary described how the law is working to deliver access, affordability, and quality coverage and outlined how the Department of Health and Human Services will meet the challenges of the upcoming Open Enrollment for the Health Insurance Marketplaces.

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Click here to view Data Point

Click here to view the Technical Notes


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9/21/15 – Medicare Advantage Premiums Remain Stable; Enrollment at All-Time High

Seniors and People with Disabilities Will Have Continued Access to a Wide Range of Medicare Health and Drug Plans in 2016

Today, the Centers for Medicare & Medicaid Services (CMS) announced that Medicare Advantage premiums will remain stable and more enrollees will have access to higher quality plans while, for a sixth straight year, enrollment is projected to increase to a new all-time high. In addition, CMS released today new information that shows that millions of seniors and people with disabilities with Medicare continue to enjoy prescription drug discounts and affordable benefits as a result of the Affordable Care Act. Today’s announcement comes as CMS releases the premiums and costs for Medicare health and drug plans for the 2016 calendar year.

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9/21/15 – Fact Sheet: Moving Medicare Advantage and Part D Forward

Since passage of the Affordable Care Act, both the Medicare Advantage and the Part D programs have continued to grow as premiums remain stable and quality improves. Thanks to the successful implementation of the Affordable Care Act’s reforms, Medicare Advantage and Part D will continue to provide greater protections for beneficiaries and value for taxpayers.

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9/15/15 – HHS Awards Nearly $500 Million in Affordable Care Act Funding to Health Centers to Expand Primary Care Services

Today, Health and Human Services Secretary Sylvia M. Burwell announced nearly $500 million in Affordable Care Act funding to support health centers nationwide in providing primary care services to those who need them most.  The awards include approximately $350 million for 1,184 health centers to increase access to services such as medical, oral, behavioral, pharmacy, and vision care. Nearly $150 million will be awarded to 160 health centers for facility renovation, expansion, or construction to increase patient or service capacity.

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Click here to view a list of the 1,184 Expanded Services awardees

Click here to view the 160 Health Infrastructure Investment Program awardees


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9/11/15 – CY 2016 MMP Explanation of Benefits (EOB) templates (Drug-only and Integrated) Posted

Click here to view Model Monthly Integrated EOB - Instructions to Health Plans

Click here to view Model Monthly Drug Claim EOB - Instructions to Health Plans


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9/9/15 – 2016 Physician Quality Reporting System (PQRS) Payment Adjustment

PQRS is a quality reporting program that uses negative payment adjustments to promote reporting of quality information by individual eligible professionals (EPs), EPs providing services at a Critical Access Hospital (CAH) billing under method II, and PQRS group practices participating in the group practice reporting option (GPRO). Those who do not satisfactorily report data on quality measures for covered Medicare Physician Fee Schedule (MPFS) services furnished to Medicare Part B beneficiaries (including Railroad Retirement Board, Medicare Secondary Payer, and Critical Access Hospitals [CAH] method II) or satisfactorily participate in a qualified clinical data registry (QCDR) will be subject to a negative payment adjustment under PQRS.

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9/9/15 – US Surgeon General Launches Campaign with National Call to Action on Walking

Effort Highlights Health Benefits of Walking While Addressing Barriers to Access

The United States Surgeon General today issued a call to action to address major public health challenges such as heart disease and diabetes. Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities articulates the health benefits of walking while addressing the fact that many communities unacceptably lack safe and convenient places for individuals to walk or wheelchair roll.

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9/8/15 – June 30, 2015 Effectuated Enrollment Snapshot

On June 30, 2015, about 9.9 million consumers had effectuated Health Insurance Marketplace coverage – which means those individuals paid their premiums and had an active policy at the end of June.1 These numbers are consistent with HHS’s effectuated enrollment target of 9.1 million for the end of 2015.

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9/8/15 – CMS Releases First Ever Plan to Address Health Equity in Medicare

Today, the Centers for Medicare & Medicaid Services (CMS) Office of Minority Health (CMS OMH), unveiled the first CMS plan to address health equity in Medicare. The CMS Equity Plan for Improving Quality in Medicare (CMS Equity Plan for Medicare) is an action-oriented plan that focuses on six priority areas and aims to reduce health disparities in four years.

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9/3/15 – HHS Takes Next Step in Advancing Health Equity Through the Affordable Care Act

Proposed Rule Implements New Protections Against Sex Discrimination; Enhances Language Assistance; Protects Individuals with Disabilities; and Extends to Insurers Participating in Health Insurance Marketplaces

Today, the Department of Health and Human Services (HHS) issued a proposed rule to advance health equity and reduce disparities in health care.  The proposed rule, Nondiscrimination in Health Programs and Activities, will assist some of the populations that have been most vulnerable to discrimination and will help provide those populations equal access to health care and health coverage.

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Click here to view the fact sheet


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9/2/15 – CMS Awards $67 Million in Affordable Care Act Funding to Help Consumers Sign-Up for Affordable Health Insurance Marketplace Coverage in 2016

With Marketplace Open Enrollment set to begin on November 1, 2015, the Centers for Medicare & Medicaid Services (CMS) today announced grant awards totaling $67 million to support outreach efforts designed to connect people with local help as they seek to understand the coverage options and financial assistance available at HealthCare.gov. Awarded to 100 organizations located in 34 states that operate Federally Facilitated Marketplaces, State Partnership Marketplaces, and supported State-Based Marketplaces, the three year-long Marketplace Navigator grants will fuel efforts to help consumers enroll in a health plan that fits their budget and best meets their family’s needs.

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9/2/15 – $750,000 HIPAA Settlement Emphasizes the Importance of Risk Analysis and Device and Media Control Policies

Cancer Care Group, P.C. agreed to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules with the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR). Cancer Care paid $750,000 and will adopt a robust corrective action plan to correct deficiencies in its HIPAA compliance program. Cancer Care Group is a radiation oncology private physician practice, with 13 radiation oncologists serving hospitals and clinics throughout Indiana.

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9/1/15 – CMS Announces Value-Based Insurance Design Model to Improve Care and Reduce Costs in Medicare Advantage Plans

The Centers for Medicare & Medicaid Services (CMS) announced today the Medicare Advantage Value-Based Insurance Design Model, which will test the hypothesis that giving Medicare Advantage plans flexibility to offer targeted extra supplemental benefits or reduced cost sharing to enrollees who have specified chronic conditions can lead to higher-quality and more cost-efficient care, helping health plans and consumers have the tools they need to improve costs and spend dollars more wisely.

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Click here to read the Fact Sheet


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8/27/15 – CMS Initiative to Reduce Avoidable Hospitalizations Among Nursing Facility Residents-Payment Model

For the past three years, the Centers for Medicare & Medicaid Services (CMS) has been partnering with seven organizations to implement strategies to reduce avoidable hospitalizations for Medicare-Medicaid enrollees who are long-stay residents of nursing facilities. This work, the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents, is a result of collaboration between the Medicare-Medicaid Coordination Office and the Center for Medicare and Medicaid Innovation. The Initiative directly supports CMS’ ongoing work to reduce avoidable hospitalizations for Medicare-Medicaid enrollees and improve quality of care in post-acute and long-term care settings. To launch the second phase of this initiative, CMS is announcing a new funding opportunity that will allow currently participating organizations to apply to test whether a new payment model for nursing facilities and practitioners will further reduce avoidable hospitalizations, lower combined Medicare and Medicaid spending, and improve the quality of care received by long-stay nursing facility residents.

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8/27/15 – CMS to Extend Initiative to Improve Care for Nursing Facility Residents

Funding Would Allow Testing of New Payment Model for Nursing Facility Care

The Centers for Medicare & Medicaid Services (CMS) today announced a new funding opportunity designed to enhance the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents.  The funding opportunity will allow the organizations currently participating in the Initiative to apply to test whether a new payment model for nursing facilities and practitioners will further reduce avoidable hospitalizations, lower combined Medicare and Medicaid spending, and improve the quality of care received by nursing facility residents.

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8/26/15 – Pioneer ACO Model Announced: Financial and Quality Results for Performance Year Three Posted

The Pioneer ACO Model is designed for health care organizations and providers that are already experienced in coordinating care for patients across care settings. It will allow these provider groups to move more rapidly from a shared savings payment model to a population-based payment model on a track consistent with, but separate from, the Medicare Shared Services Program. And it is designed to work in coordination with private payers by aligning provider incentives, which will improve quality and health outcomes for patients across the ACO, and achieve cost savings for Medicare, employers and patients.

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8/25/15 – Medicare ACOs Continue to Improve Quality of Care, Generate Shared Savings

The Centers for Medicare & Medicaid Services today issued 2014 quality and financial performance results showing that Medicare Accountable Care Organizations (ACOs) continue to improve the quality of care for Medicare beneficiaries, while generating financial savings.  As the number of Medicare beneficiaries served by ACOs continues to grow, these results suggest that ACOs are delivering higher quality care to more and more Medicare beneficiaries each year.

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Click here to view the Fact Sheet


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8/25/15 – Comprehensive Care for Joint Replacement Model

The Centers for Medicare & Medicaid Services (CMS) is proposing, through the notice and comment rulemaking process, a new model to support better and more efficient care for beneficiaries undergoing the most common inpatient surgeries for Medicare beneficiaries: hip and knee replacements (also called lower extremity joint replacements or LEJR). This model, called the Comprehensive Care for Joint Replacement Model, would test bundled payment and quality measurement for an episode of care associated with hip and knee replacements to encourage hospitals, physicians, and post-acute care providers to work together to improve the quality and coordination of care from the initial hospitalization through recovery. With publication of this proposed rule, CMS is seeking input and comments from the public, including beneficiaries, health care providers, and other stakeholders. 

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8/13/15 – Bundled Payments for Care Improvement Initiative (BPCI) Fact Sheet

Updated August 2015

The Bundled Payments for Care Improvement initiative (BPCI) is composed of four broadly defined care models, which bundle payments for multiple services beneficiaries receive during an episode of care. Under the initiative, organizations enter into payment arrangements that include financial and performance accountability for an entire episode. These models may lead to higher quality and more coordinated care for beneficiaries at a lower cost to Medicare.

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8/13/15 – 2015 Special Enrollment Period Report – February 23 – June 30, 2015

The next open enrollment period for Marketplace coverage begins on November 1, 2015 for coverage starting on January 1, 2016. Some people can sign up for health coverage outside of open enrollment, before November 1, because they qualify for a special enrollment period (SEP). A consumer can qualify for a SEP for such circumstances as loss of health coverage, losing Medicaid eligibility, changes in family status (for example, marriage or birth of a child), or other exceptional circumstances.

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8/13/15 – CMS Announces Additional Participants in Pilot Project to Improve Care and Reduce Costs for Medicare

Over 2,100 Participants in Performance Period of Bundled Payments for Care Improvement Initiative

The Centers for Medicare & Medicaid Service (CMS) today announced that over 2,100 acute care hospitals, skilled nursing facilities, physician group practices, long-term care hospitals, inpatient rehabilitation facilities, and home health agencies transitioned from a preparatory period to a risk-bearing implementation period in which they assumed financial risk for episodes of care. The participants include 360 organizations that have entered into agreements with CMS to participate in the Bundled Payments for Care Improvement initiative and an additional 1,755 providers who have partnered with those organizations. CMS defines an episode of care as the set of services provided to treat a clinical condition or procedure, such as a heart bypass surgery or a hip replacement.

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Click here to view the fact sheet


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8/11/15 – CMS Announces Timeline for Medicare DMEPOS Competitive Bidding

Bidder Education Program Begins

The Centers for Medicare & Medicaid Services (CMS) today announced the bidding timeline for the Round 1 2017 competition of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program, as required by law. CMS also has launched a comprehensive bidder education program, designed so that DMEPOS suppliers interested in bidding receive the information and assistance they need to submit complete and competitive bids in a timely manner.

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Click here to view the fact sheet


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8/11/15 – During National Health Week, HHS Announces an Additional $169 Million in Affordable Care Act Funding to 266 Community Health Centers

Health and Human Services Secretary Sylvia M. Burwell announced today $169 million in Affordable Care Act funding to 266 new health center sites in 46 states, the District of Columbia and Puerto Rico for the delivery of comprehensive primary health care services in communities that need them most. These new health center sites are projected to increase access to health care services for over 1.2 million patients. These awards build on the $101 million awarded to 164 new health center sites in May 2015.

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Click here to view a list of award winners

Click here to view the Presidential proclamation


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8/11/15 – Final CY 2016 MMP Marketing Guidance for Michigan Medicare-Medicaid Plans

All Medicare Advantage-Prescription Drug (MA-PD) plan sponsor requirements in the CY 2016 Medicare Marketing Guidelines (MMG), posted at http://www.cms.gov/Medicare/HealthPlans/ManagedCareMarketing/FinalPartCMarketingGuidelines.html, apply to Medicare-Medicaid plans (MMPs) participating in the Michigan Capitated Financial Alignment Demonstration, except as noted or modified in this guidance document.1

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8/10/15 – HHS and DOJ Issue Technical Assistance for Child Welfare Systems Under the Americans with Disabilities Act and Section 504 of the Rehabilitation Act

The Department of Health and Human Services (HHS) and the Department of Justice (DOJ) today issued joint technical assistance to state and local child welfare agencies and courts on the requirements of Title II of the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act. The technical assistance released today is part of a new partnership between HHS and DOJ to help child welfare agencies protect the welfare of children and ensure compliance with nondiscrimination laws.

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8/7/15 – Preliminary Risk Corridors Program Results

CMS has received timely submission of the risk corridors and Medical Loss Ratio (MLR) forms from virtually all QHP issuers, which were due July 31. This is the first year of data submissions for the temporary risk corridors program. While conducting quality assurance of the risk corridors data, we have identified a significant number of discrepancies in the data, which makes it necessary to conduct additional data validation. This review includes, but is not limited to, comparing risk corridors submissions with other data available to CMS.

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7/31/15 – FY 2016 Hospice Payment Rate Update

CMS Finalizes Updates to the Wage Index and Payment Rates for the Medicare Hospice Benefit for FY 2016 (CMS-1629-F)

On July 31, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1629-F) that updates fiscal year (FY) 2016 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries. The FY 2016 provisions and other issues discussed in the final rule are summarized below.

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Click here to view the final rule


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7/31/15 – Final Fiscal Year 2016 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities (CMS-1624-F)

On July 31, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining fiscal year (FY) 2016 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP).  The FY 2016 final policies are summarized below.

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Click here to view the final IRF PPS rule


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7/31/15 – Fiscal Year 2016 Final Inpatient and Long-term Care Hospital Policy and Payment Changes (CMS-1632-F)

On July 31, 2015 the Centers for Medicare & Medicaid Services (CMS) issued a final rule to update fiscal year (FY) 2016 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The final rule, which will apply to approximately 3,400 acute care hospitals and approximately 435 LTCHs, will affect discharges occurring on or after October 1, 2015.

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7/31/15 – Final FY 2016 Medicare Payment and Policy Changes for Inpatient Psychiatric Facilities

On July 31, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining fiscal year (FY) 2016 Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS).

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Click here to view the final IPF PPS rule


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7/30/15 – Competition and Choice in the Health Insurance Marketplace Lowered Premiums in 2015

The Health Insurance Marketplace established by the Affordable Care Act allows consumers to compare health insurance plans based on key factors, such as covered services, providers, and importantly, price. According to a report released today, choice and competition increased in the 2015 Marketplace and consumers benefitted as new issuers entered and price competition intensified. In 2015, 86 percent of Marketplace-eligible consumers could choose from at least three issuers, up from 70 percent in 2014.

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7/29/15 – Decision Memorandum and Revised Scope of Benefit National Coverage Determination for Speech Generating Devices

The Centers for Medicare & Medicaid Services (CMS) today posted a final decision memorandum related to coverage of speech generating devices.  Speech generating devices are considered to fall within the Medicare durable medical equipment (DME) benefit category. The current national coverage determination (NCD) for speech generating devices was established in 2001 and covers devices that generate speech for patients with a severe speech impairment.  The 2001 NCD limits coverage to devices that are not capable of performing functions other than generating speech. Software that generates speech and is used on a laptop computer, tablet, or other non-DME device is also covered under the NCD implemented in 2001, but the device the software is used on is not covered.

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Click here to view the Final Decision Memorandum


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7/29/15 – Medicare Prescription Drug Premiums Projected to Remain Stable

On the eve of the 50th anniversary of the signing of Medicare and Medicaid into law, the Centers for Medicare & Medicaid Services (CMS) projected today that the average premium for a basic Medicare Part D prescription drug plan in 2016 will remain stable, at an estimated $32.50 per month.

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7/28/15 – More Than $38 Million Awarded to Improve Coordinated Health Information Sharing in Communities Across America

As part of the Administration’s efforts to create an interoperable learning health system that achieves better care, smarter spending and healthier people, the Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) announced today twenty awardees for three health information technology (health IT) grant programs totaling about $38 million.

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7/28/15 – 2014-2024 Projections of National Health Data Released

Total health care spending growth is expected to average 5.8 percent in aggregate over 2014-2024, according to a report published today in Health Affairs authored by the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary (OACT). The authors noted that this rate of growth is still substantially lower than the 9 percent average rate seen in the three decades before 2008.

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7/28/15 – On its 50th Anniversary, More Than 55 Million Americans Covered by Medicare

New Medicare State by State Enrollment Numbers

As Medicare and Medicaid celebrate their 50th anniversary protecting the health and well-being of millions of seniors, people with disabilities and low-income individuals, the Centers for Medicare & Medicaid Services (CMS) today released updated Medicare state-by-state enrollment numbers, showing that more than 55 million Americans are covered by Medicare.

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7/28/15 – Medicaid & CHIP: May 2015 Monthly Applications, Eligibility Determinations and Enrollment Report

This monthly report on state Medicaid and Children’s Health Insurance Program (CHIP) data represents state Medicaid and CHIP agencies’ eligibility activity for the calendar month of May 2015. This report measures eligibility and enrollment activity for the entire Medicaid and CHIP programs in all states1, reflecting activity for all populations receiving comprehensive Medicaid and CHIP benefits in all states, including states that have not yet chosen to adopt the new low-income adult group established by the Affordable Care Act.2 This data is submitted to CMS by states using a common set of indicators designed to provide information to support program management and policy-making related to application, eligibility, and enrollment processes.3 

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7/25/15 – HHS Increases Access to Substance Use Disorder Treatment

New Funding and Guidance will Help States Combat Opioid Use Disorder

The Department of Health and Human Services (HHS) today announced new steps to increase access to substance use disorder treatment services, focusing on treatment for opioid use disorder. With today’s announcement, HHS is making additional funding available to states and community health centers to expand the use of medication-assisted treatment for opioid use disorder, and is releasing guidance to help states implement innovative approaches to substance use disorder treatment. 

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7/22/15 – Medicare Trustees Report Shows Continued Slow Cost Growth

Today, the Medicare Trustees projected that the trust fund that finances Medicare’s hospital insurance coverage will remain solvent until 2030, unchanged from last year, but with an improved long-term outlook from last year's report. Under this year’s projection, the trust fund will remain solvent 13 years longer than the Trustees projected in 2009, before the passage of the Affordable Care Act.

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Click here for to view the 2015 Medicare Trustees Report


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7/21/15 – CY 2016 Medicare-Medicaid Plan (MMP) Member Handbook (Chapter 9), Appeal Denial Notice, Late Coverage Decision Notice and Integrated Denial Notice Templates for MI

Click here to view the CY 2016 Medicare-Medicaid Plan (MMP) Member Handbook (Chapter 9)

Click here to view the Appeal Denial Notice Template

Click here to view the Late Coverage Decision Notice Template

Click here to view the Integrated Denial Notice Template


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7/20/15 – CMS Announces Medicare Care Choice Model Awards

Model Aims to Increase Choice and Quality by Enabling Individuals to Receive Palliative and Curative Care Concurrently

Many seniors, disabled Americans, and family members of individuals who suffer from life limiting illnesses must choose between the support services provided through hospice care or curative treatment. Fewer than half of eligible Medicare beneficiaries use hospice care and most only for a short period of time. Under current Medicare payment rules, individuals are not able to receive both palliative and curative treatment concurrently. 

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Click here to view the fact sheet


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7/17/15 – Financial Alignment Initiative Enrollment, Age and Health Risk Assessment as of July 15

The Centers for Medicare & Medicaid Services (CMS) launched the Financial Alignment Initiative in 2011 to begin addressing the financial misalignment between Medicare and Medicaid that often presents a barrier to coordinated care for enrollees. The Financial Alignment Initiative aims to better align the financing of these two programs and integrate primary, acute, behavioral health and long-term services and supports in a more easily navigable, simplified system for enrollees. The Initiative has two models, the capitated model and managed fee-for-service model, both of which are serving beneficiaries in states throughout the country. This document provides a snapshot of enrollment, age, and health risk assessment (HRA) experience to date for the capitated financial alignment model.

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7/17/15 – Statement from Assistant Secretary for Aging Kathy Greenlee on Senate Passage of Older Americans Act Reauthorization

We applaud the Senate for passing the Older Americans Act and advancing it one major step toward reauthorization. This critical legislation, which was signed into law 50 years ago this week, provides high-quality, individualized services that improve the health, safety, and well-being of nearly 12 million older adults and one million family caregivers. It is key to enabling older adults to live their lives with dignity and respect in the homes and communities they choose.

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7/17/15 – Update on Health Care and the 2014 Tax Season

By Kevin Counihan, the CEO of the health insurance marketplaces

For most Americans, April 15 marked the end of this year’s tax season. For others, including those who have yet to file because they requested an extension, tax season is not yet complete. At CMS we work throughout the year to reach out to consumers and help them understand the ways in which their taxes and health care intersect. 

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7/16/15 – Home Health Compare Quality of Patient Care Star Ratings

Consumer research has shown that summary quality measures and the use of symbols, such as stars, to represent performance are valuable to consumers. Star ratings can help consumers more quickly identify differences in quality and make use of the information when selecting a health care provider. In addition to summarizing performance, star ratings can also help home health agencies (HHAs) identify areas for improvement. They are useful to consumers, consumer advocates, health care providers, and other stakeholders when updated regularly to present the most current information available.

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Click here to view the tool


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7/16/15 – The Financial Alignment Extension Opportunity Memorandum

By Tim Engelhardt, Acting Director CMS Medicare-Medicaid Coordination Office

In 2011, we began work together to develop new models of integrated care for people dually eligible for Medicaid· and Medicare (Medicare-Medicaid beneficiaries). The first new demonstration began in July 2013, and today- thanks to the incredible work of so many people within your agencies- we have demonstrations underway in 12 different states. While several demonstrations just started serving beneficiaries in the last few months, there are already early signs of progress:

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7/14/15 – CMS Cutting-Edge Technology Identifies & Prevents $820 Million in Improper Medicare Payments in First Three Years

The Fraud Prevention System is One Part of the Administration’s Effort to Protect the Medicare Trust Fund

After three years of operations, the Centers for Medicare & Medicaid Services (CMS) today reported that the agency’s advanced analytics system, called the Fraud Prevention System, identified or prevented $820 million in inappropriate payments in the program’s first three years. The Fraud Prevention System uses predictive analytics to identify troublesome billing patterns and outlier claims for action, similar to systems used by credit card companies.  The Fraud Prevention System identified or prevented $454 million in Calendar Year 2014 alone, a 10 to 1 return on investment.

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7/13/15 – HHS Proposes to Improve Care and Safety for Nursing Home Residents

Revisions Mark First Major Rewrite of Long-Term Care Conditions of Participation Since 1991

A proposal announced today at the White House Conference on Aging would make major changes to improve the care and safety of the nearly 1.5 million residents in the more than 15,000 long-term care facilities or nursing homes that participate in the Medicare and Medicaid programs. If finalized, unnecessary hospital readmissions and infections would be reduced, quality care increased, and safety measures strengthened for the more than one million residents in these facilities.

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7/13/15 – Aging in 2015: HHS and the White House Conference on Aging

Today’s White House Conference on Aging is focusing on the issues facing every American as they plan for retirement, care for older loved ones, and improving the quality of life for older Americans. The U.S. Department of Health and Human Services (HHS) is engaged in the government-wide initiative to develop programs and provide funding and resources to help older adults live independent and fulfilling lives.

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7/13/15 – White House Conference on Aging: Combating Alzheimer’s and Other Dementias

Announcing the Release of the 2015 Update to the National Plan, HRSA Primary Care Curriculum, Brain Health Awareness Campaign, and a HIPAA Resource for Providers

The U.S. Department of Health and Human Services (HHS) announced today the release of the 2015 Update to the National Plan to Address Alzheimer’s Disease, reflecting our nation’s progress toward accomplishing goals set in 2012 and current action steps to achieving them. The 2011 National Alzheimer’s Project Act calls for the Plan to be updated annually. The 2015 Update follows updates released in May 2012, June 2013, and the 2014 Update released in April 2014.
 

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7/13/15 – HHS Targets Funding, Programs to Help Older People Reduce the Risk of Falling

As part of the White House Conference on Aging, the Administration on Aging (AoA), a component of the Administration for Community Living, announced the award of $4 million in new grants to significantly expand falls prevention efforts. The funding will reach communities in seven states over the next two years, expanding the reach of AoA’s falls prevention efforts to more than 18,000 additional older Americans. The grants will both increase participation in evidence-based community programs to reduce falls and falls risk, and also improve the programs’ long-term sustainability.

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7/10/15 – Administration Issues Final Rules on Coverage of Certain Recommended Preventative Services Without Cost Sharing

Final Rules Secure Women’s Access to Contraceptive Services While Respecting Religious Beliefs

Today, the Administration took important steps to make sure women have access to recommended preventive services, including contraceptive services, at no additional cost as required by the Affordable Care Act.  The first action announced today maintains the existing accommodation for eligible religious nonprofits, but also finalizes an alternative pathway for those organizations to provide notice of their objection to covering contraceptive services.  A second action announced today provides certain closely held for-profit entities the same accommodations. Today’s rules also finalize interim final rules on preventive services coverage generally, with limited changes.

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7/9/15 – Comprehensive Care for Joint Replacement

Hip and knee replacements are the most common inpatient surgery for Medicare beneficiaries and can require lengthy recovery and rehabilitation periods. In 2013, there were more than 400,000 inpatient primary procedures costing more than $7 billion for hospitalization alone.

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7/8/15 - CMS Begins Implementation of Key Payment Legislation

Proposed Update to Physician Fee Schedule is First Since Repeal of SGR

Today, CMS released the first proposed update to the physician payment schedule since the repeal of the Sustainable Growth Rate through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  The proposal includes a number of provisions focused on person-centered care, and continues the Administration’s commitment to transform the Medicare program to a system based on quality and healthy outcomes. “CMS is building on the important work of Congress to shift the Medicare program toward a system that rewards physicians for providing high quality care,” said Andy Slavitt, Administrator of CMS.

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7/6/15 - CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10

With less than three months remaining until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are announcing efforts to continue to help physicians get ready ahead of the October 1 deadline.  In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set. Recognizing that health care providers need help with the transition, CMS and AMA are working to make sure physicians and other providers are ready ahead of the transition to ICD-10 that will happen on October 1.

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7/6/15 - CMS Announces New Initiative To Promote Value-Based Home Health Care

Proposed initiative ties Medicare home health payments to quality performance

The Centers for Medicare & Medicaid Services (CMS) today announced a proposal to launch a new model designed to support greater quality of care among Medicare beneficiaries. The model is included in the CY 2016 Home Health Prospective Payment System proposed rule, which updates payments and requirements for home health agencies under the Medicare program. As proposed, the Home Health Value-Based Purchasing model would test whether incentives for better care can improve outcomes in the delivery of home health services. The model is part of the Department of Health and Human Service’s commitment to build a health care delivery system that’s better, smarter, and healthier – one that delivers better care, spends health care dollars more wisely, and results in healthier people and communities.

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6/30/15 - CMS Continues To Implement The Premium Stabilization Programs

Today, the Centers for Medicare & Medicaid Services (CMS) took the next steps in implementing two of the Affordable Care Act’s premium stabilization programs – risk adjustment and reinsurance – that help keep premiums affordable and provide consumers with a range of coverage choices.  CMS released a report detailing the estimated reinsurance payments by issuer and providing additional information on the premium stabilization programs. “These important programs are protecting consumers’ access to a wide range of affordable coverage choices in a new health insurance market in which no one can be denied coverage or charged higher premiums simply due to a pre-existing condition,” said Kevin Counihan, CEO of the Health Insurance Marketplaces.  “The early results for the risk adjustment and reinsurance premium stabilization programs demonstrate that these programs are working as intended, which will help keep premiums stable and encourage insurance companies to compete on quality and price, not who can attract the healthiest enrollees.”

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6/30/15 - CMS’ Open Payments Posts Full Year Of 2014 Financial Data

Financial transactions between doctors and medical manufacturers total $6.49 billion - The Centers for Medicare & Medicaid Services (CMS) today published 2014 Open Payments data about transfers of value by drug and medical device makers to health care providers. The data includes information about 11.4 million financial transactions attributed to over 600,000 physicians and more than 1,100 teaching hospitals, totaling $6.49 billion. Acting CMS Administrator Andy Slavitt said, “Consumer access to information is a key component of delivery system reform and making the health care system perform better. In year 2, Open Payments is now a highly searchable resource to provide transparency to over 1 1/2 years’ worth of financial transactions between drug and device companies and physicians and teaching hospitals. This is part of our larger effort to open up the health care system to consumers by providing more information to help in their decision making.”

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6/25/15 - Statement by HHS Secretary Sylvia M. Burwell on the Affordable Care Act

Today’s Supreme Court decision confirms that the Affordable Care Act’s tax credits are available to all eligible Americans no matter where they live. Americans in all 50 states and the District of Columbia can continue to rely on the security and peace of mind that come with affordable, quality health care coverage. Over six million Americans and their families will sleep easier knowing they will still be able to afford health coverage. Millions more won’t have to worry about an upward spiral in their premiums because of today’s decision, even if they didn’t buy their insurance through the Marketplace. And the law’s financial assistance will be available in the next open enrollment so that others can benefit as well.

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6/25/15 - Accountable Care Organization (ACO) Investment Model

The ACO Investment Model is an initiative developed by the Center for Medicare & Medicaid Innovation (Innovation Center) for organizations participating as ACOs in the Medicare Shared Savings Program (Shared Savings Program). The ACO Investment Model is a new model of pre-paid shared savings that builds on experience with the Advance Payment Model to encourage new ACOs to form in rural and underserved areas and current Medicare Shared Savings Program ACOs to transition to arrangements with greater financial risk.

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6/24/15 – Updated CY 2015 Medicare-Medicaid Plan (MMP) Integrated Denial, Appeal Denial Notice and Late Coverage Decision Notice Models 

Click here to view the Integrated Denial Notice

Click here to view the Appeal Denial Notice

Click here to view the Late Coverage Decision Notice


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6/23/15 – HHS Launches GIS-Based Tool for Health Disaster Readiness

Unique Interactive Map Helps Meet Needs of People with Electricity-Dependent Medical Equipment

The HHS emPOWER Map, an interactive online tool, launched today to aid community health agencies and emergency management officials in disaster preparedness as they plan ahead to meet the emergency needs of community residents who rely on electrically powered medical and assistive equipment to live independently at home.

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Click here to view the HHS emPOWER Map


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6/23/15 – Medicare-Medicaid Capitated Financial Alignment Model Reporting Requirements: Michigan-Specific Reporting Requirements

The measures in this document are required reporting for all MMPs in the Michigan MI Health Link Demonstration. CMS and the state reserve the right to update the measures in this document for subsequent demonstration years. These state-specific measures directly supplement the Medicare-Medicaid Capitated Financial Alignment: Core Reporting Requirements, which can be found at the following web address:

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6/18/15 – Affordable Care Act Payment Model Saves More Than $25 Million in First Performance Year

Independence at Home Practices Succeed in Improving Care, Lowering Costs

The Centers for Medicare & Medicaid Services (CMS) today announced positive and promising results from the first performance year of the Independence at Home Demonstration, including both higher quality care and lower Medicare expenditures.

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6/18/15 – National Medicare Fraud Takedown Results in Charges Against 243 Individuals for Approximately $712 Million in False Billing

Most Defendants Charged and Largest Alleged Loss Amount in Strike Force History

Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell and Attorney General Loretta E. Lynch announced today a nationwide sweep led by the Medicare Fraud Strike Force in 17 districts, resulting in charges against 243 individuals, including 46 doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $712 million in false billings.  In addition, the Centers for Medicare & Medicaid Services (CMS) also suspended a number of providers using its suspension authority as provided in the Affordable Care Act.  This coordinated takedown is the largest in Strike Force history, both in terms of the number of defendants charged and loss amount.

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6/12/15 – Administration Increases Transparency for Consumers Shopping for Health Insurance Coverage

Final Rules are Designed to Improve Consumers’ Access to Important Plan Information

The Departments of Health and Human Services (HHS), Labor, and the Treasury today issued final regulations to make it easier for people and employers to compare their options when shopping for and renewing health insurance coverage.  These rules also implement streamlined processes to help health insurance issuers and group health plans provide consumers easy to understand information.

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Click here to view the Final Rules

Click here to view the Fact Sheet


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6/10/15 – Medicare and Medicaid 50th Anniversary Count Down

This summer will mark the 50th anniversary of the enactment of Amendments to the Social Security Act that established the Medicare and Medicaid programs. Over the next 50 days, the Centers for Medicare & Medicaid Services will recognize the impact these two programs have had in transforming our nation’s health care system. By sharing daily facts and posts on Twitter (@cmsgov) and Medicaid.gov, CMS will highlight people, places, and progress that represent the Medicare and Medicaid programs as we know today.

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6/8/15 – Comprehensive Prevention Program Effectively Reduces Falls Among Older People

HHS-Supported Study Tests Falls Intervention Program

Families and physicians have a new tool in the fight against falls- a comprehensive prevention program developed by the U.S. Department of Health and Human Services that reduces both falls and resulting use of long-term care such as nursing homes.

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Click here to view the full report


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6/4/15 – CMS Bulletin on Proposed Out-Of-Pocket (OOP) Cost Comparison Tool for the Federally-facilitated Marketplaces (FFMs)

The Centers for Medicare & Medicaid Services (CMS) is developing an Out-of-Pocket (OOP) Cost Comparison Tool to help consumers make more informed choices about their health insurance coverage and to help them pick a plan that will best meet their needs. The OOP Cost Tool will allow shoppers in the Federally-facilitated Marketplaces (FFMs) to see estimates of total spending (to include premiums and cost-sharing) across various health insurance plans. The purpose of this bulletin is to provide information and solicit comments on the proposed OOP Cost Comparison Tool, how the tool computes OOP Cost, and how it would be incorporated into the FFMs’ web sites. We anticipate this comparison tool would be available to consumers for the 2016 annual open enrollment period (for coverage effective starting as soon as January 1, 2016).

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6/4/15 – CMS Finalizes Rules for Medicare Shared Savings Program

Continued Growth in ACO Program is a Core Component of Delivery System Reform  – The Centers for Medicare & Medicaid Services (CMS) today released a final rule updating the Medicare Shared Savings Program to encourage the delivery of high-quality care for Medicare beneficiaries and build on the early successes of the program and of the Pioneer Accountable Care Organization (ACO) Model.  This final rule is an effort to provide support for the care provider community in creating a delivery system with better care, smarter spending, and healthier people.

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Click here to view the fact sheet


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6/2/15 – March 31, 2015 Effectuated Enrollment Snapshot

About 11.7 million Americans selected plans through the Health Insurance Marketplaces as of February 22, the end of the “in-line” special enrollment period for 2015 Open Enrollment for individual market coverage. On March 31, 2015, about 10.2 million consumers had “effectuated” coverage which means those individuals paid for Marketplace coverage and still have an active policy in the applicable month.1  These numbers are consistent with HHS’s effectuated target for the end of 2015. About 6.3 million consumers were enrolled in health coverage through the Marketplaces and had paid their premiums on December 31, 2014.

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6/2/15 – CMS Announces Entrepreneurs and Innovators to Access Medicare Data

Today at Health Datapalooza, the acting Centers for Medicare & Medicaid Services (CMS) Administrator, Andy Slavitt, announced a new policy that for the first time will allow innovators and entrepreneurs to access CMS data, such as Medicare claims. As part of the Administration’s commitment to use of data and information to drive transformation of the healthcare delivery system, CMS will allow innovators and entrepreneurs to conduct approved research that will ultimately improve care and provide better tools that should benefit health care consumers through a greater understanding of what the data says works best in health care. The data will not allow the patient’s identity to be determined, but will provide the identity of the providers of care. CMS will begin accepting innovator research requests in September 2015.  

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6/1/15 – Medicaid/CHIP Provider Fingerprint-Based Criminal Background Check

This guidance is part of a series relating to the implementation of Section 6401 of the Affordable Care Act, Provider Screening and Other Enrollment Requirements under Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).

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6/1/15 – New Medicare Data Available to Increase Transparency on Hospital and Physician Utilization

Data Serves as a Rich Resource to Clearer Look into Parts A and B Costs, Services, and Trends – As part of the Administration’s efforts to promote better care, smarter spending, and healthier people, today CMS is posting the third annual release of the Medicare hospital utilization and payment data (both inpatient and outpatient) and the second annual release of the physician and other supplier utilization and payment data. The announcement was made at the annual Health Datapalooza conference in Washington, DC.

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Click here to view a fact sheet on the 2013 hospital charge data

Click here to view a fact shhet on the 2013 Medicare Part B physician data


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5/28/15 – New Affordable Care Act Payment Model Seeks to Reduce Cardiovascular Disease

Speaking today at the White House Conference on Aging regional forum in Boston, Health and Human Services Secretary Sylvia M. Burwell announced a unique opportunity for health care providers to decrease cardiovascular disease risk for tens of thousands of Medicare beneficiaries by assessing an individual patient’s risks for heart attack or stroke and working with them to reduce those risks.

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Click here top view the fact sheet


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5/26/15 – CMS Proposes Rule to Strengthen Managed Care for Medicaid and CHIP Enrollees

Proposal will Modernize and Improve Quality of Care for Medicaid and CHIP Enrollees  – Today, the Centers for Medicare & Medicaid Services (CMS) proposed to modernize Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations to update the programs’ rules and strengthen the delivery of quality care for beneficiaries.  This proposed rule is the first major update to Medicaid and CHIP managed care regulations in more than a decade. It would improve beneficiary communications and access, provide new program integrity tools, support state efforts to deliver higher quality care in a cost-effective way, and better align Medicaid and CHIP managed care rules and practices with other sources of health insurance coverage.  Overall, this proposed rule supports the agency’s mission of better care, smarter spending, and healthier people.

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Click here to view the fact sheet


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5/26/15 – HHS Awards $112 Million to Help 5,000 Primary Care Professionals Advance Heart Health

Health and Human Services Secretary Sylvia M. Burwell announced today awards of $112 million to regional cooperatives to work with about 5,000 primary care professionals in 12 states to improve the heart health of their nearly 8 million patients. Heart disease is the leading cause of death for men and women in the United States. EvidenceNOW: Advancing Heart Health in Primary Care, will help primary care practices in both urban and rural communities use the latest evidence to encourage Better Care, Smarter Spending, and Healthier People. Today’s awards are aligned with the Department’s Million Hearts® national initiative to prevent heart attacks and stroke.

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5/26/15 – Memo To Long Term Care Facilities On Disenrollment Issues

Only a Medicare beneficiary, the beneficiary’s legal representative or the party authorized to act on behalf of the beneficiary under state law (collectively “the representative”) can request enrollment or voluntary disenrollment from a Medicare plan. This applies equally for beneficiaries receiving care in a nursing facility or skilled nursing facility (Long Term Care, or LTC facilities). The CMS continues to see an unacceptable practice of LTC facilities disenrolling beneficiaries from Medicare advantage prescription drug plans (MAPDs) and enrolling them into stand-alone drug plans (PDPs) without the beneficiary’s or the representative’s knowledge and/or complete understanding. This action automatically returns the beneficiary to Original Medicare coverage for those services covered by Parts A and B. This practice is noncompliant with regulatory requirements.

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5/14/15 – About 137 Million Individuals with Private Insurance are Guaranteed Access to Free Preventive Services

Nationwide, about 137 million individuals, including 55 million women and 28 million children, have private health insurance that covers recommended preventive services without cost sharing, according to a new ASPE Data Point from the Department of Health and Human Services. Under the Affordable Care Act, most health plans are required to provide coverage for recommended preventive health care services without copays. Increased access to preventive services can reduce and prevent costly chronic diseases and help Americans live healthier lives.

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Click here to view the fact sheet


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5/7/15 – OIG – Incorrect Place-of-Service Claims Resulted in Potential Medicare Overpayments Costing Millions

Physicians did not always correctly code the place of service on physician claims. As a result, Medicare contractors made potential overpayments totaling approximately $33.4 million for services provided from January 2010 through September 2012.

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5/6/15 – Some Observations Related to the Generic Drug Market

The incentive for a manufacturer of a brand-name prescription drug to undertake measures that attempt to prolong the period of marketing exclusivity for a brand-name drug is very strong. For most prescription drug products, incremental production costs are quite low—literally pennies a pill—while successful new drugs can command high prices. The period of a drug’s market exclusivity is therefore a highly-profitable one, particularly in cases where the drug confers substantial clinical benefits and where patients and providers have few therapeutic alternatives.  Over 30 years of experience have shown that when a generic competitor enters the market, the brand-name manufacturer typically faces a rapid and steep loss of market share and profits as patients and providers shift toward a much less expensive generic product that offers the same clinical benefits. Once several generic manufacturers enter the market, competition generally drives prices down “close to marginal cost.”1 It is not unusual for successful new drugs to have annual sales of a billion dollars or more during the exclusive sales period, so delaying the availability of an inexpensive generic alternative even for a short time can preserve enormous profits for the original manufacturer.

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5/5/15 – HHS Announces $101 Million in Affordable Care Act Funding to 164 New Community Health Centers

Health and Human Services Secretary Sylvia M. Burwell announced today approximately $101 million in Affordable Care Act funding to 164 new health center sites in 33 states and two U.S. Territories for the delivery of comprehensive primary health care services in communities that need them most.  These new health centers are projected to increase access to health care services for nearly 650,000 patients.

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Click here to view a list of award winners


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5/4/15 – Affordable Care Act Payment Model Saves More Than $384 Million in Two Years, Meets Criteria for First-Ever Expansion

Pioneer ACO Model Advances Quality and Value in Health Care

Today, an independent evaluation report released by the Department of Health and Human Services showed that an innovative payment model created as a pilot project by the Affordable Care Act generated substantial savings to Medicare in just two years. Additionally, the independent Office of the Actuary in the Centers for Medicare & Medicaid Services (CMS) has certified that this patient care model is the first to meet the stringent criteria for expansion to a larger population of Medicare beneficiaries.

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Click here to view the CMS Office of the Actuary Certification of Pioneer ACO Model Savings

Click here to view the second Pioneer ACO Model evaluation report


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5/1/15 – CMS Issues Rule Modifying the Part D Enrollment Requirements for Prescribers

On May 1, 2015, the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule with comment (IFC) to make changes to the final rule published on May 23, 2014 that requires prescribers of Part D drugs to enroll in or have validly opted out of Medicare.

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4/30/15 – New Medicare Prescription Drug Cost Data Available

Data Serves as a Rich Resource for Clearer Look into Part D Costs and Services

As part of the Administration’s goals of better, care, smarter spending, and healthier people, the Centers for Medicare & Medicaid Services announced the availability of new, privacy-protected data on Medicare Part D prescription drugs prescribed by physicians and other health care professionals in 2013. This data shows which prescription drugs were prescribed to Medicare Part D beneficiaries by which practitioners.

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Click here to view the fact sheet


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4/30/15 – 2016 Hospice NPRM CMS-1629-P

CMS Updates to the Wage Index and Payment Rates for the Medicare Hospice Benefit

On April 30, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1629-P) that would update fiscal year (FY) 2016 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries. The proposed hospice payment rule reflects the ongoing efforts of CMS to support beneficiary access to hospice care.  The FY 2016 proposals and other issues discussed in the proposed rule are summarized below.  

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4/29/15 – Financial CY 2016 Medicare-Medicaid Plan Provider and Pharmacy Directory National Model Template

Attached to this memorandum is the CY 2016 Medicare-Medicaid Plan Provider and Pharmacy Directory national model template. This template will serve as the basis for state-specific models that Medicare-Medicaid Plans (MMPs) will use in CY 2016.

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Click here to view Instructions to Health Plans


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4/24/15 – New Instructions for Providers Filing an Appeal with the Departmental Appeals Board (DAB)

Effective October 1, 2014, providers that disagree with actions imposed on their facility and want to request a hearing with an Administrative Law Judge in the Civil Remedies Division must submit their request electronically to the Departmental Appeals Board using the DAB E-File at https://dab.efile.hhs.gov. In order to utilize the electronic filing system, petitioners must first become a registered user. Detailed instructions on how to register and use the DAB’s Electronic Filing System are attached. Please note that all documents must be submitted in Portable Document Format (“pdf.”).

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4/24/15 – Proposed FY 2016 Medicare Payment and Policy Changes For Inpatient Psychiatric Facilities

On April 24, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining proposed fiscal year (FY) 2016 Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS).

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Click here to view the proposed IRF PPS Rule


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4/23/15 – Proposed Fiscal Year 2016 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities (CMS-1264-P)

On April 23, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining proposed fiscal year (FY) 2016 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP).  The FY 2016 proposals are summarized below.

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Click here to view the propsed IRF PPS Rule


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4/23/15 – Participation Continues To Rise In Medicare Physician Quality Reporting System and Electronic Prescribing Incentive Program

The Centers for Medicare & Medicaid Services (CMS) today released the 2013 Physician Quality Reporting System (PQRS) and Electronic Prescribing (e-prescribing) Incentive Program Experience Report, which provides data and trends on participation, incentive eligibility, incentive payments and payment adjustments since the beginning of the programs.  

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4/20/15 – 10 Days to Take Advantage of Tax Season Special Enrollment Period

Uninsured tax filers who owe a fee on their 2014 taxes for not having minimum essential health coverage in 2014 have 10 more days to take advantage of a Special Enrollment Period through the Federally-facilitated Marketplace to enroll in health coverage for the remainder of 2015.

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4/20/15 – Evaluation of the Medicare Advantage (MA) Quality Bonus Demonstration

The Medicare Advantage (MA) Quality Bonus Payment demonstration is designed to reward MA plans that demonstrate quality improvement through the Medicare Star Ratings program. This interim evaluation report contains preliminary findings from stakeholder interviews, a plan survey, and preliminary analyses of trends in MA quality measures. The report shows general improvements in Part C summary star ratings between 2009 and 2014, with greatest increases pre-dating the quality bonus payment demonstration period. MA plans showed similar pre-demonstration trends to Medicaid and Commercial plans and no discernable deviations from quality trends during the demonstration period. The plan survey suggests the quality bonus payment demonstration provides incentives to improve quality.

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4/17/15 – Fiscal Year 2016 Proposed Inpatient and Long-Term Care Hospital Policy and Payment Changes (CMS-1632-P)

On April 17, 2015 the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to update fiscal year (FY) 2016 Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The proposed rule, which would apply to approximately 3,400 acute care hospitals and approximately 435 LTCHs, would affect discharges occurring on or after October 1, 2015.

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4/16/15 – CMS Releases First Ever Hospital Compare Star Ratings

Comparison Ratings that Help Consumers Compare and Choose Among Hospitals

Today, the Centers for Medicare & Medicaid Services (CMS) for the first time introduced star ratings on Hospital Compare, the agency’s public information website, to make it easier for consumers to choose a hospital and understand the quality of care they deliver. Today’s announcement builds on a larger effort across HHS to build a health care system that delivers better care, spends health care dollars more wisely, and results in healthier people.

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Click here to view the fact sheet 


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4/15/15 – Proposed Fiscal Year 2016 Payment and Policy Changes for Medicare Skilled Nursing Facilities

On April 15, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule [CMS-1622-P] outlining proposed Fiscal Year (FY) 2016 Medicare payment rates for skilled nursing facilities (SNFs). The FY 2016 proposals and other issues discussed in the proposed rule are summarized below.

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4/15/15 – CMS Announces Opportunity to Apply for Navigator Grants in Federally-Facilitated and State Partnership Marketplaces

Navigator Awards Extend to Three Years to Provide Stability and Assistance to Consumers as They Enroll in Coverage

The Centers for Medicare & Medicaid Services (CMS) announced today the availability of funding to support Navigators in Federally-facilitated Marketplaces (FFM), including State Partnership Marketplaces.  The Affordable Care Act is working for millions of Americans who are able to access quality health coverage at a price they can afford, in part because of the efforts of in-person assisters in local communities across the nation.  People shopping for and enrolling in coverage through the Health Insurance Marketplaces can get local help in a number of ways, including through Navigators. Navigators provide objective information about health coverage to consumers to help them make the best possible choice.  They are knowledgeable about qualified health plans in the Marketplaces, and public programs including Medicaid and the Children’s Health Insurance Program.  Grantees will be selected for a three year project period, and a total of up to $67 million is available for the first year of the award.

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4/15/15 – Medicare Spending Growth Since 2009

From 2009 to 2012, Medicare spending per beneficiary (across Traditional Medicare and Medicare Advantage) grew at an average rate of 1.8 percent annually or less than 1/3 its rate of growth during 2000-2008. There was essentially no growth in Medicare spending on a per beneficiary basis in 2013 (see Table 1).

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4/13/15 – Plan Selections by ZIP Code in the Health Insurance Marketplace

The dataset provides the total number of Qualified Health Plan selections by ZIP Code for the 37 states that use the HealthCare.gov platform, including the Federally-facilitated Marketplace, State Partnership Marketplaces and supported State-based Marketplaces for the Marketplace open enrollment period from November 15, 2014 through February 15, 2015, including additional special enrollment period (SEP) activity reported through February 22, 2015.

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4/10/15 – Meaningful Use “MU” Aligning Stage 1 and 2 with Stage 3 (CMS 3311P)

Modifications to Meaningful Use for 2015 through 2017: Realigning the EHR Incentive Programs to Support Health Information Exchange and Quality Improvement

On April 10, 2015, the Centers for Medicare & Medicaid Services issued a new proposed rule for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs to align Stage 1 and Stage 2 objectives and measures with the long-term proposals for Stage 3, to build progress toward program milestones, to reduce complexity, and to simplify providers’ reporting. These modifications would allow providers to focus more closely on the advanced use of certified EHR technology to support health information exchange and quality improvement.

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4/10/15 - Implementation of Section 6106 of the Affordable Care Act

Collection of Staffing Data for Long Term Care Facilities

Section 6106 of the Affordable Care Act, enacted on March 23, 2010, amended section 1128(I) of the Act to incorporate specific provisions pertaining to the collection of staffing data for long term care facilities. Section 1128(I)(g) of the Act specifies that the Secretary shall require nursing homes to electronically submit to the Secretary direct care staffing information (including information with respect to agency and contract staff) based on payroll and other verifiable and auditable data in a uniform format (according to specifications established by the Secretary in consultation with such programs, groups, and parties). Such specifications shall require that the information submitted under the preceding sentence detail the category of work a certified employee performs (such as whether the employee is a registered nurse, licensed practical nurse, licensed vocational nurse, certified nursing assistant, therapist, or other medical personnel).

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4/9/15 - Applicability of Final Call Letter Provisions to Medicare-Medicaid Plans

This memorandum provides additional guidance regarding the applicability to MedicareMedicaid Plans (MMPs) of the provisions of the Contract Year (CY) 2016 Final Call Letter issued on April 6, 2015. In the chart below, we specify whether a particular provision in the CY2016 Final Call Letter is:(1) not applicable to MMPs; (2) applicable to MMPs; (3) partlyapplicable to MMPs; or (4) informational only. For some provisions, comments are provided as further background. 
 

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4/9/15 – Estimated Financial Effects of the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2)

On March 26, 2015, the House passed the Medicare Access and CHIP Reauthorization Act of 2015 (H.R. 2). This bill includes a provision to replace the Sustainable Growth Rate (SGR) formula used by Medicare to pay physicians with new systems for establishing annual payment rate updates for physicians’ services. In addition, it would temporarily extend the Children’s Health Insurance Program (CHIP) and increase premiums for Part B and Part D of Medicare for beneficiaries with income above certain levels. H.R. 2 would also make numerous other changes to Medicare and Medicaid.

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Applicability of Final Call Letter Provisions to Medicare-Medicaid Plans

This memorandum provides additional guidance regarding the applicability to MedicareMedicaid Plans (MMPs) of the provisions of the Contract Year (CY) 2016 Final Call Letter issued on April 6, 2015.  In the chart below, we specify whether a particular provision in the CY 2016 Final Call Letter is: (1) not applicable to MMPs; (2) applicable to MMPs; (3) partly applicable to MMPs; or (4) informational only. For some provisions, comments are provided as further background.

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4/6/15 - CMS Finalizes 2016 Payment And Policy Updates For Medicare Health And Drug Plans

Rate Announcement Details Plan Payments and Other Program Updates for 2016

The Centers for Medicare & Medicaid Services (CMS) today released final Medicare Advantage (MA) and Part D Prescription Drug program changes for 2016 that provide fair and accurate payments to plans, and encourage the delivery of high-quality care for all populations. “These policies strengthen Medicare Advantage for current and future consumers by encouraging higher quality care,” said Andy Slavitt, acting CMS Administrator. “As the Medicare Advantage marketplace continues to grow, consumers are getting access to better care through more choice and competition. Seniors and people with disabilities, including the dual-eligible population, will continue to have an extensive choice of plans, affordable premiums, and better and more transparent information about provider networks and pharmacies.”

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Click here to view the fact sheet

Click here to view the 2016 Medicare Advantage and Part D RAte Announcement and Call Letter


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4/6/15 – CMS Proposes Mental Health Parity Rule for Medicaid and CHIP

Proposed Rule Will Strengthen Access to Mental Health and Substance Use Disorder Benefits for Low-Income Americans

The Centers for Medicare & Medicaid Services (CMS) today announced a proposed rule to align mental health and substance use disorder benefits for low-income Americans with benefits required of private health plans and insurance. The proposal applies certain provisions of the Mental Health Parity and Addiction Equity Act of 2008 to Medicaid and Children's Health Insurance Program (CHIP). The Act ensures that mental health and substance use disorder benefits are no more restrictive than medical and surgical services.

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Click here to view the proposed rule


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4/2/15 – Online Tools and Resources Available to Help States Use Health IT to Improve Health Care Quality and Lower Cost

The Office of the National Coordinator for Health Information Technology (ONC) announced today the availability of online tools and resources designed to help states participating in the State Innovation Models initiative improve health care quality and lower costs.

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4/1/15 - Fifteen Days Remain Before Tax Filing Deadline

CMS Continues To Raise Awareness About The Intersection Of Taxes And Health Care

With the tax filing deadline two weeks away, the Centers for Medicare & Medicaid Services (CMS) is continuing to help consumers understand how health coverage and taxes intersect. This year’s tax season is the first time individuals and families will be asked to provide basic information regarding their health coverage on their tax returns. While the vast majority of tax filers – about three quarters – will just need to check a box on their tax return indicating they had health coverage in 2014, people who have coverage through the Health Insurance Marketplaces, or did not enroll in coverage, will take different steps that will be a part of the tax filing process starting this year. 

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3/25/15 – Better, Smarter, Healthier: Health Care Payment Learning and Action Network Kick Off to Advance Value and Quality in Health Care

Over 2,800 Patients, Insurers, Providers, States, Consumer Groups, Employers and Other Partners Have Registered; Dozens Have Set Goals that Meet or Exceed HHS’ Goals

The Affordable Care Act established an ambitious new framework to move our health care system away from rewarding health providers for the quantity of care they provide and toward rewarding quality. These new models have been put to work in Medicare, and have contributed to 50,000 fewer patient deaths in hospitals due to avoidable harms, such as infections or medication errors, and 150,000 fewer preventable hospital readmissions since 2010, when the Affordable Care Act became law.

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Click here to view the fact sheet


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3/23/15 – The Economic Impacts of Medicaid Expansion, Uncompensated Care Costs and the Affordable Care Act

Expanding Medicaid has positive economic effects. These two factsheets highlight information on the economic impact of Medicaid expansion on individuals' financial circumstances, uncompensated care costs and state Gross Domestic Product (GDP). Research confirms that expanding Medicaid will benefit states both directly and indirectly by generating additional federal revenue, increasing jobs and earnings, increasing Gross State Product (GSP), increasing state and local revenues (via provider taxes and fees and increased prescription drug rebates), and reducing uncompensated care and hospital costs.

Click here to view the Economic Impact of the Medicaid Expansion fact sheet

Click here to view the Insurance Expansion, Hospital Uncompensated Care, and the Affordable Care Act fact sheet


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3/20/15 – Medicaid Enrollment and the Affordable Care Act

The Affordable Care Act allows states to receive federal matching funds to cover 100% of the cost (until 2016) of expanding Medicaid coverage to non-elderly, non-disabled adults up to 133% of the federal poverty level (FPL), including parents and childless adults. To reduce the number of uninsured in their state and to improve the health status of their residents, 28 states and the District of Columbia have expanded Medicaid coverage.

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3/20/15 – HHS Announces Proposed Rules to Support the Path to Nationwide Interoperability

Electronic Health Record Incentive Programs and 2015 Edition Health IT Certification Criteria Rules Proposed

The U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) today announced the release of the Stage 3 notice of proposed rulemaking for the Medicare and Medicaid Electronic Health Records (EHRs) Incentive Programs and 2015 Edition Health IT Certification Criteria to improve the way electronic health information is shared and ultimately improve the way care is delivered and experienced. Together, these proposed rules will give providers additional flexibility, make the program simpler, and drive interoperability among electronic health records, and increase the focus on patient outcomes to improve care.

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3/19/15 – Departments of Justice and Health and Human Services Announce Over $27.8 Billion in Returns from Joint Efforts to Combat Health Care Fraud

Administration recovers $7.70 for every dollar spent to fight health care-related fraud and abuse; third-highest on record

More than $27.8 billion has been returned to the Medicare Trust Fund over the life of the Health Care Fraud and Abuse Control (HCFAC) Program, Attorney General Eric Holder and HHS Secretary Sylvia M. Burwell announced today.  The government’s health care fraud prevention and enforcement efforts recovered $3.3 billion in taxpayer dollars in Fiscal Year (FY) 2014 from individuals and companies that attempted to defraud federal health programs, including programs serving seniors, persons with disabilities or those with low incomes. For every dollar spent on health care-related fraud and abuse investigations in the last three years, the administration recovered $7.70. This is about $2 higher than the average return on investment in the HCFAC program since it was created in 1997.  It is also the third-highest return on investment in the life of the program. 

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Click here to read the fact sheet


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3/19/15 – The Health Care Fraud and Abuse Control Program Protects Consumers and Taxpayers by Combating Health Care Fraud

The Affordable Care Act has Helped the Government Fight Fraud, Strengthen Health Insurance Programs, Protect Consumers, and Save Taxpayer Dollars

The Obama Administration is committed to reducing fraud, waste, and abuse across the government.  Since 2010, the U.S. Department of Health & Human Services, Office of Inspector General (HHS OIG), the Centers for Medicare & Medicaid Services (CMS), and the U.S. Department of Justice (DOJ) have been using powerful, new anti-fraud tools to protect Medicare and Medicaid by shifting beyond a “pay and chase” approach toward fraud prevention. Through the groundbreaking Healthcare Fraud Prevention Partnership, stronger relationships have been built between the government and private sector to help protect all consumers.

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3/18/15 – Michigan’s MI Health Link Demonstration – Frequently Asked Questions

The Michigan MI Health Link Provider Frequently Asked Questions (FAQs) have been released.

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3/17/15 - Medicare-Medicaid Coordination Office Fiscal Year 2014 Report to Congress

Section 2602 of the Patient Protection and Affordable Care Act, hereinafter referred to as the Affordable Care Act, created the Federal Coordinated Health Care Office (“Medicare‐Medicaid Coordination Office,” hereafter “the Office” or “MMCO”). The purpose of MMCO is to bring together Medicare and Medicaid in order to more effectively integrate benefits, and improve the coordination between the Federal Government and states to enhance access to quality services for individuals who are enrolled in both programs (Medicare-Medicaid enrollees, sometimes referred to as “dual-eligibles”). The Affordable Care Act sets forth the specific goals and responsibilities for the Office, including the annual submission of a Report to Congress.  In its fourth year, MMCO continues to make progress on its statutory mandate, with a sustained focus on initiatives to better integrate and strengthen access to care for beneficiaries dually eligible for Medicare and Medicaid. This annual report describes the Office’s efforts to develop policies, programs, and initiatives that promote coordinated, high‐quality, and cost‐effective care for all Medicare‐Medicaid enrollees.

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3/16/15 – Health Insurance Coverage and the Affordable Care Act

Five years after the enactment of the Affordable Care Act, millions of Americans have gained health insurance coverage. This factsheet highlights the changes in health insurance coverage after the ACA's enactment in March 2010, for young adults who were able to gain coverage through their parents' health insurance plan, as well as adults who gained coverage after the start of open enrollment for the Health Insurance Marketplaces in October 2013 through March 4, 2015. Details on people who gained health insurance coverage include race and ethnicity, household income and state Medicaid expansion status, and young adults.

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Click here to read the fact sheet


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3/10/15 – Nationwide Nearly 11.7 Million Consumers are Enrolled in 2015 Health Insurance Marketplace Coverage

More Than 4.1 Million Young People Selected a Plan or Were Re-enrolled; Nearly 7.7 Million People with Plan Selections in HealthCare.gov States Qualify for an Average Tax Credit of $263 per Month

Nationwide, nearly 11.7 million consumers selected or were automatically re-enrolled in quality, affordable health insurance coverage through the Health Insurance Marketplace as of Feb. 22, according to a report released today by the U.S. Department of Health and Human Services. Of those, 8.84 million (76 percent) were in states using the HealthCare.gov platform and 2.85 million (24 percent) were in the 14 states (including Washington, D.C.) using their own Marketplace platforms.  Nearly 7.7 million individuals with a plan selection in the states using HealthCare.gov qualified for an average tax credit of $263 per month and more than half (55 percent) paid $100 or less per month after tax credits.

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Click here to view the monthly enrollment report


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3/10/15 – Affordable Care Act Initiative Builds on Success of ACOs

New Generation ACO Model Sets Stronger Measures and More Opportunities for Care

The U.S. Department of Health and Human Services today announced a new initiative from the Centers for Medicare & Medicaid Services’ Innovation Center (CMS Innovation Center): the Next Generation Accountable Care Organization (ACO) Model of payment and care delivery. Made possible by the Affordable Care Act, ACOs encourage quality improvement and care coordination, helping to move our health care system to one that achieves the Department’s goals of better care, smarter spending, and healthier people.

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Click here to read the fact sheet


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3/9/15 – Department of Health and Human Services – Office of Inspector General – Medicare Could Have Saved Billions at Critical Access Hospitals if Swing-Bed Services were Reimbursed Using the Skilled Nursing Facility Prospective Payment System Rates

By Daniel R. Levinson

Congress established the Rural Flexibility Program, which created Critical Access Hospitals (CAHs) to ensure that beneficiaries in rural areas have access to a range of hospital services. CAHs have broad latitude in the types of inpatient and outpatient services they provide, including “swing-bed” services, which are the equivalent of services performed at a skilled nursing facility (SNF). Medicare reimburses CAHs at 101 percent of their reasonable costs for providing services to beneficiaries rather than at rates set by Medicare’s prospective payment system (PPS) or Medicare’s fee schedules.
 

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2/27/15 – Fact Sheet: Health Care Payment Learning and Action Network Working Together to Move Payment toward Value and Quality in the U.S. Health System

In January 2015, Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell announced an ambitious initiative to move the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity of care they give patient. The Health Care Payment Learning and Action Network is a key component of this effort to deliver better care, smarter spending of health dollars, and healthier people.

Click here to read the fact sheet


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2/27/15 – Health Care Payment Learning and Action Network

To help achieve better care, smarter spending, and healthier people, the Department of Health and Human Services (HHS) is working in concert with our partners in the private, public, and non-profit sectors to transform the nation’s health system to emphasize value over volume. HHS has set a goal of tying 30 percent of Medicare fee-for-service payments to quality or value through alternative payment models by 2016 and 50 percent by 2018. HHS has also set a goal of tying 85 percent of all Medicare fee-for-service to quality or value by 2016 and 90 percent by 2018. To support these efforts, HHS has launched the Health Care Payment Learning and Action Network to help advance the work being done across sectors to increase the adoption of value-based payments and alternative payment models.

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2/27/15 – Department of Health and Human Services – Office of Inspector General – Comparing Average Sales Prices and Average Manufacturer Prices for Medicare Part B Drugs: An Overview of 2013

By Suzanne Murrin

When Congress established average sales prices (ASPs) as the primary basis for Medicare Part B drug reimbursement, it also mandated that the Office of Inspector General (OIG) compare ASPs with average manufacturer prices (AMPs) and directed the
Centers for Medicare & Medicaid Services (CMS) to substitute payment amounts for drugs with ASPs that exceed AMPs by a threshold of 5 percent. To comply with its statutory mandate, OIG has completed over 30 quarterly pricing comparisons. In April 2013, CMS began substituting payment amounts in accordance with its published price substitution policy, which currently applies to only certain drug codes with complete AMP data that exceed the 5-percent threshold in two consecutive quarters or three of the previous four quarters.
 

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2/25/15 - Posting of 2014 Star Ratings RFI Submissions and Star Ratings Request for Comment Summary

As promised in the 2016 draft Call Letter, CMS has posted several files to the CMS website, including summary of CMS’ review of internal research and a subset of the RFI submissions. The remainder of submissions will be posted as they complete the 508 compliance check process next week.

Click here to view Part C and D Performance Data


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2/25/15 – Transitioning to ICD-10 

The International Classification of Diseases, or ICD, is used to standardize codes for medical conditions and procedures. While most countries already use the 10th revision of these codes (or ICD-10), the United States has yet to adopt this convention. The Centers for Medicare & Medicaid Services (CMS) is working closely with all industry stakeholders to provide support in transitioning to ICD-10 on Oct. 1, 2015.

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2/24/15 – Since 2010, 9.4 Million People with Medicare have Saved over $15 Billion on Prescription Drugs

The Department of Health and Human Services released today new information that shows that millions of seniors and people with disabilities with Medicare continued to enjoy prescription drug savings and improved benefits in 2014 as a result of the Affordable Care Act.

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2/23/15 - Medicare-Medicaid Plan Annual Requirements and Timeline for CY 2016

This guidance provides an overview of the contract year (CY) 2016 Medicare requirements and timeframes for Medicare-Medicaid plans (MMPs) whose contracts are already effective, or will become effective at any point in CY 2015. The requirements described in this guidance are in addition to those required at the time of application and are consistent with the annual renewal requirements for all Medicare health plans. This memorandum also provides additional clarification regarding the use of past performance information for determining eligibility for receipt of passive enrollment. CMS will provide additional guidance regarding the applicability of CY 2016 Final Call Letter guidance to MMPs following the release of the Final Call Letter.

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2/20/15 - CMS Proposes 2016 Payment and Policy Updates for Medicare Health and Drug Plans

The Centers for Medicare and Medicaid Services (CMS) today released proposed changes for the coming year for the Medicare Advantage (MA) and Part D Prescription Drug Programs that will advance Health and Human Services Secretary Sylvia M. Burwell’s vision of building a better, smarter health care system and moving the Medicare program, and the health care system at large, toward paying providers based on the quality, rather than the quantity of care they give patients.
 
“The proposed rates will enhance the stability of Medicare Advantage program and minimize disruption to seniors and care providers," said Andy Slavitt, CMS Principal Deputy Administrator. "The policies in the Notice and Call Letter will continue the movement to reward providers of high quality, consumer-friendly care for the Medicare Advantage and Part D programs."
 
 
 
 

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2/20/15 - CMS Announces Special Enrollment Period for Tax Season

The Centers for Medicare & Medicaid Services (CMS) announced today a special enrollment period (SEP) for individuals and families who did not have health coverage in 2014 and are subject to the fee or “shared responsibility payment” when they file their 2014 taxes in states which use the Federally-facilitated Marketplaces (FFM). This special enrollment period will allow those individuals and families who were unaware or didn’t understand the implications of this new requirement to enroll in 2015 health insurance coverage through the FFM.

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2/20/15 – CMS Strengthens Five Star Quality Rating System for Nursing Homes

The Centers for Medicare & Medicaid Services (CMS) today strengthened the Five Star Quality Rating System for Nursing Homes on the Nursing Home Compare website to give families more precise and meaningful information on quality when they consider facilities for themselves or a loved one. Today’s announcement also marks an important milestone to achieving the goal of implementing further improvements to the Five Star system in 2015, as the Administration announced last October.

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2/20/15 - FINAL 2016 Letter to Issuers in the Federally-facilitated Marketplaces

The Centers for Medicare & Medicaid Services (CMS) is releasing this final 2016 Letter to Issuers in the Federally-facilitated Marketplaces (Letter). This Letter provides issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Marketplaces (FFMs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs) with operational and technical guidance to help them successfully participate in those Marketplaces in 2016. Unless otherwise specified, references to the FFMs include the FF-SHOPs. Throughout this Letter, CMS identifies the areas in which States performing plan management functions in the FFMs have flexibility to follow an approach different from that articulated in this guidance. CMS notes that the policies articulated in this Letter apply to the certification process for plan years beginning in 2016.

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2/20/15 – CMS Issues the Final HHS Notice of Benefit and Payment Parameters for 2016

Stronger standards for issuers and Marketplaces

The Centers for Medicare & Medicaid Services (CMS) has issued the Final HHS Notice of Benefit and Payment Parameters for 2016.  This rule seeks to improve consumers’ experience in the Health Insurance Marketplace and to ensure their coverage options are affordable and accessible.  This rule builds on previously issued standards which seek to make high-quality health insurance available to all Americans.  The final notice further strengthens transparency, accountability, and the availability of information for consumers about their health plans.

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Click here to read the Final Rule.

Click here to read the Final HHS Notice of Benefit and Payment Parameters for 2016. 


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2/19/15 - Basic Health Program Funding Methodology Final Notice

Fact Sheet

The Centers for Medicare & Medicaid Services (CMS) today issued a final notice establishing the methodology for determining federal funding for the Basic Health Program in program year 2016. The Basic Health Program provides states with the option to establish a health benefits coverage program for lower-income individuals as an alternative to Health Insurance Marketplace coverage under the Affordable Care Act. This voluntary program enables states to create a health benefits program for residents with incomes that are too high to qualify for Medicaid through Medicaid expansion in the Affordable Care Act, but are in the lower income bracket to be eligible to purchase coverage through the Marketplace. This final notice is substantially the same as the final notice for program year 2015.

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2/18/15 – Financial Alignment Initiative

The Centers for Medicare & Medicaid Services (CMS) launched the Financial Alignment Initiative in 2011 to begin addressing the financial misalignment between Medicare and Medicaid that often presents a barrier to coordinated care for enrollees. The Financial Alignment Initiative aims to better align the financing of these two programs and integrate primary, acute, behavioral health and long-term services and supports in a more easily navigable, simplified system for enrollees. The Initiative has two models, the capitated model and managed fee-for-service model, both of which are serving beneficiaries in states throughout the country. This document provides a snapshot of enrollment, age, and health risk assessment (HRA) experience to date for the capitated financial alignment model.

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2/18/15 – The 2016 Qualified Health Plan (QHP) Application is Available to Issuers Applying for Certification to Participate in the Federally-facilitated Marketplaces

QHP and SADP issuers should use the templates, instructions, and corresponding supporting documentation and justification forms when applying for Plan Year 2016 certification to participate in the Federally-facilitated Marketplaces and States Performing Plan Management in an FFM.

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2/12/15 - New Affordable Care Act Initiative to Encourage Better Oncology Care

The U.S. Department of Health and Human Services (HHS) today announced a new multi-payer payment and care delivery model to support better care coordination for cancer care as part of the Department’s ongoing efforts to improve the quality of care patients receive and spend health care dollars more wisely, contributing to healthier communities. The initiative will include 24-hour access to practitioners for beneficiaries undergoing treatment and an emphasis on coordinated, person-centered care, aimed at rewarding value of care, rather than volume.

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2/12/15 - Nursing Home Compare 3.0: Revisions to the Nursing Home Compare 5-Star Quality Rating System

On Friday, February 20, 2015, the Centers for Medicare & Medicaid Services (CMS) will unveil Nursing Home Compare (NHC) 3.0, an expanded and strengthened NHC 5-Star Quality Rating System for Nursing Homes on the CMS Nursing Home Compare website (Medicare.gov/nursinghomecompare). CMS will complete the following actions:  
 
Add 2 Quality Measures (QMs): for antipsychotic medication use in nursing homes to the 5- Star calculations.  One measure is for short-stay residents when a nursing home begins use of antipsychotics for people without diagnoses of schizophrenia, Huntington’s disease, or Tourette syndrome, and a second measure reflects continued use of such medications for long-stay nursing home residents without diagnoses of schizophrenia, Huntington’s disease, or Tourette syndrome.
 
 

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02/10/15 – Michigan MMPs: Release of the Plan-Delegated Enrollment Notices

The Michigan Medicare-Medicaid Plan (MMP) Delegated Notices (5a, 5b, 16, 23, 29 and 30) have been posted.

Click here to view exhibit 5a

Click here to view exhibit 5b

Click here to view exhibit 16

Click here to view exhibit 23

Click here to view exhibit 29

Click here to view exhibit 30


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2/9/15 – Health Insurance Marketplace 2015:  Average Premiums After Advance Premium Tax Credits Through January 30 In 37 States Using The Healthcare.gov Platform

By Arpit Misra and Thomas Tsai

The Affordable Care Act helps families afford health insurance coverage by providing financial assistance in the form of advanced premium tax credits and cost-sharing reductions in the Health Insurance Marketplaces (the “Marketplaces”). From November 15, 2014 through January 30, 2015, almost 7.5 million individuals had selected or been automatically re-enrolled into 2015 Marketplace Plans in the 37 states that use the Healthcare.gov platform.  The vast majority of these individuals are receiving financial assistance.  Data in this report are preliminary, and data in this report will be updated after the close of the 2015 Open Enrollment Period.

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2/6/15 – CMS Finalizes Program Changes for Medicare Advantage and Prescription Drug Benefit Programs for Contract Year 2016

On February 6, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule revising regulations for the Medicare Advantage (MA) program (Part C) and prescription drug benefit program (Part D). This final rule implements statutory requirements, improves program efficiencies, strengthens beneficiary protections, clarifies program requirements, improves payment accuracy, and makes technical changes for Contract Year (CY) 2016. 

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2/5/15 – National Coverage Determination (NCD) for Screening for Lung Cancer with Low Dose Computed Tomography

Today the Centers for Medicare & Medicaid Services (CMS) issued a final national coverage determination that provides for Medicare coverage of Screening for Lung Cancer with Low Dose Computed Tomography (LDCT). The coverage is effective immediately.  “This is the first time that Medicare has covered lung cancer screening. This is an important new Medicare preventive benefit since lung cancer is the third most common cancer and the leading cause of cancer deaths in the United States,” said Dr. Patrick Conway, chief medical officer and deputy administrator for innovation and quality for CMS.

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1/30/15 - HHS Proposes Path To Improve Health Technology And Transform Care

ONC issues draft nationwide health IT Interoperability Roadmap; Implementation resources also released as first deliverable - The Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) today released Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0. The draft Roadmap is a proposal to deliver better care and result in healthier people through the safe and secure exchange and use of electronic health information. “HHS is working to achieve a better health care system with healthier patients, but to do that, we need to ensure that information is available both to consumers and their doctors,” said HHS Secretary Sylvia M. Burwell. “Great progress has been made to digitize the care experience, and now it’s time to free up this data so patients and providers can securely access their health information when and where they need it. A successful learning system relies on an interoperable health IT system where information can be collected, shared, and used to improve health, facilitate research, and inform clinical outcomes. This Roadmap explains what we can do over the next three years to get there.

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Click here to read draft Roadmap and Standard Advisory


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1/27/15 - CMS and Indiana Agree on Medicaid Expansion

 
CMS Administrator Marilyn Tavenner and HHS Secretary Sylvia Burwell issued the following statement today after Indiana became the 28th state – plus the District of Columbia – to expand Medicaid under the Affordable Care Act.  “With today’s agreement, Indiana will become the 28th state, plus the District of Columbia, to expand Medicaid under the Affordable Care Act. This agreement will bring much needed access to health care coverage to an estimated 350,000 uninsured low-income Hoosiers over the next three years,” said CMS Administrator Marilyn Tavenner. “HHS and CMS are committed to working with states to design programs uniquely their own, while maintaining essential health benefits guaranteed under the Affordable Care Act and other key consumer protections consistent with the law.”
 

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01/26/15 – Appendix 5: State of Michigan Additional Requirements - The Michigan Medicare-Medicaid Plan (MMP) State-Specific Enrollment Guidance and updated Delegated Notices (5a & 5b)

Click here to view Appendix 5 


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1/26/15 - Better Care, Smarter Spending, Healthier People: Improving Our Health Care Delivery System

Improving the quality and affordability of care received by Americans is, alongside increasing access to it, a core pillar of the Affordable Care Act. The Administration is working to ensure that Americans receive better care; that we spend our health care dollars more wisely; and that we have healthier communities, a healthier economy, and ultimately, a healthier country. This means finding better ways to deliver care, pay providers, and share and utilize information. The Affordable Care Act offers many tools to improve the way providers are paid to reward quality and value instead of quantity, to strengthen care delivery by better integrating and coordinating care for patients, and to make information more readily available to consumers and providers.

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1/26/15 - Better Care. Smarter Spending. Healthier People: Why It Matters

We are taking action to build on progress made in improving health care so patients and their families can get the best care possible. Our goal is to spend our health care dollars more wisely, so—ultimately—people can live healthier lives. These shared goals are important: For patients and families: Giving doctors the opportunity to focus on patient-centered care and to be accountable for quality and cost means keeping people healthier for longer. It also creates opportunities for providers to spend more time with their patients.

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1/26/15 - Better Care. Smarter Spending. Healthier People: Paying Providers for Value, Not Volume - Rewarding Volume: Where We Are Now

Improving the quality and affordability of care for all Americans has always been a pillar of the Affordable Care Act, alongside expanding access to such care. The law gives us the opportunity to shape the way health care is delivered to patients and to improve the quality of care system-wide while helping to reduce the growth of health care costs. When it comes to improving the way providers are paid, we want to reward value and care coordination – rather than volume and care duplication.  In partnership with the private sector, the Department of Health and Human Services (HHS) is testing and expanding new health care payment models that can improve health care quality and reduce its cost.

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1/22/15 - CMS Launches Dialysis Facility Compare Star Ratings

Today, the Centers for Medicare & Medicaid Services (CMS) added star ratings to the Dialysis Facility Compare (DFC) website. These ratings summarize performance data, making it easier for consumers to use the information on the website. These ratings also spotlight excellence in health care quality. In addition to posting the star ratings, CMS updated data on individual DFC quality measures to reflect the most recent data for the existing measures. “Star ratings are simple to understand and are an excellent resource for patients, their families, and caregivers to use when talking to doctors about health care choices,” said CMS Administrator Marilyn Tavenner. “CMS has taken another step in its continuous commitment to improve quality measures and transparency.”

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1/14/15 - Release of the CY2016 Medicare Advantage, Prescription Drug Plan, and CY2015 PACE Applications

CMS has released the 2016 Medicare Advantage, Prescription Drug Plan, Employer/Union-Only Group Waiver Plan (EGWP) applications, the Special Needs Plan (SNP) proposals, and the 2015 PACE application. All applications (excluding PACE applications) are due to CMS by 8:00 p.m. EST on February 18, 2015.  All materials and supporting documentation must be submitted through CMS' Health Plan Management System (HPMS).

Click here to view 2016 consolidated Part C application (including Employer/Union-Only Group Waiver Plans) and instructions

Click here to view 2016 consolidated Part D applications (including Employer/Union-Only Group Waiver Plans) and instructions 

 


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1/2/15 – First Annual Report: Final – Evaluation of the Community-based Care Transitions Program

The Community-based Care Transitions Program (CCTP) was initiated by the Centers for Medicare & Medicaid Services (CMS) in April 2011 with the goal of improving transitions of Medicare beneficiaries from inpatient hospitals to home or other care settings. Care transition services are designed to improve quality of care, reduce readmissions to hospitals by high-risk beneficiaries, and achieve cost savings for the Medicare program. As of June 2013, CCTP
agreements had been awarded to 101 community-based organizations (CBOs). In August 2012, CMS awarded a contract to Econometrica, Inc., and IMPAQ International to design and conduct an evaluation of the CCTP to assess the impact of the program on continuity of care and outcomes including readmissions, emergency department (ED) visits, observation stays, costs, patient experiences, and patient activation.
 

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12/16/14 - State Innovation Models Initiative Round Two

The Centers for Medicare and Medicaid Services (CMS) announced the recipients of 11 Model Test and 21 Model Design awards under the second round of the State Innovation Models initiative on December 16, 2014.
In round two, the State Innovation Models initiative is providing more than $665 million over the next four years to support state-led, multi-payer health care payment and service delivery models that will improve health system performance, increase quality of care, and decrease costs for Medicare, Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries—and for all residents of participating states. This includes both model “design” awardees (states/entities that are designing plans and strategies for statewide innovation) and model “test” awardees (states that are taking the next step from “designing” to “testing” and implementing comprehensive statewide health transformation plans). States will engage a broad group of stakeholders including health care providers and systems, long-term service and support providers, commercial payers, state hospital and medical associations, tribal communities and consumer advocacy organizations.
 

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12/11/14 - Medicare and Medicaid Program; Revisions to Certain Patient’s Rights Conditions of Participation and Conditions for Coverage Overview

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to revise selected conditions of participation (CoPs) for providers, conditions for coverage (CfCs) for suppliers, and requirements for long-term care facilities, to ensure that certain requirements are consistent with the Supreme Court decision in United States v. Windsor, 570 U.S. 12, 133 S.Ct. 2675 (2013) and U.S. Health and Human Services policy. In United States v. Windsor, the Supreme Court held that section 3 of the Defense of Marriage Act (DOMA) is unconstitutional because it violates the Fifth Amendment (See Windsor, 133 S. Ct. 2675, 2695).  Section 3 of DOMA provided that in determining the meaning of any Act of the Congress, or of any ruling, regulation, or interpretation of the various administrative bureaus and agencies of the United States, the word “marriage” meant only a legal union between one man and one woman as husband and wife, and the word “spouse” could refer only to a person of the opposite sex who was a husband or a wife (1 U.S.C. § 7). For all Medicare and Medicaid provider and supplier types, we conducted a review of the Code of Federal Regulations (CFR) for instances in which our regulations defer to state law for purposes of defining “representative,” “spouse,” and similar terms in which reference to a spousal relationship is explicit or implied. We have identified several provisions that we believe should be revised in light of the Windsor decision.

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12/11/14 - Home Health Compare Star Ratings

Consumer research has shown that summary quality measures and the use of symbols, such as stars, to represent performance are valuable to consumers. Star ratings can help consumers more quickly identify differences in quality and make use of the information when selecting a health care provider. In addition to summarizing performance, star ratings can also help home health agencies (HHAs) identify areas for improvement. They are useful to consumers, consumer advocates, health care providers, and other stakeholders, when updated regularly to present the most current information available. The Affordable Care Act calls for transparent, easily understood information on provider quality to be publicly reported and made widely available  In order to provide home health care consumers with a summary quality measure in an accessible format, CMS proposes to publish a star rating for home health agencies on Home Health Compare starting in 2015. This is part of CMS’ plan to adopt star ratings across all Medicare.gov Compare websites.

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12/11/14 - CMS Announces Next Phase in Medicare DMEPOS Competitive Bidding

The Centers for Medicare & Medicaid Services (CMS) today announced the bidding timeline for Round 2 Recompete and the national mail-order recompete of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program, as required by law. CMS also launched a comprehensive bidder education program. This program is designed to ensure that DMEPOS suppliers interested in bidding receive the information and assistance they need to submit complete bids in a timely manner. The DMEPOS Competitive Bidding Program changes the amount Medicare pays for certain DMEPOS while maintaining beneficiary access to items and services and quality of care. The program replaces the outdated, inflated fee-schedule prices Medicare paid for these items with lower, more accurate prices to help Medicare and its beneficiaries save money while ensuring access to quality equipment, supplies, and services. This program also helps limit fraud and abuse in Medicare. 

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12/3/14 - National Health Expenditures Continued Slow Growth In 2013

Health spending continued to grow at a slow rate last year the Office of the Actuary (OACT) at the Centers for Medicare & Medicaid Services (CMS) reported today. In 2013, health spending grew at 3.6 percent and total national health expenditures in the United States reached $2.9 trillion, or $9,255 per person. The annual OACT report showed health spending continued a pattern of low growth—between 3.6 percent and 4.1-- percent for five consecutive years. The report is being published today in Health Affairs. The recent low rates of national health spending growth coincide with modest growth in Gross Domestic Product (GDP), which averaged 3.9 percent per year since the end of the severe economic recession in 2010. As a result, the share of the economy devoted to health remained unchanged over this period at 17.4 percent.

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12/3/14 - New CMS Rules Enhance Medicare Provider Oversight; Strengthens Beneficiary Protections

CMS Administrator Marilyn Tavenner today announced new rules that strengthen oversight of Medicare providers and protect taxpayer dollars from bad actors. These new safeguards are designed to prevent physicians and other providers with unpaid debt from re-entering Medicare, remove providers with patterns or practices of abusive billing, and implement other provisions to help save more than $327 million annually.  “The changes announced today are common-sense safeguards to preserve Medicare for generations to come, while making the rules more consistent for all providers that work with us,” Administrator Tavenner said. “The Administration is committed to using all appropriate tools as part of its comprehensive program integrity strategy shaped by the Affordable Care Act.”

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12/2/14 - Early Preview – CY2016 Medicare Advantage Ratebook Growth Rates

On October 10, 2014, CMS published in the Federal Register the calendar year (CY) 2015 Part A and Part B premiums. Supporting the CY 2015 premium determinations are the underlying estimates of the United States Per Capita Cost (USPCC) for beneficiaries entitled to Part A and/or enrolled in Part B. Based on these estimates, the early preview of the CY 2016 ratebook growth rates for non-ESRD beneficiaries is projected to be 2.45 percent for total USPCC and 2.02 percent for fee-for-service (FFS) USPCC. Table 1 illustrates the calculation of these growth rates, and Tables 2 and 3 illustrate the year-by-year USPCCs relative to the estimate in the Announcement of the CY 2015 Medicare Advantage Capitation Rates.

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12/1/14 - CMS Releases New Proposal To Improve Accountable Care Organizations

Shared Savings Program Proposed Rule reflects focus on primary care and improved incentives for participation, quality, and efficiency

The Centers for Medicare & Medicaid Services (CMS) today released a proposal to strengthen the Shared Savings Program for Accountable Care Organizations (ACOs) through a greater emphasis on primary care services and promoting transitions to performance-based risk arrangements. The proposed rule reflects input from program participants, experts, consumer groups, and the stakeholder community at large. CMS is seeking to continue this important dialogue to ensure that the Medicare Shared Savings Program ACOs are successful in providing seniors and people with disabilities with better care at lower costs. CMS Administrator Marilyn Tavenner said, “This proposed rule is part of our continued commitment to rewarding value and care coordination – rather than volume and care duplication.  We look forward to partnering with providers and stakeholders to continuously refine and improve the Medicare Shared Savings program.”

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11/21/14 - CMS Issues the HHS Notice of Benefit and Payment Parameters for 2016 Proposed Rule

Stronger payment standards for issuers and Marketplaces proposed

The Centers for Medicare & Medicaid Services (CMS) today issued a notice of proposed rulemaking to improve consumers’ experience in the Health Insurance Marketplace and to ensure their coverage options are affordable and accessible. To establish the new consumer standards for 2016, the proposed rule seeks to implement several Affordable Care Act provisions on payment parameters for issuers and Marketplaces. Today’s proposed rule would build on previously issued standards and provisions, which are making high-quality health insurance available to millions of Americans. The proposed rules for 2016 would further strengthen transparency, accountability, and the availability of information for consumers about their health plans. “It is one of our many goals to strengthen the integrity of programs that fall under the Affordable Care Act to ensure the delivery of quality care with affordable options,” said CMS Administrator Marilyn Tavenner. “CMS is working to improve the consumer experience and promote accountability, uniformity and transparency in private health insurance.”
 

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11/9/14 - Health Insurance Marketplace Offers Tool To Help Consumers Review Their Plan Options For 2015

Consumers should visit the HealthCare.gov window shopping tool to learn about their plan choices. This year there are even more plans on the market than last year.

Beginning this week, consumers can visit HealthCare.gov to review detailed information about each health insurance plan offered in their area before applying ahead of open enrollment, which starts November 15, according to an announcement made today by Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner. With more issuers offering coverage through the Health Insurance Marketplace this year, the majority of consumers will find more affordable options for themselves and their families. By answering a few simple questions, such as location and family size, consumers will be able to compare plans and get an estimate on how much financial assistance they may qualify for when shopping for coverage, without needing to submit an application.
 

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11/7/14 - Medicare ACOs Continue To Succeed In Improving Care, Lowering Cost Growth

Pioneer ACO Model and Medicare Shared Savings Program ACOs show continued quality of care improvements and additional Medicare savings

The Centers for Medicare & Medicaid Services today issued quality and financial performance results showing that Medicare Accountable Care Organizations (ACOs) have successfully improved the quality of care for Medicare beneficiaries by fostering greater collaboration between doctors, hospitals, and health care providers to coordinate care for beneficiaries. Last year, many ACOs had higher quality and better patient experience than published benchmarks. This year, compared to previous year performance, the ACOs improved significantly for almost all of the quality and patient experience measures demonstrating that these organizations improve care. ACOs in the Pioneer ACO Model and Medicare Shared Shavings Program (Shared Savings Program) also generated over $417 million in savings for Medicare.
 

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10/29/14 – Michigan Financial Alignment Demonstration Contract Posted

CMS has publicly released the three-way contract for the Michigan Financial Alignment Demonstration.
 

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10/21/14 - Basic Health Program Funding Methodology Proposed Notice

The Centers for Medicare & Medicaid Services (CMS) today issued a proposed notice establishing the methodology for determining federal funding for the Basic Health Program in program year 2016. The Basic Health Program provides states with the option to establish a health benefits coverage program for lower-income individuals as an alternative to Health Insurance Marketplace coverage under the Affordable Care Act. This voluntary program enables states to create a health benefits program for residents with incomes that are too high to qualify for Medicaid through Medicaid expansion in the Affordable Care Act, but are in the lower income bracket to be eligible to purchase coverage through the Marketplace. This proposed notice is substantially the same as the final notice for program year 2015.
 

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10/15/14 - New Affordable Care Act Initiative To Support Care Coordination Nationwide

The Centers for Medicare & Medicaid Services (CMS) today announced the availability of a new initiative for Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program. Made possible by the Affordable Care Act, ACOs encourage quality improvement and care coordination through the use of health information technology, helping to move our health care system to one that values quality over quantity and preventing illness over treating people after they get sick. The new ACO Investment Model is designed to bring these efforts to better coordinate care to rural and underserved areas by providing up to $114 million in upfront investments to up to 75 ACOs across the country. The ACO Investment Model will give Medicare Accountable Care Organizations more flexibility in setting quality and financial goals, while giving them greater accountability for delivering quality care efficiently, said CMS Administrator Marilyn Tavenner. 
 

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10/15/14 - Medicare Open Enrollment Begins Today

Seniors Have More High Quality Choices For Medicare Health And Drug Plans

The Centers for Medicare & Medicaid Services (CMS) announced the start of the Medicare Open Enrollment, which begins today, October 15th and ends December 7th. CMS encourages people with Medicare to review their current health and prescription drug coverage options for 2015. For 2015, steadily increasing quality of plans should give seniors confidence that they have an array of quality choices at competitive prices. Quality in Medicare Advantage and the Part D Prescription Drug Program continues to improve. About 60 percent of Medicare Advantage enrollees are currently enrolled in plans with four or more stars for 2015, in contrast to an estimated 17 percent in 2009. And Medicare Advantage enrollment is projected to be at an all-time high in 2015 with more than 16 million beneficiaries.
 

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10/15/14 - CMS Kicks Off Effort To Help Marketplace Enrollees Stay Covered

Consumers should come back to HealthCare.gov, reach out to the call center, or visit with an in-person assister to make sure they choose the plan that best meets their needs starting November 15.

The Centers for Medicare & Medicaid Services (CMS) is committed to making it as easy as possible for current Health Insurance Marketplace enrollees to renew their coverage for 2015. It is encouraging consumers to come back at the start of Open Enrollment on November 15, update their 2015 application, and compare their options to make sure they enroll in the plan that best meets their budget and health needs for next year. This week, consumers will begin to receive notices from the Federally-facilitated Marketplace in the mail and in their HealthCare.gov accounts, explaining how they can renew their coverage during Open Enrollment.
 

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10/15/14 - Accountable Care Organization (ACO) Investment Model Fact Sheet

Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to provide coordinated, high-quality care to their Medicare patients to help them deliver better care at lower cost. The goal of coordinated care is to ensure that patients, especially people with chronic conditions, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. ACOs represent one part of a comprehensive series of initiatives in the Affordable Care Act that are designed to lower costs and improve care. When an ACO succeeds in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.
 

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10/10/14 - Release of CY 2015 Model Materials for Michigan Medicare-Medicaid Plans

CMS has released the following information for Michigan Medicare-Medicaid Plans (MMPs):
 
* Chapters 1-3, 5-8, and 10-12 of the Member Handbook (Evidence of Coverage)
 
* ID Card
 
* List of Covered Drugs (formulary)
 
* Provider and Pharmacy Directory
 
* Summary of Benefits
 
Michigan will provide information separately to MMPs about the Michigan Health Link logo that plans will need for their ID cards.
 
To view the posted model materials, click here. Additional required model materials will be released on a flow basis as they are finalized and posted with all other Michigan MMP materials.

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10/9/14 - 2015 Medicare Part B Premiums And Deductibles To Remain The Same As Last Two Year

Premiums, copays and deductibles for other Medicare programs for 2015 also announced
Secretary of Health and Human Services Sylvia Burwell announced today that next year’s standard Medicare Part B monthly premium and deductible will remain the same as the last two years. Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items. For the approximately 49 million Americans enrolled in Medicare Part B, premiums and deductibles will remain unchanged in 2015 at $104.90 and $147, respectively. This leaves more of seniors’ cost of living adjustment from Social Security in their pockets. According to the HHS Office of the Assistant Secretary for Planning and Evaluation, as compared to Congressional Budget Office (CBO) projections for 2015 made in 2009, premiums will be more than $125 lower over the course of a year.
 

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10/6/14 - CMS Announces Two Medicare Quality Improvement Initiatives

Administration Redoubles Its Efforts To Improve Quality Of Post-Acute Care For Medicare Beneficiaries 

Today, the Centers for Medicare & Medicaid Services (CMS) announced two initiatives to improve the quality of post-acute care. First, the expansion and strengthening of the agency’s widely-used Five Star Quality Rating System for Nursing Homes will improve consumer information about individual nursing homes’ quality. Second, proposed new conditions of participation for home health agencies will modernize Medicare’s Home Health Agency Conditions of Participation to ensure safe delivery of quality care to home health patients. “We are focused on using as many tools as are available to promote quality improvement and better outcomes for Medicare beneficiaries,” said Marilyn Tavenner, CMS administrator. “Whether it is the regulations that guide provider practices or the information we provide directly to consumers, our primary goal is improving outcomes.”
 

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9/24/14 - New Report Projects A $5.7 Billion Drop In Hospitals’ Uncompensated Care Costs Because Of The Affordable Care Act

Hospitals In States That Have Expanded Medicaid Will Receive About 74 Percent Of The Total Savings Nationally

A report released today by the Department of Health and Human Services projects that hospitals will save $5.7 billion this year in uncompensated care costs because of the Affordable Care Act, with states that have expanded Medicaid seeing about 74 percent of the total savings nationally compared to states that have not expanded Medicaid. For over a decade prior to the Affordable Care Act, the percentage of the American population that was uninsured had been growing steadily. But with the significant expansion of coverage under the health care law through the Health Insurance Marketplace and Medicaid, the uninsurance rate is at historic lows. As a result, the volume of uncompensated care provided in hospitals and emergency departments has fallen substantially in the last year, particularly in Medicaid expansion states.
 

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9/23/14 - New Report: Health Insurance Marketplace Will Have 25 Percent More Issuers In 2015

77 New Health Insurance Issuers Means Greater Choice And Competition For Consumers

A report released today by the Department of Health and Human Services shows that consumers will have more choices as they shop for quality, affordable coverage on the Health Insurance Marketplace in 2015, because there will be a net 25 percent increase in the number of issuers offering Marketplace coverage in 2015. In total, 77 new issuers will offer Marketplace coverage. 
“When consumers have more choices, we all benefit,” said Secretary Sylvia M. Burwell. “In terms of affordability, access, and quality, today’s news is very encouraging. It’s a real sign that the Affordable Care Act is working.” Today’s report examines preliminary data from 36 states run or fully supported by the federal government (Federal Marketplace) plus eight states operating State-based Marketplaces, and finds that a larger set of insurance issuers will offer plans in the Marketplaces in 2015.
 

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9/19/14 - National Partnership To Improve Dementia Care Exceeds Goal To Reduce Use Of Antipsychotic Medications In Nursing Homes: CMS Announces New Goal

Coalition Provides Tools And Support To Achieve Continued Decreases

The National Partnership to Improve Dementia Care, a public-private coalition, today established a new national goal of reducing the use of antipsychotic medications in long-stay nursing home residents by 25 percent by the end of 2015, and 30 percent by the end of 2016. The coalition includes the Centers for Medicare & Medicaid Services (CMS), consumers, advocacy organizations, providers and professional associations. Between the end of 2011 and the end of 2013, the national prevalence of antipsychotic use in long-stay nursing home residents was reduced by 15.1 percent, decreasing from 23.8 percent to 20.2 percent nationwide. The National Partnership is now working with nursing homes to reduce that rate even further.
 

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9/18/14 - Medicare Advantage Enrollment At All-Time High; Premiums Remain Affordable

Seniors and people with disabilities will have continued access to a wide range of Medicare health and drug plans in 2015; CMS reports $12 billion in prescription drug savings

Today, the Centers for Medicare & Medicaid Services (CMS) announced that more people with Medicare will have access to higher quality Medicare Advantage (MA) plans, and for the fifth straight year, enrollment is projected to increase to a new all-time high, while premiums remain affordable. The average MA premium submitted by health plans for 2015 would increase by $2.94 next year, to $33.90 per month. However, CMS estimates the actual 2015 MA average premium will increase by only $1.30, as more beneficiaries elect to enroll in lower cost plans. The vast majority of MA enrollees will face little or no premium increase for next year with 61 percent of beneficiaries not seeing any premium increase at all. “Since the Affordable Care Act was enacted, enrollment in Medicare Advantage plans is now at an all-time high, and premiums have fallen,” said CMS Administrator Marilyn Tavenner. “Seniors and people with disabilities are benefiting from a transparent and competitive marketplace for Medicare health and drug plans.”
 

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9/16/14 - Medicare ACOs Continue To Succeed In Improving Care, Lowering Cost Growth

Pioneer ACO Model And Medicare Shared Savings Program ACOs Show Continued Quality Of Care Improvements And Additional Medicare Savings

The Centers for Medicare & Medicaid Services today issued quality and financial performance results showing that Medicare Accountable Care Organizations (ACOs) have successfully improved the quality of care for Medicare beneficiaries by fostering greater collaboration between doctors, hospitals, and health care providers and keeping patients healthy rather than treating them when they were sick. Last year, the ACOs had higher quality and better patient experience than published benchmarks. This year, the ACOs improved significantly for almost all of the quality and patient experience measures demonstrating that these organizations improve care. ACOs in the Pioneer ACO Model and Medicare Shared Shavings Program (Shared Savings Program) also generated over $372 million in total program savings for Medicare ACOs. At the same time, ACOs qualified for shared savings payments of $445 million. The encouraging news comes from preliminary quality and financial results from the second year of performance for 23 Pioneer ACOs and the first year of performance for 220 Shared Savings Program ACOs.
 

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9/16/14 - Delivering Better Care At Lower Cost Is Working

Over the past five years, the Obama Administration has made significant progress towards improving access to quality, affordable care for all Americans. Purchasers of health care, both public and private, are increasingly pursuing innovative approaches to health care improvement, wellness and cost containment, and encouraging results over the past several years show that success is achievable, particularly where public and private actors are aligned:
 
Nationally, the lowest per capita cost growth in national health expenditures over the last four years in more than 50 years.
According to a major annual survey released last week, employer premiums for family coverage grew just 3.0 percent in 2014, tied with 2010 for the lowest on record back to 1999.
Health care price growth is historically slow, with prices rising at a 1.8 percent annual rate since passage of the Affordable Care Act, the slowest rate of increase over a period of that length in 50 years.
All in all, the slowdown in Medicare spending between 2009 and 2012 has resulted in spending that is $116 billion below what it would have been had 2000-2008 trends continued.
Looking forward, the Congressional Budget Office now estimates that Federal spending on Medicare and Medicaid in 2020 will be $188 billion below what it projected as recently as August 2010.
 

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9/12/14 - HHS Awards More Than $295 Million In Affordable Care Act Funds To Increase Access To Primary Care At Health Centers

Funding Creates An Estimated 4,750 New Jobs; Helps Newly Insured Access Care

Health and Human Services Secretary Sylvia M. Burwell announced today $295 million in Affordable Care Act funding to 1,195 health centers in every U.S. State, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Basin to expand primary care services. Today’s awards enable health centers to increase access to comprehensive primary health care services by hiring an estimated 4,750 new staff including new health care providers, staying open for longer hours, and expanding the care they provide to include new services such as oral health, behavioral health, pharmacy, and vision services. These investments will help health centers reach an estimated 1.5 million new patients nationwide, including over 137,000 oral health patients and more than 38,000 mental and substance abuse patients.
 

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9/8/14 - HHS Announces $60 Million To Help Consumers Navigate Their Health Care Coverage Options In The Health Insurance Marketplace

The Affordable Care Act is working for millions of Americans who are able to access quality health coverage at a price they can afford, in large part because of the efforts of in-person assisters in local communities across the nation. People shopping for and enrolling in coverage through the Health Insurance Marketplace can get local help in a number of ways, including through Navigators. Health and Human Services Secretary Sylvia M. Burwell today announced $60 million in Navigator grant awards to 90 organizations in states with federally-facilitated and state partnership Marketplaces. These awards support preparation and outreach activities in year two of Marketplace enrollment and build on lessons learned from last year. “In-person assisters have an impact on the lives of so many Americans, helping individuals and families across the country access quality, affordable health coverage,” said Secretary Burwell. “We are committed to helping Americans get covered and stay covered with in-person assistance in their own communities.”
 

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9/3/14 - Number of Uninsured Projected to Decrease, Faster Health Expenditure Growth Expected as Coverage Expands and the Economy Improves, CMS Actuary Reports

The number of uninsured is expected to decline by nearly half from 45 million in 2012 to 23 million by 2023 as a result of the coverage expansions associated with the Affordable Care Act, according to a report from the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary. The report is being published today in Health Affairs. “Health care costs are increasing at a slower rate thanks to the Affordable Care Act,” said Marilyn Tavenner, CMS administrator. “The dramatic decrease in the number of uninsured Americans is a win for our country and its economy in the future.” Health spending growth for 2013 is projected to remain slow at 3.6 percent, which would mark the fifth consecutive year of spending growth under 4.0 percent. National health expenditures (NHE) are projected to grow at an average rate of 5.7 percent for 2013 through 2023, about 1.1 percentage points faster than the expected average annual growth rate for the Gross Domestic Product (GDP). 
 
 

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9/2/14 - CMS Finalizes Auto-Enrollment Process For Current Marketplace Consumers

The Centers for Medicare & Medicaid Services (CMS) finalized a policy today that provides current Health Insurance Marketplace consumers with a simple way to keep their current health insurance plan, while encouraging them to return to the Marketplace to ensure they are getting the best deal on their premiums and to shop for the plan that best fits their needs. These policies build on our efforts to enhance the consumer experience and make shopping for health care coverage as simple as possible. “We are committed to providing a simple, familiar process for consumers to renew their coverage next year,” said CMS Administrator Marilyn Tavenner. “Consumers should use this time to evaluate their health needs, browse other options, and see if they qualify for additional financial assistance. However, consumers who are happy with their plan and have no changes to their income or family situation can be auto-enrolled in their same plan next year, similar to how it is done in the employer insurance market today.”
 

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8/26/14 - The Affordable Care Act Supports Patient-Centered Medical Homes In Health Centers

Obama Administration Awards Over $35 Million To Support Facility Improvements In 147 Health Centers Nationwide To Deliver Better Coordinated Care

Health and Human Services Secretary Sylvia M. Burwell today announced $35.7 million in Affordable Care Act funding to 147 health centers in 44 states, the District of Columbia, and Puerto Rico to support patient-centered medical homes through new construction and facility renovations. “Health centers provide access to quality health care for millions of Americans regardless of their ability to pay,” said Secretary Burwell. “We’re making these investments so that health centers will be able to provide even higher quality services to the patients that rely upon them.” The patient-centered medical home delivery model is designed to improve quality of care through team-based coordination of care, treating the many needs of the patient at once, increasing access to care, and empowering the patient to be a partner in their own care.
 

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8/12/14 - Federal Health Insurance Marketplace: Send in Requested Documents Now to Keep Marketplace Coverage

Administration has closed approximately 450,000 citizenship and immigration status data matching cases and another 210,000 are in progress; warns remaining consumers to respond quickly or their Marketplace coverage could end

The Federal Health Insurance Marketplace began sending notices this week to consumers with a citizenship or immigration data matching issue (also called an inconsistency) who have not responded to previous notices via mail, email, and phone. While the Federal Marketplace has already received documents and cleared a large number of data inconsistencies related to citizenship or immigration status, consumers who have not yet responded must act now and submit supporting documents by September 5 or their Marketplace coverage will end on September 30. A citizenship or immigration data matching issue can happen when the information reported in a consumer’s application, such as a Social Security or Permanent Resident Card number, is incomplete or different than the information the government has on file. 
 

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8/4/14 - CMS Issues Hospital Inpatient Payment Regulation

Final rule strengthens tie between payment and quality improvement

The final rule issued today by the Centers for Medicare & Medicaid Services (CMS) adopts improvements in the quality of care that limit payment for hospital acquired conditions (HACs) and readmissions. The rule, which updates Medicare payment policies and rates for inpatient stays at general acute care and long-term care hospitals (LTCHs) for fiscal year (FY) 2015, builds on the administration’s efforts for better hospital patient outcomes and slowing the long-term health care cost growth. The rule also supports price transparency by reminding hospitals of the Affordable Care Act requirement to post or otherwise make their charges available to patients and the public. “Today’s policies further support our efforts to continue improving the care our Medicare beneficiaries receive while also cutting the growth of Medicare costs,” said CMS Administrator Marilyn Tavenner. “This final rule builds on our recent efforts to improve hospital performance while giving hospitals the clarity and resources they need to deliver the best possible patient care.”
 

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8/4/14 - CMS Finalizes Updates To The Wage Index And Payment Rates For The Medicare Hospice Benefit For Fiscal Year 2015

On August 1, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1609-F] to update the Medicare hospice payment rates and the wage index for fiscal year (FY) 2015. The final rule reflects the ongoing efforts of CMS to protect beneficiary access to patient-centered hospice care. Hospices will see an estimated 1.4 percent ($230 million) increase in their payments for FY 2015. The hospice payment increase would be the net result of a hospice payment update to the hospice per diem rates of 2.1 percent (a “hospital market basket” increase of 2.9 percent minus 0.8 percentage point for reductions required by law), and a 0.7 percent decrease in payments to hospices due to updated wage data and the sixth year of CMS’ seven-year phase-out of its wage index budget neutrality adjustment factor (BNAF).
 

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8/1/14 - Frequently Asked Questions Regarding Medicare and the Marketplace

This document is a compilation of the most frequently asked questions (FAQs) regarding the intersection of Medicare and the Marketplace. Unless otherwise noted, these FAQs have been cleared for use in response to public inquiries.
 

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7/29/14 - CMS Extends Moratoria For Newly Enrolling Ground Ambulance Suppliers & Home Health Agencies

Patient Access Uninterrupted As Agency Continues To Target High Risk Areas

The Centers for Medicare & Medicaid Services (CMS) today announced it will extend its current enrollment moratoria on new ground ambulances in the Houston and Philadelphia metropolitan areas and new home health agencies in the metropolitan areas of Chicago, Fort Lauderdale, Detroit, Dallas, Houston, and Miami (please see the full list of extended moratoria counties below). CMS Administrator Marilyn Tavenner said the extension is necessary because the significant potential for fraud, waste and abuse continues in these areas. CMS used this powerful Affordable Care Act tool twice before to fight fraud, safeguard taxpayer dollars and ensure access to care is not interrupted. Factors that CMS considered in imposing the provider enrollment moratoria include a disproportionate ratio of providers and suppliers relative to beneficiaries, and law enforcement activity in these areas.
 

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7/28/14 - Trustees Report Shows Continued Reduced Cost Growth, Longer Medicare Solvency

The Medicare Trustees today projected that the trust fund that finances Medicare’s hospital insurance coverage will remain solvent until 2030, four years beyond what was projected in last year’s report. Due in part to cost controls implemented in the Affordable Care Act, per capita spending is projected to continue to grow slower than the overall economy for the next several years. “The Medicare Hospital Insurance trust fund is projected to be solvent for longer, which is good news for beneficiaries and taxpayers,” said Marilyn Tavenner, administrator of the Centers for Medicare & Medicaid Services (CMS). “Thanks to the Affordable Care Act, we are taking important steps to improve the quality of care for Medicare beneficiaries, while improving Medicare’s long-term solvency. Specifically, we have made major progress in improving patient safety, decreasing hospital readmissions, and establishing new payment models such as accountable care organizations aimed at reducing costs and improving quality. These reforms slow the rise in health care spending while improving the quality of care for beneficiaries.”
 

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7/18/14 - CMS Launches Next Phase Of New Quality Improvement Program

The Centers for Medicare & Medicaid Services (CMS) today awarded additional contracts as part of a restructuring the Quality Improvement Organization (QIO) Program to create a new approach to improve care for beneficiaries, families and caregivers. QIOs are private, mostly not-for-profit organizations staffed by doctors and other health care professionals trained to review medical care and help beneficiaries with complaints about the quality of care and to implement improvements in the quality of care available throughout the spectrum of care. The new contracts being awarded to fourteen organizations represent the second phase of QIO restructuring. The awardees will work with providers and communities across the country on data-driven quality initiatives. These QIOs will be known as Quality Innovation Network (QIN)-QIOs. QIN-QIO projects will be based in communities, health care facilities and clinical practices.
 

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7/14/14 - Medicaid Innovation Accelerator Program Factsheet

The Center for Medicare & Medicaid Services (CMS) has launched a collaborative initiative called the Medicaid Innovation Accelerator Program (IAP). The goal of IAP is to improve care and improve health for Medicaid beneficiaries, and reduce costs by supporting states in accelerating new payment and service delivery reforms. The Medicaid Innovation Accelerator Program is an important new component of CMS’ wide ranging efforts to support system-wide payment and delivery system reform innovation. Medicaid’s role in the health system and for vulnerable individuals underscores the importance of ensuring it is a strong partner in delivery system reform. A joint state federal program, Medicaid is projected to cover about 65 million people in 2014 and has a particularly strong role to play in helping to advance improvements for certain populations and in key segments of our health care system. The IAP will focus on populations with significant needs served by Medicaid programs: pregnant women and newborns, children, individuals with mental illness, individuals receiving long-term services and supports, and others.
 

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7/9/14 - Health Care Innovation Awards To Provide Better Health Care And Lower Costs

Today, Health and Human Services Secretary Sylvia Mathews Burwell announced new prospective awardees to test innovative care models, bringing the total amount of funding to as much as $360 million for 39 recipients spanning 27 states and the District of Columbia. These models are designed to deliver better health care and lower costs under the Health Care Innovation Awards program. “The Health Care Innovation Awards support our ongoing work to drive down health care costs while providing high quality care to CMS beneficiaries,” said Secretary Burwell. “These awards advance innovative solutions in delivering and improving care from all across our nation.” The prospective (not yet final) awards range from an expected $2 million to $23.8 million over a three year period. These awards are made possible by the Affordable Care Act and round out the anticipated recipients for round two of the Health Care Innovation Awards program. Examples include projects to promote better care for persons living with HIV/AIDS, reduce unnecessary use of emergency departments, improve pediatric dental care, promote prevention and management of cardiovascular disorders, and to improve care coordination in rural areas of the country. 
 

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7/8/14 - HHS Announces The Availability Of $100 Million In Affordable Care Act Funding To Expand Access To Primary Care Through New Community Health Centers

HHS Secretary Sylvia Mathews Burwell announced today the availability of $100 million from the Affordable Care Act to support an estimated 150 new health center sites across the country in 2015. New health center sites will increase access to comprehensive, affordable, high quality primary health care services in the communities that need it most. Later today, Secretary Burwell will also visit a Community Health Center in Decatur, Georgia to talk with its health care professionals about the important work they are doing to connect the community with high quality primary care. “In communities across the country, Americans turn to their local Community Health Center for vital health care services that help them lead healthy, productive lives,” said Secretary Burwell. “That’s why it’s so important that the Affordable Care Act is supporting the expansion of health centers.”
 

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7/3/14 - Proposed Policy And Payment Changes To The Medicare Physician Fee Schedule For Calendar Year 2015

On July 3, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update payment policies and payment rates for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2015. Medicare primarily pays physicians and other practitioners for care management services as part of face-to-face visits. Last year, CMS finalized a separate payment, outside of a face-to-face visit, for managing the care of Medicare patients with two or more chronic conditions beginning in 2015. Through this year’s rule, CMS is proposing details relating to the implementation of the new policy, including payment rates. In addition, CMS is proposing a new process for establishing PFS payment rates that will be more transparent and allow for greater public input prior to payment rates being set. Under the new process, payment changes will go through notice and comment rulemaking before being adopted beginning for 2016. We are also proposing to define screening colonoscopy to include anesthesia so that beneficiaries do not have to pay coinsurance on the anesthesia portion of a screening colonoscopy when furnished by an anesthesiologist.
 

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7/1/14 - CMS Proposes Payment Changes For Medicare Home Health Agencies For 2015

The Centers for Medicare & Medicaid Services (CMS) today announced proposed changes to the Medicare home health prospective payment system (HH PPS) for calendar year (CY) 2015 that would foster greater efficiency, flexibility, payment accuracy, and improved quality. Based on the most recent data available, CMS estimates that approximately 3.5 million beneficiaries received home health services from nearly 12,000 home health agencies, costing Medicare approximately $18 billion in 2013. In the rule, CMS projects that Medicare payments to home health agencies in CY 2015 will be reduced by 0.30 percent, or -$58 million based on the proposed policies. The proposed decrease reflects the effects of the 2.2 percent home health payment update percentage ($427 million increase)and the rebasing adjustments to the national, standardized 60-day episode payment rate, the national per-visit payment rates, and the non-routine medical supplies (NRS) conversion factor ($485 million decrease).
 

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6/25/14 - CMS Fraud Prevention System Identified or Prevented $210 Million in Improper Medicare Payments in 2nd Year of Operations

In its second year of operations, CMS’ state-of-the-art Fraud Prevention System, that employs advanced predictive analytics, identified or prevented more than $210 million in improper Medicare fee-for-service payments, double the previous year. It also resulted in CMS taking action against 938 providers and suppliers, according to a report sent to Congress today. “CMS is using the best of private sector technology to move beyond the ‘pay-and-chase’ approach to protect the Medicare Trust Funds,” said CMS Administrator Marilyn Tavenner. “While CMS is continuing to enhance the Fraud Prevention System we have demonstrated that investing in cutting-edge technology pays off for taxpayers and Medicare beneficiaries.” The Fraud Prevention System is a key element of the anti-fraud strategy that has led to a record $19.2 billion in fraud recoveries over the previous five years. The Fraud Prevention System uses predictive algorithms and other sophisticated analytics to analyze billing patterns against every Medicare fee-for-service claim. 
 

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6/16/14 - CMS Initiative Helps People Make The Most Of Their New Health Coverage

“From Coverage to Care” outreach to engage doctors and new patients

Today, the Centers for Medicare & Medicaid Services (CMS) launched a national initiative “From Coverage to Care” (C2C), which is designed to help answer questions that people may have about their new health coverage, to help them make the most of their new benefits, including taking full advantage of primary care and preventive services. It also seeks to give health care providers the tools they need to promote patient engagement. “Helping to ensure that new health care consumers know about the benefits available through their coverage, and how to use it appropriately to obtain primary care and preventive services is essential to improving the health of the nation and reducing health care costs,” said Dr. Cara V. James, director of the CMS Office of Minority Health. Dr. James noted that, “to achieve these goals, we need to make sure that people who are newly covered know that their coverage can help them stay healthy, not just help them get better if they get sick.”
 

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6/10/14 - CMS Announces Opportunity to Apply for Navigator Grants in Federally-facilitated and State Partnership Marketplaces

“Navigator” program will continue to help consumers understand health coverage options as they enroll in coverage

The Centers for Medicare & Medicaid Services (CMS) today announced the availability of funding, totaling $60 million, to support Navigators in Federally-facilitated and State Partnership Marketplaces in 2014-2015. Navigators provide unbiased information to consumers about health insurance, the Health Insurance Marketplace, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program. “Navigators have been an important resource for the millions of Americans who enrolled in coverage in 2014. This funding ensures this work will continue next year, including during the open enrollment period for the Marketplaces,” said CMS Administrator Marilyn Tavenner.
 

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5/22/14 – Prior Authorization To Ensure Beneficiary Access And Help Reduce Improper Payments

The Centers for Medicare & Medicaid Services today announced plans to expand a successful demonstration for prior authorization for power mobility devices, test prior authorization in additional services in two new demonstration programs, and propose regulation for prior authorization for certain durable medical equipment, prosthetics, orthotics, and supplies. Prior authorization supports the administration’s ongoing efforts to safeguard beneficiaries’ access to medically necessary items and services, while reducing improper Medicare billing and payments. The proposed rule is estimated to reduce Medicare spending by $100 to $740 million over the next ten years. “With prior authorization, Medicare beneficiaries will have greater confidence that their medical items and services are covered before services and supplies are rendered. This will improve access to services and quality of care,” said CMS Administrator Marilyn Tavenner.
 

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5/22/14 – New Funding Gives States And Innovators Tools And Flexibility To Implement Delivery System Reform

Health and Human Services Secretary Kathleen Sebelius today announced new delivery system reform efforts made possible by the Affordable Care Act that offer states and innovators tools and flexibility to transform health care. HHS announced twelve prospective recipients receiving as much as $110 million in combined funding, ranging from an expected $2 million to $18 million over a three-year period, under the Health Innovation Awards program to test innovative models designed to deliver better care outcomes and lower costs. Examples include projects to provide better care for dementia patients, improve coordination between specialists and primary care physicians, and to improve cardiac care. Round two of the Health Care Innovation Awards program focuses on four priority areas: rapidly reducing costs for patients with Medicare and Medicaid; improving care for populations with specialized needs; testing improved financial and clinical models for specific types of providers, including specialists; and linking clinical care delivery to preventive and population health. The twelve prospective recipients will test models in all four categories and spanning 13 states. Additional prospective recipients will be announced in the coming months.
 

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5/19/14 – CMS Makes Improvements To Medicare Drug And Health Plans

The Centers for Medicare & Medicaid Services (CMS) today issued final regulations (CMS-4159-F) for the Medicare Advantage and prescription drug benefit (Part D) programs that continue efforts to curb fraud and abuse and to improve benefits and the quality of care for seniors and people with disabilities enrolled in these programs. The final rule is projected to save an estimated $1.615 billion over the next ten years 2015 – 2024. “The policies finalized in this regulation will strengthen Medicare by providing better protections and improving health care quality for beneficiaries participating in Medicare health and drug plans,” said Marilyn Tavenner, CMS administrator. “The final rule will give CMS new and enhanced tools in combating fraud and abuse in the Medicare Part D program so that we can continue to protect beneficiaries and taxpayers.”
 

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5/13/14 - Medicare Fraud Strike Force Charges 90 Individuals For Approximately $260 Million In False Billing

27 Medical Professionals, Including 16 Doctors, Charged with Health Care Fraud

Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that a nationwide takedown by Medicare Fraud Strike Force operations in six cities has resulted in charges against 90 individuals, including 27 doctors, nurses and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $260 million in false billings. Attorney General Holder and Secretary Sebelius were joined in the announcement by Acting Assistant Attorney General David A. O’Neil of the Justice Department’s Criminal Division, FBI Assistant Director Joseph Campbell, U.S. Department of Health and Human Services (HHS) Inspector General Daniel R. Levinson and Deputy Administrator and Director of the Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity Shantanu Agrawal.
 

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5/9/14 - CMS launches improved Quality Improvement Program

The Centers for Medicare and Medicaid Services (CMS) today took the agency’s first step in restructuring the Quality Improvement Organization (QIO) Program to improve patient care, health outcomes, and save taxpayer resources. This first phase of the restructuring will allow two Beneficiary and Family-Centered Care (BFCC) QIO contractors to support the program’s case review and monitoring activities separate from the traditional quality improvement activities of the QIOs. The two BFCC QIO contractors are Livanta LLC, located in Annapolis Junction, Maryland, and KePRO, located in Seven Hills Ohio. They will be responsible for ensuring consistency in the review process with consideration of local factors important to beneficiaries.
 

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5/9/14 - CMS launches improved Quality Improvement Program

The Centers for Medicare and Medicaid Services (CMS) today took the agency’s first step in restructuring the Quality Improvement Organization (QIO) Program to improve patient care, health outcomes, and save taxpayer resources. This first phase of the restructuring will allow two Beneficiary and Family-Centered Care (BFCC) QIO contractors to support the program’s case review and monitoring activities separate from the traditional quality improvement activities of the QIOs. The two BFCC QIO contractors are Livanta LLC, located in Annapolis Junction, Maryland, and KePRO, located in Seven Hills Ohio. They will be responsible for ensuring consistency in the review process with consideration of local factors important to beneficiaries.
 
 

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5/7/14 - Reforms Of Regulatory Requirements To Save Health Care Providers $660 Million Annually

Reforms to Medicare regulations identified as unnecessary, obsolete, or excessively burdensome on hospitals and other health care providers will save nearly $660 million annually, and $3.2 billion over five years, through a rule issued today by the Centers for Medicare & Medicaid services (CMS). Together with another rule finalized in 2012, this rule is estimated to save heath care providers more than $8 billion over the next five years. This final rule supports President Obama’s unprecedented regulatory retrospective review—or “regulatory lookback”— initiative, where federal agencies are modifying, streamlining or eliminating excessively burdensome and unnecessary regulations on business. “By eliminating stumbling blocks and red tape we can assure that the health care that reaches patients is more timely, that it’s the right treatment for the right patient, and greater efficiency improves patient care across the board,” said CMS Administrator Marilyn Tavenner.
 

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5/5/14 - Per Capita Health Spending for Elderly Grows at Lowest Rate among all Age Groups from 2002-2010

Average annual growth in per capita personal health care spending for the elderly was 4.1 percent from 2002 to 2010, the lowest among any other age groups studied, according to a report by the Centers for Medicare & Medicaid Services’ Office of the Actuary released today and published in the journal Health Affairs. These estimates are a subset of the annually-issued National Health Expenditure (NHE) data, which measures health care spending in the United States. The report examines aggregate and per-capita health spending by gender and major age groups. Personal health care costs consist of all the medical goods and services used to treat or prevent a specific disease or condition in a specific person. As such, the estimates of health spending by age and gender reflect the types of goods and services delivered including hospital care, physician and clinical services, retail prescription drugs, and the programs and payers for that care, such as private health insurance, Medicare, Medicaid.
 

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5/2/14 - CMS Proposes Updates To The Wage Index And Payment Rates For The Medicare Hospice Benefit

On May 2, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule [CMS-1609-P] that would update fiscal year (FY) 2015 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries. The proposed hospice payment rule reflects the ongoing efforts of CMS to protect beneficiary access to patient-centered hospice care. As proposed, hospices would see an estimated 1.3 percent ($230 million) increase in their payments for FY 2015. The hospice payment increase would be the net result of a proposed hospice payment update to the hospice per diem rates of 2 percent (a “hospital market basket” increase of 2.7 percent minus 0.7 percentage point for reductions mandated by law), and a 0.7 percent decrease in payments to hospices due to updated wage data and the sixth year of CMS’ seven-year phase-out of its wage index budget neutrality adjustment factor (BNAF).
 

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5/2/14 - Administration Announces Proposal To Clarify Availability Of Health Insurance Marketplace Coverage To Workers Eligible For COBRA

The Obama administration today announced updates to model notices informing workers of their eligibility to continue health-care coverage through the Consolidated Omnibus Budget Reconciliation Act. The updates make it clear to workers that if they are eligible for COBRA continuation coverage when leaving a job, they may choose to instead purchase coverage through the Health Insurance Marketplace.
“In many cases, workers eligible for COBRA continuation coverage can save significant sums of money by instead purchasing health insurance through the Marketplace,” said Assistant Secretary of Labor for Employee Benefits Security Phyllis C. Borzi. “COBRA continues to play an important role in helping workers and families maintain coverage after a job loss, and it is important that workers know that in some cases there is a Marketplace option as well.”
 

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5/1/14 - Health Insurance Marketplace: Summary Enrollment Report For the Initial Annual Open Enrollment Period

This is the sixth in a series of issue briefs highlighting national and state-level enrollment-related information for the Health Insurance Marketplace (Marketplace). This brief includes data for states that are implementing their own Marketplaces (also known as State-Based Marketplaces or SBMs), and states with Marketplaces that are supported by or fully run by the Department of Health and Human Services (including those run in partnership with states, also known as the Federally-facilitated Marketplace or FFM). This brief also includes updated data on the characteristics of persons who have selected a Marketplace plan (by gender, age, and financial assistance status) and the plans that they have selected (by metal level). Additionally, for the first time, Appendix C of this report includes self-reported race/ethnicity data on persons who have selected a Marketplace plan through the FFM. This report also includes data on other characteristics of people who have selected plans in the FFM and the plans they have selected.
 
 

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5/1/14 - Proposed Fiscal Year 2015 Payment And Policy Changes For Medicare Skilled Nursing Facilities

On May 1, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule [CMS-1605-P] outlining proposed Fiscal Year (FY) 2015 Medicare payment rates for skilled nursing facilities (SNFs). The FY 2015 proposals and other issues discussed in the proposed rule are summarized below. Based on proposed changes contained within this rule, CMS projects that aggregate payments to SNFs will increase by $750 million, or 2.0 percent, from payments in FY 2014, which represents a higher update factor than the 1.3 percent update finalized for SNFs last year. This estimated increase is attributable to 2.4 percent market basket increase, reduced by the 0.4 percentage point multifactor productivity adjustment required by law.
 
 

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5/1/14 - Medicaid & CHIP: March 2014 Monthly Applications, Eligibility Determinations, and Enrollment Report

Today the Centers for Medicare & Medicaid Services (CMS) is announcing more than 4.8 million additional individuals enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) from October 1, 2013 through the end of March 2014, compared to enrollment before the Health Insurance Marketplace opened on October 1, 2013. This announcement comes as part of the release of the sixth in a series of monthly reports on state Medicaid and CHIP data, and represents state Medicaid and CHIP agencies’ eligibility activity for March 2014, which coincided with the last month of the Health Insurance Marketplace Open Enrollment. This report includes state data and analysis on applications to Medicaid and CHIP agencies and the State-Based Marketplaces, eligibility determinations made by these agencies, and state data on total enrollment in the Medicaid and CHIP programs. 
 

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4/9/14 - Historic Release Of Data Gives Consumers Unprecedented Transparency On The Medical Services Physicians Provide And How Much They Are Paid

Today, as part of the Obama administration’s work to make our health care system more transparent, affordable, and accountable, Health and Human Services (HHS) Secretary Kathleen Sebelius announced the release of new, privacy-protected data on services and procedures provided to Medicare beneficiaries by physicians and other health care professionals. The new data also show payment and submitted charges, or bills, for those services and procedures by provider. “Currently, consumers have limited information about how physicians and other health care professionals practice medicine,” said Secretary Sebelius “This data will help fill that gap by offering insight into the Medicare portion of a physician’s practice. The data released today afford researchers, policymakers and the public a new window into health care spending and physician practice patterns.”
 
 

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Rate Announcement Details Plan Payments and Other Program Updates for 2015 

Today, the Centers for Medicare & Medicaid Services (CMS) issued the 2015 rate announcement and final call letter for Medicare Advantage and prescription drug benefit (Part D) programs. The announcement sets a stable path for Medicare Advantage and implements a number of policies that ensure beneficiaries will continue to have access to a wide array of high quality, high value, and low cost options while making certain that plans are providing value to Medicare and taxpayers.
Since the Affordable Care Act was passed in 2010, Medicare Advantage premiums have fallen by 10 percent and enrollment has increased by 38 percent to an all-time high of more than 15 million beneficiaries. Today, nearly 30 percent of Medicare beneficiaries are enrolled in a Medicare Advantage plan. Furthermore, enrollees are benefiting from greater quality as over half of enrollees are now in plans with 4 or more stars, a significant increase from 37 percent of enrollees in such plans in 2013.
 
 
 

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4/3/14 - CMS and Michigan Partner to Coordinate Care for Medicare-Medicaid Enrollees 

On April 3, 2014, the Centers for Medicare & Medicaid Services (CMS) announced that CMS is partnering with the state of Michigan to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience. Under the demonstration, CMS and Michigan will contract with health plans that will provide an integrated set of Medicare and Medicaid benefits to Medicare-Medicaid enrollees in Michigan. Improving the care experience for low-income seniors and people with disabilities who are Medicare-Medicaid enrollees – sometimes referred to as “dual eligibles” – is a priority for CMS.
 

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4/3/14 - HHS Announces Important Medicare Information For People In Same-Sex Marriages 

Today, the Department of Health and Human Services (HHS) announced that the Social Security Administration (SSA) is now able to process requests for Medicare Part A and Part B Special Enrollment Periods, and reductions in Part B and premium Part A late enrollment penalties for certain eligible people in same-sex marriages. This is another step HHS is taking in response to the June 26, 2013 Supreme Court ruling in U.S. v. Windsor, which held section 3 of the Defense of Marriage Act (DOMA) unconstitutional. Because of this ruling, Medicare is no longer prevented by DOMA from recognizing same-sex marriages for determining entitlement to, or eligibility, for Medicare.
 

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4/3/14 - Participation Rises in Medicare Physician Quality Reporting System and Electronic Prescribing Incentive Program 

The Centers for Medicare & Medicaid Services (CMS) today released the 2012 Physician Quality Reporting System and Electronic Prescribing (eRx) Experience Report, showing a significant increase in participation in two key programs that allow eligible professionals to earn incentive payments through voluntary participation. “Our physician and other clinician quality programs reached new records this year with over 430,000 professionals participating in the Physician Quality Reporting System and over 340,000 e-prescribing,” said Patrick Conway, M.D. deputy Administrator for innovation and quality and chief medical officer at CMS. “Clinicians are actively measuring and reporting on quality, and CMS is in the beginning stages of adding this information to the Physician Compare website, which can be viewed by patients. Measuring, transparently sharing, and improving quality performance is key to a better health system.”
 

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3/30/14 - CMS Operational Background On The Health Insurance Marketplace 

As anticipated, in the final weekend of this historic first ever open enrollment period for the Health Insurance Marketplace consumers nationwide are rushing to meet the March 31 deadline to enroll in affordable health coverage. Open enrollment ends tomorrow, March 31, 2014. Consumers should act now to enroll in coverage this year. CMS’ Exchange Operations Center continues real time monitoring of HealthCare.gov systems around the clock to ensure a smooth consumer experience. Over the past week the site has handled record consumer demand well – supporting more than 8.7m visits since last Sunday, with 2 million alone this weekend. The site continues to perform well under the largest sustained period of volume to date with average response times less than 400 milliseconds and an error rate of 0.5%.
 

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3/28/14 - HHS Releases Security Risk Assessment Tool To Help Providers With HIPAA Compliance 

A new security risk assessment (SRA) tool to help guide health care providers in small to medium sized offices conduct risk assessments of their organizations is now available from HHS. The SRA tool is the result of a collaborative effort by the HHS Office of the National Coordinator for Health Information Technology (ONC) and Office for Civil Rights (OCR). The tool is designed to help practices conduct and document a risk assessment in a thorough, organized fashion at their own pace by allowing them to assess the information security risks in their organizations under the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. The application, available for downloading at www.HealthIT.gov/security-risk-assessment also produces a report that can be provided to auditors.
 

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3/21/14 - 7.9 Million People With Medicare Have Saved Over $9.9 Billion On Prescription Drugs 

37.2 million Medicare beneficiaries received free preventive services in 2013 

On the 4th anniversary of the signing of the Affordable Care Act into law, new information released today by the Department of Health and Human Services (HHS) shows that millions of seniors and people with disabilities with Medicare continue to enjoy lower costs on prescription drugs and improved benefits in 2013 thanks to the health care law. Since enactment of the Affordable Care Act, 7.9 million seniors and people with disabilities have saved $9.9 billion on prescription drugs, or an average of $1,265 per beneficiary. In 2013 alone, 4.3 million seniors and people with disabilities saved $3.9 billion, or an average of $911 per beneficiary. These figures are higher than in 2012, when 3.5 million beneficiaries saved $2.5 billion, for an average of $706 per beneficiary.
 

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3/21/14 - Medicare Advantage: Stronger Under The Affordable Care Act 

On the fourth Anniversary of the signing of the Affordable Care Act into Law, the continuing implementation of the health care law’s reforms is making Medicare stronger by improving quality, providing greater protections for beneficiaries, and ensuring better value for taxpayers. 
Since the Affordable Care Act was passed:
• Medicare Advantage premiums have fallen by nearly 10 percent.
• Medicare Advantage enrollment has increased by 38 percent to an all-time high of over15 million beneficiaries, or nearly 30 percent of all Medicare beneficiaries.
• Over half of Medicare Advantage enrollees are now in plans with 4 or more stars.
 

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3/18/14 - Medicare Care Choices Model 

Today, the Centers for Medicare & Medicaid Services launched an initiative to develop innovative payment systems to improve care options for beneficiaries by allowing greater beneficiary access to comfort and rehabilitative care in Medicare and Medicaid. The Medicare Care Choices Model will test improvements to certain Medicare beneficiaries’ quality of life while they are receiving both curative and palliative care. “The Medicare Care Choices Model empowers clinicians and patients with choices. Specifically, clinicians, family members, and caregivers in this model will no longer need to choose between hospice services and curative care,” said Patrick Conway, M.D., deputy administrator for innovation and quality and CMS chief medical officer. “This initiative represents a fundamental change in the way health care is delivered,” said U.S. Sen. Ron Wyden of Oregon, who authored the provisions that established the model.
 

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3/5/14 - HHS 2015 Health Policy Standards Fact Sheet 

The Department of Health and Human Services (HHS) is releasing key standards for health insurers and the Health Insurance Marketplace for 2015, ensuring that consumers have multiple health insurance coverage options, that states continue to have flexibility in their markets, and that issuers and employers have the early guidance and certainty they need to provide affordable health coverage next year. “These policies implement the health care law in a common-sense way by continuing to smooth the transition for consumers and stakeholders and fixing problems wherever the law provides flexibility,” said HHS Secretary Kathleen Sebelius. “This comprehensive guidance will help ensure that consumers, employers and insurers have the information they need to plan for next year and make it easier for families to make decisions to access quality, affordable coverage.”
 

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2/24/14 - CMS Seeks Input on Next Phase of Competitive Bidding Implementation

The Centers for Medicare & Medicaid Services (CMS) today announced that it will seek public comment as it moves toward nationwide implementation of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. The Competitive Bidding Program, established by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Medicare Modernization Act or MMA), has saved more than $400 million for beneficiaries and taxpayers in its first two years of operation and is projected to save an additional $17.2 billion for beneficiaries and $25.8 billion for the Medicare program over the next 10 years. Currently, competitive bidding is in effect for a national mail order program for diabetic testing supplies and for additional items in 100 areas across the country. By 2016, Medicare must implement competitive bidding or competitive bidding pricing for included items to non-competitive bidding areas.
 

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2/21/14 - CMS Proposes 2015 Payment And Policy Updates For Medicare Health And Drug Plans

Greater Quality And Value For Medicare Beneficiaries And Improved Payment Accuracy

Beneficiaries can get greater protections, value, and care in the Medicare services they receive through the proposed policies released today by the Centers for Medicare & Medicaid Services (CMS). The 2015 Advance Notice and draft Call Letter takes important steps to improve payment accuracy for Medicare Advantage (Part C) for 2015. The proposed changes for 2015 are smaller than those implemented in 2014 – a year in which CMS expects to exceed its 5 percent enrollment growth projection in Medicare Advantage for 2014. Since the Affordable Care Act was passed in 2010, Medicare Advantage premiums have fallen by 10 percent and enrollment has increased by nearly 33 percent to an all-time high of approximately 15 million beneficiaries. Today, nearly 30 percent of Medicare beneficiaries are enrolled in a Medicare Advantage plan. Furthermore, enrollees are benefiting from greater quality as over half of enrollees are now in plans with 4 or more stars, a significant increase from 37 percent of enrollees in such plans in 2013.
 

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2/12/14 - Enrollment in the Health Insurance Marketplace increases by 53 percent in January 

27 percent of January enrollees are young adults – up 3 percentage points from the previous reporting period 

Enrollment in the Health Insurance Marketplace continued to rise in January, with a 53 percent increase in overall enrollment over the prior three month reporting period, with young adult enrollment outpacing all other age groups combined, HHS Secretary Kathleen Sebelius announced today. Nearly 3.3 million people enrolled in the Health Insurance Marketplace plans by Feb. 1, 2014 (the end of the fourth reporting period for open enrollment), with January alone accounting for 1.1 million plan selections in state and federal marketplaces. In January, 27 percent of those who selected plans in the Federally-facilitated Marketplace are between the ages of 18 and 34, a three percentage point increase over the figure reported for the previous three month period. Young adult enrollment grew by 65 percent in January, from 489,460 at the end of December to 807,515 as of Feb. 1, while all other age groups combined grew by 55 percent.
 

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1/10/14 - CMS and Maryland Announce Joint Initiative to Modernize Maryland’s Health Care System to Improve Care and Lower Costs 

Today, the Centers for Medicare & Medicaid Services (CMS) and the state of Maryland jointly announced a new initiative to modernize Maryland’s unique all-payer rate-setting system for hospital services aimed at improving patient health and reducing costs. This initiative will replace Maryland’s 36-year-old Medicare waiver to allow the state to adopt new policies that reduce per capita hospital expenditures and improve health outcomes as encouraged by the Affordable Care Act. Under this model, Medicare is estimated to save at least $330 million over the next five years. “Today’s announcement is an encouraging step to ensure that Maryland’s unique health care delivery system can also be aligned with the goals of lowering cost and improving health outcomes for our citizens,” said CMS Administrator Marilyn Tavenner. “This is an example of how CMS works with states to achieve the shared goals of creating a more efficient health system that also delivers improved care for the American people.”
 

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1/10/14 - HHS Strengthens Community Living Options For Older Americans And People With Disabilities 

The Centers for Medicare & Medicaid Services (CMS) issued a final rule today to ensure that Medicaid’s home and community-based services programs provide full access to the benefits of community living and offer services in the most integrated settings. The rule, as part of the Affordable Care Act, supports the Department of Health and Human Services’ Community Living Initiative. The initiative was launched in 2009 to develop and implement innovative strategies to increase opportunities for Americans with disabilities and older adults to enjoy meaningful community living. Under the final rule, Medicaid programs will support home and community-based settings that serve as an alternative to institutional care and that take into account the quality of individuals’ experiences. The final rule includes a transitional period for states to ensure that their programs meet the home and community-based services settings requirements. Technical assistance will also be available for states.
 
 

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1/6/14 - CMS Proposes Program Changes For Medicare Advantage And Prescription Drug Benefit Programs For Contract Year 2015 

On January 6, 2014, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule with comment period that would strengthen protections, improve health care quality and reduce costs for Medicare beneficiaries with private Medicare Advantage (MA) and Part D prescription drug plans in Contract Year (CY) 2015. Among the technical and program changes this rule proposes are new criteria for identifying protected classes of drugs, revisions that promote competition in Part D plans, changes to the regulatory definition of negotiated prices, and changes to ensure that plan choices are meaningful for beneficiaries. This fact sheet discusses the major provisions of the proposed rule. The proposed rule would save $1.3 billion over the five years 2015 – 2019 if finalized.
 

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1/6/14 - CMS Strategy To Combat Medicare Part D Prescription Drug Fraud And Abuse 

Prescription drug abuse is a serious and growing problem nationwide. Unfortunately, the Medicare Part D prescription drug program (Part D) is not immune from the abuses associated with this nationwide epidemic. The Centers for Medicare & Medicaid Services (CMS) takes this problem seriously and is taking steps to protect Medicare beneficiaries and the Medicare Trust fund from the harm and damaging effects associated with prescription drug abuse. CMS’ fraud and abuse strategy for Part D is data driven and focuses on the validation and analysis of Part D claims data (Prescription Drug Event, or PDE, data) that CMS receives from Part D sponsors. We are leveraging CMS’ access to all PDE data and using it to guide our anti-fraud efforts and share the results of our analysis with Part D plan sponsors, law enforcement agencies and pharmacy and physician licensing boards, as appropriate, so this information can assist our joint efforts to combat fraud and abuse.
 

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12/23/13 - More Partnerships Between Doctors And Hospitals Strengthen Coordinated Care For Medicare Beneficiaries 

123 New Accountable Care Organizations Join Program to Improve Care for Medicare Beneficiaries 

Doctors, hospitals and other health care providers have formed 123 new Accountable Care Organizations (ACOs) in Medicare, providing approximately 1.5 million more Medicare beneficiaries with access to high-quality coordinated care across the United States, Health and Human Services Secretary Kathleen Sebelius announced today. Doctors, hospitals and health care providers establish ACOs in order to work together to provide higher-quality coordinated care to their patients, while helping to slow health care cost growth. Since passage of the Affordable Care Act, more than 360 ACOs have been established, serving over 5.3 million Americans with Medicare. Beneficiaries seeing health care providers in ACOs always have the freedom to choose doctors inside or outside of the ACO. ACOs share with Medicare any savings generated from lowering the growth in health care costs when they meet standards for high quality care.
 

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12/20/13 - Emergency Preparedness Standards For Medicare And Medicaid Participating Providers And Suppliers 

The Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to establish consistent emergency preparedness requirements for health care providers participating in Medicare and Medicaid, increase patient safety during emergencies, and establish a more coordinated response to natural and man-made disasters. Over the past several years, the United States has been challenged by several natural and man-made disasters and readiness for public health emergencies has been put on the national agenda. This notice of proposed rulemaking would establish national emergency preparedness requirements to ensure that health care facilities adequately plan for disasters and coordinate with Federal, state, tribal, regional, and local emergency preparedness systems to make sure that providers and suppliers are adequately prepared to meet the needs of patients during disasters and emergency situations.
 

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12/17/13 - More Than 25 Million Original Medicare Beneficiaries Received Free Preventive Services Through November 2013

According to new data released by the Centers for Medicare & Medicaid Services (CMS) today, more than 25.4 million people covered by Original Medicare received at least one preventive service at no cost to them during the first eleven months of 2013, because of the Affordable Care Act. Today’s news comes after last month’s announcement showing that the health care law also saved seniors $8.9 billion on their prescription drugs since the law’s enactment. “Thanks to the Affordable Care Act, millions of seniors have been able to receive important preventive services and screenings such as an annual wellness visit, screening mammograms and colonoscopies, and smoking cessation at no cost to them,” said CMS Administrator Marilyn Tavenner. “Prevention and early detection are so vital to ensure that Americans are healthy and Medicare is healthy. The Affordable Care Act makes Medicare stronger and improves the wellbeing of millions of beneficiaries who have taken advantage of preventive services and wellness visits."
 

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12/12/13 - Taking Steps to Smooth Consumers' Transition into Health Coverage Through the Marketplace 

Today, the Administration is announcing the steps we are taking to immediately make it easier for individuals to purchase health plans through the Marketplace and access the doctors and prescription medications they may need during the transition to new health insurance. We will continue to look for additional steps we can take to make this process easier for consumers.
 

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12/11/13 - Nearly 365,000 Americans Selected Plans In The Health Insurance Marketplace In October And November 

1.9 million customers made it through the process but have not yet selected a plan; an additional 803,077 assessed or determined eligible for Medicaid or CHIP 

Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that nearly 365,000 individuals have selected plans from the state and federal Marketplaces by the end of November. November alone added more than a quarter million enrollees in state and federal Marketplaces. Enrollment in the federal Marketplace in November was more than four times greater than October’s reported federal enrollment number. Since October 1, 1.9 million have made it through another critical step, the eligibility process, by applying and receiving an eligibility determination, but have not yet selected a plan. An additional 803,077 were determined or assessed eligible for Medicaid or the Children’s Health Insurance Program (CHIP) in October and November by the Health Insurance Marketplace.
 

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12/3/13 - A Better HealthCare.gov and Improved Enrollment Experience

Since the launch of the Health Insurance Marketplace the Centers for Medicare & Medicaid Services (CMS) has taken many steps to improve the consumer experience of HealthCare.gov and strengthen enrollment channels for consumers seeking quality, affordable health coverage. As we enter the third month of open enrollment, the steps we’ve taken have put us on a path for millions of Americans to gain new, affordable coverage, and to do so online, by phone, in person, or by mail. CMS enlisted a general contractor, putting in place real-time decision making, and protocols for prioritizing the most important fixes, diagnosing and solving software glitches, and upgrading infrastructure and hardware. The site today is working smoothly for the vast majority of users. Specifically, since October 1, CMS has made measurable improvements to HealthCare.gov, allowing more users to move quickly through the system, from seeking information to completing the application to shopping and enrollment.
 

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12/1/13 - HealthCare.gov Progress and Performance Report 

In mid-October, the Obama administration conducted an assessment of the site HealthCare.gov. The assessment was conducted by experts from across government and private sector. The team identified the problems and necessary fixes and determined that HealthCare.gov was fixable, but only with significant changes to the management approach, and a relentless focus on execution. This report details the substantial progress that has been made to improve and stabilize HealthCare.gov, including hundreds of software fixes and numerous hardware upgrades, so that the system runs smoothly for the vast majority of users. The status of HealthCare.gov in October was marked by an unacceptable user experience. Consumers were experiencing slow response times and frequent, inexplicable error messages. The website experienced frequent outages. For some weeks in the month of October, the site was down an estimated 60 percent of the time. The assessment determined the root causes for these site flaws to be hundreds of software bugs, insufficient hardware and infrastructure. The system monitoring and response mechanisms were not sufficient for identifying issues or bugs or responding to them in real time. Inadequate management oversight and coordination among technical teams prevented real-time decision making and efficient responses to address the issues with the site.
 

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11/26/13 - New Data Shows Affordable Care Act Helped Seniors Save $8.9 Billion On Prescription Drugs Nationwide

Seniors and people with disabilities with Medicare prescription drug plan coverage saved $8.9 billion to date on their prescription drugs thanks to the Affordable Care Act, according to new data released today by the Centers for Medicare & Medicaid Services (CMS). At the same time, these seniors will be free to use more of their Social Security benefit cost of living adjustment on what they choose because the Medicare Part B premium will not increase in 2014, thanks to the health care law’s successful efforts to keep cost growth low. Since the Affordable Care Act was enacted, more than 7.3 million seniors and people with disabilities who reached the donut hole in their Medicare Part D (Medicare Prescription Drug Coverage) plans have saved $8.9 billion on their prescription drugs, an average of $1,209 per person since the program began. During the first 10 months of 2013, nearly 3.4 million people nationwide who reached the coverage gap -- known as the “donut hole” -- this year have saved $2.9 billion, an average of $866 per beneficiary. These figures are higher than at this same point last year, when 2.8 million beneficiaries had saved $1.8 billion for an average of $677 per beneficiary.
 

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11/22/13 - Medicare Finalizes Home Health Payments For 2014

Changes Promote Lower Costs For Beneficiaries And Taxpayers

The Centers for Medicare & Medicaid Services (CMS) today issued the final calendar year (CY) 2014 home health care payment rule. The final policies in this rule better align Medicare payments with home health agencies’ costs providing care, while lowering costs to taxpayers and the 3.5 million Medicare beneficiaries who receive home health services nationwide. The CY 2014 final rule reduces Medicare payments under the Home Health Prospective Payment System (HH PPS) by 1.05 percent. This amount reflects the combined effects of an increase in the home health payment update percentage of 2.3 percent, offset by a decrease of 2.7 percent—the result of rebasing the adjustments required by the Affordable Care Act—and a 0.6 percent decrease due to a refinement of the HH PPS Grouper.
 

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11/22/13 - CMS Finalizes Policy and Payment Rate Changes for End-Stage Renal Disease Facilities in 2014

CMS Strengthens Incentives To Improve Outcomes For Patients With ESRD

The Centers for Medicare & Medicaid Services (CMS) today issued a final rule that updates Medicare policies and payment rates for 2014 for dialysis facilities paid under the End Stage Renal Disease (ESRD) Prospective Payment System (PPS). CMS received extensive public comment on the proposed rule, issued in July. CMS carefully reviewed the comments and has decided to implement a three- to four-year transition for the drug utilization adjustment to the base rate mandated by Congress as part of the American Taxpayer Relief Act, and overall payments for 2014 will see a zero percent change. The rule also finalized a 50 percent increase to the home dialysis training add-on payment adjustment that is made for both peritoneal dialysis and home hemodialysis training treatments.
 

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11/12/13 - CMS Announces New Data Sharing Tool

Virtual Research Data Center Offers Secure, Timely Access To Data At Lower Cost

In a move that advances the Obama administration’s work to make the health care system more transparent and accountable—and to help meet the pressing challenge of health care delivery system reform—the Centers for Medicare & Medicaid Services (CMS) today announced the launch of the CMS Virtual Research Data Center (VRDC) at the White House event Data to Knowledge to Action: Building New Partnerships. Part of the President’s Big Data Research and Development Initiative, which aims to improve researchers’ ability to extract knowledge and insights from large and complex collections of digital data, the VRDC is a secure and efficient means for researchers to virtually access and analyze CMS’s vast store of health care data.
 

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11/7/13 - HHS Awards Affordable Care Act Funds To Expand Access To Care

Funding Supports New Primary Care Sites In 236 Communities To Serve More Than 1.25 Million Additional Patients

The U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius today announced $150 million in awards under the Affordable Care Act to support 236 new health center sites across the country. These investments will help care for approximately 1.25 million additional patients.
Community health centers work to improve access to comprehensive, culturally competent, quality primary health care services. Community health centers play an especially important role in delivering health care services in communities with historically high uninsurance rates. Community health centers are also on the front line of helping uninsured residents enroll in new health insurance options available in the Health Insurance Marketplaces under the Affordable Care Act, through expanded access to Medicaid in many states, and new private health insurance options and tax credits.
 

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10/28/13 - CMS Announces Major Savings For Medicare Beneficiaries

Part B Premiums Will See Zero Growth; Billions Of Dollars Saved In Donut Hole

The Centers for Medicare & Medicaid Services (CMS) today said that health care reform efforts are eliciting significant out-of-pocket savings for Medicare beneficiaries, pointing to zero growth in 2014 Medicare Part B premiums and deductibles, and more than $8 billion in cumulative savings in the prescription drug coverage gap known as the “donut hole.” According to CMS, since the Affordable Care Act provision to close the prescription drug donut hole took effect, more than 7.1 million seniors and people with disabilities who reached the donut hole have saved $8.3 billion on their prescription drugs. In the first nine months of 2013 nearly 2.8 million people nationwide who reached the donut hole this year have saved $2.3 billion, an average of $834 per beneficiary. These figures are higher than at this point last year (2.3 million beneficiaries had saved $1.5 billion for an average of $657 per beneficiary).
 
 

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10/28/13 - CMS Issues New Patient Safety Standards for Community Mental Health Centers

On October 28, 2013, the Centers for Medicare & Medicaid Services (CMS) announced a final rule [CMS 3202-F] establishing a formal set of community mental health center (CMHC) conditions of participation, which are the health and safety regulations Medicare providers must meet to participate in the Medicare program. The new conditions of participation will help raise standards for the 100 CMHCs that participate in Medicare and ensure high quality and safe care for the more than 13,000 Medicare beneficiaries they serve. CMHCs must continue to follow already-existing Medicare program integrity and payment regulations and are still required to comply with applicable provisions of the Public Health Service Act.
 

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10/25/13 - CMS and South Carolina Partner to Coordinate Care for Medicare-Medicaid Enrollees

On October 25, 2013, the Centers for Medicare & Medicaid Services (CMS) announced that the State of South Carolina will partner with CMS to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience. Under the demonstration, known as “Healthy Connections Prime,” South Carolina and CMS will contract with Medicare-Medicaid Plans to coordinate the delivery of covered Medicare and Medicaid services for participating Medicare-Medicaid enrollees. Improving the care experience for low-income seniors and people with disabilities who are Medicare-Medicaid enrollees – sometimes referred to as “dual eligibles” – is a priority for CMS.
 
 

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10/15/13 - Medicare Open Enrollment Begins Today

Seniors Have More High Quality Choices - The Centers for Medicare & Medicaid Services (CMS) announced the start of the Medicare Open Enrollment, which begins today, October 15th and ends December 7th. CMS encourages people with Medicare to review their current health and prescription drug coverage options for 2014. Medicare’s Open Enrollment is not part of the Affordable Care Act’s new Health Insurance Marketplace, and people with Medicare do not need to do anything with Marketplace plans. “Thanks to the Affordable Care Act, Medicare remains strong with more benefits, better choices, and lower costs to beneficiaries,” said CMS Administrator Marilyn Tavenner. “Seniors and people with disabilities have the opportunity to find and compare the best plan for them.” 
 

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10/1/13 - Health Insurance Marketplace Opens, Offers Millions of Americans Quality, Affordable Health Care Coverage

For the first time ever, today all Americans can begin shopping for quality health coverage that is affordable, and not be denied or charged more because they have a pre-existing condition. The Health Insurance Marketplace is a new, simpler way for uninsured Americans and their families to purchase health insurance in one place. Coverage begins as early as January 1, 2014 for people enrolling by December 15, 2013. Today also marks the kick-off of outreach and enrollment activities in communities nationwide. Enrollment events will take place in a variety of local settings including public libraries, churches, festivals, sports events, and community meetings. “For years, the financial, physical or mental health of millions of Americans suffered because they couldn’t afford the care they or their family needed,” said U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius. “But thanks to the health care law, all of that is changing. Today’s launch begins a new day when health care coverage will be more accessible and affordable than ever before.”
 

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5/8/13 - Administration Offers Consumers An Unprecedented Look At Hospital Charges
 

ADMINISTRATION OFFERS CONSUMERS AN UNPRECEDENTED LOOK AT HOSPITAL CHARGES

 

Today, as part of the Obama administration’s work to make our health care system more affordable and accountable, Health and Human Services (HHS) Secretary Kathleen Sebelius announced a three-part initiative that for the first time gives consumers information on what hospitals charge.  New data released today show significant variation across the country and within communities in what hospitals charge for common inpatient services.  Also today, HHS made approximately $87 million available to states to enhance their rate review programs and further health care pricing transparency. In an example of how these data might be used, the Robert Wood Johnson Foundation (RWJF) is planning a data visualization challenge which will further the dissemination of these data to larger audiences.

“Currently, consumers don’t know what a hospital is charging them or their insurance company for a given procedure, like a knee replacement, or how much of a price difference there is at different hospitals, even within the same city,” Secretary Sebelius said. “This data and new data centers will help fill that gap.”

The data posted today on CMS’s website include information comparing the charges for services that may be provided during the 100 most common Medicare inpatient stays.  Hospitals determine what they will charge for items and services provided to patients and these “charges” are the amount the hospital generally bills for an item or service.

"Transformation of the health care delivery system cannot occur without greater price transparency," said Risa Lavizzo-Mourey, M.D., RWJF president and CEO. "While more work lies ahead, the release of these hospital price data will allow us to shine a light on the often vast variations in hospital charges."

These amounts can vary widely.  For example, average inpatient charges for services a hospital may provide in connection with a joint replacement range from a low of $5,300 at a hospital in Ada, Okla., to a high of $223,000 at a hospital in Monterey Park, Calif.

Even within the same geographic area, hospital charges for similar services can vary significantly. For example, average inpatient hospital charges for services that may be provided to treat heart failure range from a low of $21,000 to a high of $46,000 in Denver, Colo., and from a low of $9,000 to a high of $51,000 in Jackson, Miss.

To make these data useful to consumers, HHS is also providing funding to data centers to collect, analyze, and publish health pricing and medical claims reimbursement data.  The data centers’ work helps consumers better understand the comparative price of procedures in a given region or for a specific health insurer or service setting. Businesses and consumers alike can use these data to drive decision-making and reward cost-effective provision of care.

The Affordable Care Act also makes available many tools to help ensure consumers, Medicare, and other payers get the best value for their health care dollar.  Medicare is beginning to pay providers based on the quality they provide rather than just the quantity of services they furnish by implementing new programs such as value-based purchasing and readmissions reductions.  HHS awarded $170 million to states to enhance their rate review programs, and since the passage of the Affordable Care Act, the proportion of insurance company requests for double-digit rate increases fell from 75 percent in 2010 to 14 percent so far in 2013.


 


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5/2/13 - Proposed Fiscal Year 2014 Payment And Policy Changes For Medicare Inpatient Rehabilitation Facilities

PROPOSED FISCAL YEAR 2014 PAYMENT AND POLICY CHANGES FOR MEDICARE INPATIENT REHABILITATION FACILITIES

 

On May 2, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining proposed fiscal year (FY) 2014 Medicare payment policies and rates for the inpatient rehabilitation facilities (IRFs) Prospective Payment System (PPS), as well as updates and changes for the IRF Quality Reporting Program (QRP).  The FY 2014 proposals are summarized below.

Updates to the payment rates under the IRF PPS.  Based on proposed changes contained within this rule, CMS estimates that aggregate payments to IRFs will increase by $150 million, or 2.0 percent.  This estimated increase is attributable to a 1.8 percent payment update, which includes a 2.5 percent market basket increase factor, reduced by a 0.4 percent multi-factor productivity adjustment and an additional 0.3 percentage point reduction as required under the Affordable Care Act. In addition, CMS is proposing an update to the outlier threshold, which would increase IRF PPS payments by an estimated 0.2 percent.

Facility-level adjustment updates.  CMS is proposing updates to the IRF facility-level rural, low-income percentage, and teaching status adjustments, including a new variable in the regression methodology to indicate whether the IRF is a freestanding hospital or a unit of an acute care hospital (or critical access hospital).  The updated methodology enhances the accuracy of the adjustments.  CMS continues to base the adjustments on three years’ worth of data, instead of one year, to improve the stability of the adjustments over time. 

“60-percent rule” Presumptive Methodology Code List Updates In order to be excluded from the hospital inpatient PPS and be paid at the higher IRF PPS rates, an inpatient hospital must demonstrate that at least 60 percent of its patients meet the criteria specified in the regulations, including the need for intensive inpatient rehabilitation services for one or more of the 13 listed conditions, representing a presumptive need for intensive inpatient rehabilitation.  Compliance is demonstrated through either medical review or the “presumptive” method, in which a patient’s diagnosis codes are compared to a “presumptive compliance” list.    For FY 2014, CMS proposes to remove a number of codes from the “presumptive compliance” list because the described conditions would not prove compliance in the absence of additional facts that would have to be pulled from a patient’s medical record.  We have not updated the presumptive methodology policies since 2004, and we welcome comments on this proposal. 

CMS is proposing to revise the list of codes so that it reflects only those codes which can be identified presumptively as both representing the 13 conditions and requiring intensive rehabilitation.  The proposed revisions fall in the following categories:  non-specific diagnosis codes, arthritis diagnosis codes, unilateral upper extremity diagnosis, some congenital anomalies diagnosis codes, other miscellaneous diagnosis codes.

 PROPOSED CHANGES TO THE IRF QUALITY REPORTING PROGRAM:

Prior-Year Quality Measures.  CMS proposes to continue to use the NQF-endorsed National Healthcare Safety Network (NHSN) Catheter-Associated Urinary Tract Infection (CAUTI) outcome measure that we adopted in the FY 2013 OPPS/ASC PPS final rule.  This measure had been updated from a non-endorsed measure we adopted in the FY 2012 IRF PPS final rule.  CMS proposes to adopt the NQF-endorsed version of the “Percent of Residents or Patients with Pressure Ulcers that are New or Worsened (Short Stay)” measure, and to stop using the non-risk adjusted version of this measure. 

New Quality Measures.  In this rule, CMS is proposing to add three new quality measures to the IRF Quality Reporting Program:  NQF #0680:  Percent of Residents or Patients Who Were Assessed and Appropriately Given the Seasonal Influenza Vaccine (Short-Stay); NQF #0431:  Influenza Vaccination Coverage among Healthcare Personnel; and an All-Cause Unplanned Readmission Measure for an Unplanned Readmission Measure for 30 Days Post Discharge from Inpatient Rehabilitation Facilities.

Proposed Changes to the IRF Patient Assessment Instrument.  In order to adopt the NQF-endorsed pressure ulcer measure, which is a risk-adjusted measure, CMS has proposed to revise the IRF-PAI to include the data elements necessary to accommodate risk adjustment.  Also, based on feedback CMS received from wound care experts and IRF providers, CMS is proposing to revise the pressure ulcer question set on the IRF Patient Assessment Instrument, in order to better reflect up-to-date medical practice and better assess patients’ needs.

CMS proposes to add new patient influenza vaccination data elements to the Quality Indicator section of the assessment instrument, and to change the assessment instrument data collection period from a calendar year to a fiscal year.  Data that is reported to the National Health Safety Network (NHSN) would continue data collection based on a calendar year period. 

Proposed Reconsideration and Disaster Waiver Processes for Quality Reporting.  In this rule, CMS is proposing to implement both a reconsideration and disaster waiver process for Quality Reporting. The reconsideration process would allow IRFs to dispute a finding of non-compliance with quality reporting requirements.  The proposed disaster waiver process would allow providers that experienced a natural or man-made disaster to request a waiver of quality reporting requirements under a disaster waiver statute or through the reconsideration process.

The proposed rule went on display at the Office of the Federal Register’s Public Inspection Desk and can be downloaded at:

 www.ofr.gov/inspection.aspx?AspxAutoDetectCookieSupport=1

 It will appear in the May 8, 2013 Federal Register.  Public comments on the proposals will be accepted until July 1, 2013.

 For more information, please see: www.cms.hhs.gov/InpatientRehabFacPPS


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5/1/13 - Proposed Fiscal Year 2014 Payment And Policy Changes For Medicare Skilled Nursing Facilities

PROPOSED FISCAL YEAR 2014 PAYMENT AND POLICY CHANGES FOR MEDICARE SKILLED NURSING FACILITIES

 

On May 1, 2013, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule [CMS-1446-P] outlining proposed Fiscal Year (FY) 2014 Medicare payment rates for skilled nursing facilities (SNFs). The FY2014 proposals are summarized below. Based on proposed changes contained within this rule, CMS estimates that aggregate payments to SNFs will increase by $500 million, or 1.4 percent, from payments in FY 2013. This estimated increase is attributable to the 2.3 percent market basket increase, reduced by the 0.5 percentage point forecast error correction (explained below) and further reduced by the 0.4 percentage point multifactor productivity adjustment required by law. A forecast error correction is applied when the difference between the actual and projected market basket percentage change for a given year (the most recent available FY for which there is final data) exceeds the 0.5 percentage point threshold. While CMS normally reports the forecast error to one significant digit, such reporting makes it difficult to determine if the threshold has been exceeded in those instances where the difference between the projected and actual market basket percentage change rounds to 0.5 percentage point.

 Click to read more

 


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