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CMS & HHS Releases

10/11/2019 - Trump Administration Drives Access to More High-Quality Medicare Plan Choices in 2020

Consistent with the direction of President Trump’s recent Executive Order on Strengthening and Improving Medicare for Our Nation’s Seniors, the Centers for Medicare & Medicaid Services (CMS) announced today that seniors will have access to more high-quality Medicare Advantage and Part D prescription drug plans in 2020. Most people with Medicare will have access to Medicare Advantage and Part D plans with four or more stars in 2020, and approximately 81 percent of Medicare Advantage enrollees with prescription drug coverage will be in plans with four and five stars in 2020, an increase from 69 percent in 2017.
 

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10/7/19 - CY 2021 Medicare-Medicaid Integration and Unified Appeals and Grievance Requirements for Dual Eligible Special Needs Plans (D-SNPs)

The Bipartisan Budget Act (BBA) of 2018 permanently authorized Dual Eligible Special Needs Plans (D-SNPs), strengthened Medicare-Medicaid integration requirements, and directed the establishment of procedures to unify Medicare and Medicaid grievance and appeals procedures to the extent feasible for D-SNPs beginning in 2021. On April 16, 2019, CMS finalized rules (hereafter referred to as the April 2019 final rule) to implement these new statutory provisions.1 This memorandum summarizes the new requirements and provides guidance to D-SNPs on the contract and operational changes needed for each type of D-SNP beginning for Contract Year (CY) 2021.
 

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10/07/2019 - Trump Administration Empowers Nursing Home Patients, Residents, Families, and Caregivers by Enhancing Transparency about Abuse and Neglect

The Trump Administration and the Centers for Medicare & Medicaid Services (CMS) announced a major enhancement of the information available to nursing home residents, families, and caregivers on the Agency’s Nursing Home Compare website. Later this month, CMS will – for the first time – display a consumer alert icon next to nursing homes that have been cited for incidents of abuse, neglect, or exploitation. By making this information accessible and understandable, CMS is empowering consumers to make the right decisions for themselves and their loved ones. This critical move toward improved transparency is yet another way CMS is delivering on the Agency’s five-part approach to ensuring safety and quality in nursing homes, which Administrator Seema Verma announced in April 2019.
 

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9/30/19 - Trump Administration Announces Opportunity for States to Participate in Wellness Program Demonstration Project

Today, the Centers for Medicare & Medicaid Services (CMS), released an informational bulletin announcing the opportunity for 10 states to apply to participate in a wellness program demonstration project for their individual market. This bulletin gives states and issuers new flexibility to design and offer wellness programs for individual market health plans that provide people with direct incentives to make healthier choices and achieve better health outcomes.
 

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9/26/19 - Omnibus Burden Reduction (Conditions of Participation) Final Rule CMS-3346-F

On September 26, 2019, the Centers for Medicare & Medicaid Services (CMS) took action at President Trump’s direction to “cut the red tape,” by reducing unnecessary burden for American’s healthcare providers allowing them to focus on their priority – patients. The Omnibus Burden Reduction (Conditions of Participation) Final Rule removes Medicare regulations identified as unnecessary, obsolete, or excessively burdensome on hospitals and other healthcare providers to reduce inefficiencies and moves the nation closer to a healthcare system that delivers value, high quality care and better outcomes for patients at the lowest possible cost.
 

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9/26/19 - CMS’ Discharge Planning Rule Supports Interoperability and Patient Preferences

The Centers for Medicare & Medicaid Services (CMS) today issued a final rule that empowers patients to make informed decisions about their care as they are discharged from acute care into post-acute care (PAC), a process called “discharge planning.”  In addition to improving quality by improving these care transitions, today’s rule supports CMS’ interoperability efforts by promoting the seamless exchange of patient information between health care settings, and ensuring that a patient’s health care information follows them after discharge from a hospital or PAC provider.
 

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9/10/19 – Remarks by Administrator Seema Verma at the American Hospital Association Regional Policy Board Meeting

America is at an inflection point – a crossroads of two profoundly different paths for the future of our health care.  Our choices are clear, we can choose Medicare for All or a public option, doubling down on government and a one-size-fits-all, socialist approach, with government price setting…threatening our world-class system of innovation and top-notch care, and replacing it with long lines and rationing.
 

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9/5/19 – CMS Announces New Enforcement Authorities to Reduce Criminal Behavior in Medicare, Medicaid, and CHIP

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that strengthens the agency’s ability to stop fraud before it happens by keeping unscrupulous providers out of our federal health insurance programs. This first-of-its-kind action – stopping fraudsters before they get paid – marks a critical step forward in CMS’ longstanding fight to end “pay and chase” in federal healthcare fraud efforts and replace it with smart, effective and proactive measures. Today’s action is part of the Trump Administration’s ongoing effort to safeguard taxpayer dollars and protect the core integrity of the critical Medicare and Medicaid programs that millions rely on.
 

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8/30/19 – CMS Patient Driven Payment Model

In July 2018, CMS finalized a new case-mix classification model, the Patient Driven Payment Model (PDPM), that, effective beginning October 1, 2019, will be used under the Skilled Nursing Facility (SNF) Prospective Payment System (PPS) for classifying SNF patients in a covered Part A stay. This site includes a variety of educational and training resources to assist stakeholders in preparing for PDPM implementation.
 
 

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8/27/19 - Medicare Plan Finder Gets an Upgrade for the First Time in a Decade

For the first time in a decade, the Centers for Medicare & Medicaid Services (CMS) today launched a modernized and redesigned Medicare Plan Finder. The Medicare Plan Finder, the most used tool on Medicare.gov, allows users to shop and compare Medicare Advantage and Part D plans. There are more than 60 million people with Medicare coverage. The updated Medicare Plan Finder also provides them and their caregivers with a personalized experience through a mobile friendly and easy-to-read design that will help them learn about different options and select coverage that best meets their health needs. The new Plan Finder walks users through the Medicare Advantage and Part D enrollment process from start to finish and allows people to view and compare many of the supplemental benefits that Medicare Advantage plans offer.
 

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8/23/19 - Speech: Remarks by Administrator Seema Verma at the CMS National Forum on State Relief and Empowerment Waivers

Remarks by Administrator Seema Verma at the CMS National Forum on State Relief and Empowerment Waivers - (As prepared for delivery – April 23, 2019)
 

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8/15/19 - CMS is Bringing Health Plan Quality Ratings to All Exchanges for the First Time

For the first time, the Centers for Medicare & Medicaid Services (CMS) will require the display of the five-star Quality Rating System (or star ratings) available nationwide for health plans offered on the Health Insurance Exchanges beginning with the 2020 Open Enrollment Period. This step builds on the Trump Administration’s overall commitment to increasing transparency and empowering consumers to make informed healthcare decisions for themselves and their families. 
 

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8/12/19 - CMS Releases Reports Showing Declining Enrollment for the Unsubsidized Population

The Centers for Medicare & Medicaid Services (CMS) released two reports, the Early 2019 Effectuated Enrollment Report and the Trends in Subsidized and Unsubsidized Enrollment Report. These reports provide information on the stability of the individual health insurance market during the 2018 plan year as well as offering preliminary insights into the market for 2019. 
 

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07/31/2019 - FY 2020 Hospice Payment Rate Update Final Rule (CMS-1714-F) 

Today, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1714-F) that demonstrates continued commitment to strengthening Medicare by better aligning the hospice payment rates with the costs of providing care and increasing transparency so patients can make more informed choices.The final rule went on display at the Federal Register’s Public Inspection Desk and will be available under “Special Filings".
 
 

 

 


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07/31/2019 – FY2020 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities (CMS-1710-F)

 
Today, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1718-F] for Fiscal Year (FY) 2020 Medicare payment rates and quality programs for skilled nursing facilities (SNFs). This final rule is part of our continuing efforts to strengthen the Medicare program by better aligning payment rates for these facilities with the costs of providing care and increasing transparency so that patients are able to make informed choices.
 
 

 

 


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07/29/2019 – Trump Administration’s Patients over Paperwork Delivers for Doctors

The Centers for Medicare & Medicaid Services (CMS) is proposing major policy changes to ensure clinicians spend more time providing high-value care for patients instead of filing cumbersome paperwork. As part of CMS’s annual changes to the Medicare Physician Fee Schedule and Quality Payment Program, the agency’s proposals are aimed at reducing burden, recognizing clinicians for the time they spend with patients, removing unnecessary measures and making it easier for them to be on the path towards value-based care. This proposed rule builds on the Trump Administration’s efforts to establish a patient-driven healthcare system that focuses on better health outcomes, and is projected to save 2.3 million hours per year in burden reduction. Public comments on the proposed rules are due by September 27, 2019.

 

 


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07/22/2019 – Keynote Remarks by Administrator Seema Verma at the Better Medicare Alliance (GMA) 2019 Medicare Advantage Summit

Keynote Remarks by Administrator Seema Verma at the Better Medicare Alliance (BMA) 2019 Medicare Advantage Summit (As prepared for delivery – July 22, 2019) Excerpt: “As head of the nation’s largest insurer—Medicare, Medicaid, and the Obamacare exchanges—I see the day to day challenges of government-run programs, and am deeply concerned about the proposals we have seen to upend healthcare in America, particularly Medicare for All and the public option. These proposals are the largest threats to the American healthcare system.”
 
 
 

 


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7/18/19 - CMS Refreshes Medicaid and CHIP Scorecard

Data refresh captures progress in state reporting as Scorecard seeks to improve transparency and accountability regarding health care quality and outcomes 

Today, the Centers for Medicare & Medicaid Services (CMS) refreshed data within the Medicaid and Children’s Health Insurance Program (CHIP) Scorecard, which was released for the first time last year. The targeted data refresh, which comes amidst CMS’s ongoing effort to transform Medicaid by promoting accountability and ensuring program integrity for taxpayers, reflects states’ progress in increasing their reporting of patients’ health outcomes, particularly related to behavioral health. 

 

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Click here to view scorecard

 


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7/17/19 - CMS Releases Final 2015 Medicare Advantage Encounter Data to Researchers

The Centers for Medicare & Medicaid Services (CMS) announced today that final calendar year 2015 Medicare Advantage (MA) encounter data is now available to researchers under a data use agreement. The data provides detailed information about the services received by beneficiaries enrolled in MA plans.  Researchers can use this information to help drive innovation to improve quality of care, lower costs, and to better understand the experience of patients in private health plans. 

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7/15/19 - CMS Proposes to cover Acupuncture for Chronic Low Back Pain for Medicare beneficiaries enrolled in approved studies

 

Proposed decision would add new access to acupuncture for Medicare beneficiaries, as a potential treatment alternative to opioid use, while data is collected on patient outcomes 

 

Today the Centers for Medicare & Medicaid Services (CMS) proposed to cover acupuncture for Medicare patients with chronic low back pain who are enrolled participants either in clinical trials sponsored by the National Institutes of Health (NIH) or in CMS-approved studies.  Currently, acupuncture is non-covered by Medicare.  CMS conducted evidence reviews to inform today’s proposal, and the agency recognizes that the evidence base for acupuncture has grown in recent years, but questions remain. 

 

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7/15/19 - CMS Responds to States and Releases State Relief and Empowerment Waiver Application Resources

Resource tools designed to help states better understand waiver regulations and available resources 

Today, the Centers for Medicare & Medicaid Services (CMS), released new resources to support states with improving their health insurance markets and making coverage more affordable through State Relief and Empowerment Waivers, also known as section 1332 waivers. These new resources include a checklist of required waiver elements and model templates designed to help states better understand and navigate the section 1332 waiver application process.    

 

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7/13/19 - CMS offers broad support for Louisiana with Tropical Storm Barry preparation 
 

The Centers for Medicare & Medicaid Services (CMS) today announced efforts underway to support Louisiana in response to Tropical Storm Barry. On July 12, 2019, Health and Human Services Secretary Alex Azar declared a public health emergency (PHE) in the state. CMS is working to ensure hospitals and other facilities can continue operations and provide access to care despite the effects of Tropical Storm Barry. CMS will be waiving certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements; creating special enrollment opportunities for individuals to access healthcare quickly; and taking steps to ensure dialysis patients obtain critical life-saving services.  

 

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7/11/10 - CMS Launches Comprehensive Effort to Strengthen Monitoring of Medicaid Beneficiary Access for Patients While Relieving Administrative Burden for States

Today the Centers for Medicare & Medicaid Services (CMS) issued a notice of proposed rulemaking to rescind outdated 2015 requirements that impose complex administrative burdens on States without meaningful impact to beneficiaries.  This proposed rule is designed to help streamline federal oversight of access to care requirements that protect Medicaid beneficiaries.  CMS anticipates that the proposed rule would, if finalized, result in overall cost savings for State partners that could be redirected to better serve the needs of their beneficiaries. Concurrent with the proposed rule, CMS is also issuing guidance to States to remind them of their ongoing statutory responsibilities to ensure appropriate access to care for beneficiaries, while also outlining a strategy to develop a more comprehensive approach to monitoring access in Medicaid.

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Click here to view information on the proposed rule


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7/11/19 - Trump Administration Announces Steps to Strengthen Medicare with New Home Infusion Therapy Benefit and New Regulations that Put Patients Over Paperwork

Proposals keep unique needs of patients first, reduce burden on providers, and give patients access to care at home

Today, the Centers for Medicare & Medicaid Services (CMS) proposed significant changes to the Home Health Prospective Payment System (Home Health PPS) that keep the unique needs of patients first, with proposals to implement a new home infusion benefit for beneficiaries, increasing home-based care. This proposed rule also includes updates to payments for home health agencies that would increase Medicare payments to home health agencies (HHAs) by 1.3 percent ($250 million), as well as proposals to protect taxpayer dollars against fraud and abuse.

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6/28/19 – Trump Administration Approves Two New State Medicaid Demonstrations to Treat Substance Use Disorders and Combat National Opioid Epidemic

The Centers for Medicare and Medicaid Services (CMS) announced today that Minnesota and Nebraska have become the 23rd and 24th states who have received approval under the Trump Administration for innovative demonstration projects that increase access to treatment for opioid use disorder (OUD) and other substance use disorders (SUD). 

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6/27/19 – OCR Provides Critical Technical Assistance to Ensure that Individuals with Disabilities have Full and Equal Access to Health Care Services

On March 26, 2019, OCR’s Eastern and Caribbean Region received a call from an advocate for the deaf community, alleging that the Caribbean Medical Center (CMC), a 36-bed, short term, acute care and surgical facility in Fajardo, Puerto Rico, failed to provide appropriate sign language interpretive services to a deaf individual who sought an evaluation for surgical care, which resulted in amputation surgery.  The advocate reported that during the patient’s encounter with CMC staff, CMC staff relied on his family member to relay complex medical information and recommendations to him. CMC then sought a staff social worker who had some knowledge of sign language to attempt to communicate with the patient.  The advocate expressed concern about CMC’s failure to provide the patient with a qualified sign language interpreter.

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6/26/19 – New Frequently Asked Questions on HIPAA and Health Plans Support Care Coordination and Continuity of Care

Today, the Office for Civil Rights at the U.S. Department of Health and Human Services issued a frequently asked question (FAQ) document that clarifies how the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule permits health plans to share protected health information (PHI) in a manner that furthers the HHS Secretary's goal of promoting coordinated care.

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Click here to view FAQs


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6/26/19 – CMS Approves Louisiana State Plan Amendment for Supplemental Rebate Agreements Using a Modified Subscription Model for Hepatitis C Therapies in Medicaid

Today the Centers for Medicare and Medicaid Services (CMS) approved Louisiana’s Medicaid State Plan Amendment (SPA) authorizing the state to negotiate supplemental rebate agreements from prescription drug manufacturers. The SPA permits the state to negotiate supplemental rebate agreements using a new “modified subscription” model that initially focuses on antiviral agents for hepatitis C and that promotes eliminating the hepatitis C virus statewide.

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6/25/19 – CMS Commits $50 Million to Assist States with Substance Use Disorder Treatment and Recovery

Today, the Centers for Medicare & Medicaid Services (CMS) announced a Notice of Funding Opportunity that provides State Medicaid agencies with information to apply for planning grants that will aid in the treatment and recovery of substance use disorders (SUDs), including opioid use disorder (OUD). Fighting the opioid epidemic is one of CMS’s top priorities, and the planning grants are an important step in that effort.

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6/21/19 – CMS Finalizes Updates to Coverage Policy for Transcatheter Aortic Valve Replacement (TAVR)

Today the Centers for Medicare & Medicaid Services (CMS) finalized its decision to update the national coverage policy for Transcatheter Aortic Valve Replacement (TAVR), a procedure for a condition known as “aortic stenosis” in which the heart valve that propels blood from the heart to the rest of the body becomes narrowed. CMS’ decision comes in response to the continued development of this therapy and streamlines key elements of the original national coverage determination, which went into effect in 2012.

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Click here to view the decision


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6/20/19 – CMS Issues Renewed Guidance in Effort to Ensure Medicaid Program Integrity, Signifies Agency’s Commitment to Safeguard Health and Welfare of Medicaid Enrollees

Today, the Centers for Medicare & Medicaid Services (CMS) issued guidance to state Medicaid agencies that outlines the necessary assurances that states should make to ensure that program resources are reserved for those who meet eligibility requirements.

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6/17/19 – CMS Proposes to Update E-Prescribing Standards to Reduce Provider Burden and Expedite Access to Needed Medications

Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would improve patients’ access to needed medications by updating the prior authorization process for Medicare Part D, the program that provides coverage for prescription drugs that beneficiaries pick up at a pharmacy counter. The prior authorization process requires that providers supply additional clinical information to verify that the medication can be covered under the Medicare Part D benefit. The process promotes better clinical decision-making and helps ensure that patients receive medically necessary prescription drugs. The proposed rule would update the Part D e-prescribing program by adopting standards that ensure secure transmissions and expedite prior authorizations.

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Click here to view proposed rule


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6/13/19 – US Departments of Health and Human Services, Labor, and the Treasury Expand Access to Quality, Affordable Health Coverage through Health Reimbursement Arrangements

Today, the U.S. Departments of Health and Human Services, Labor, and the Treasury issued a new policy that will provide hundreds of thousands of employers, including small businesses, a better way to provide health insurance coverage, and millions of American workers more options for health insurance coverage. The Departments issued a final regulation that will expand the use of health reimbursement arrangements (HRAs). When employers have fully adjusted to the rule, it is estimated this expansion of HRAs will benefit approximately 800,000 employers, including small businesses, and more than 11 million employees and family members, including an estimated 800,000 Americans who were previously uninsured.

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Click here to view the final rule


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6/10/19 – Speech: Remarks by Administrator Seema Verma at the American Medical Association Annual Meeting of the House of Delegates

Thank you for that kind introduction…it’s an honor to be here today.  And I would like to start by recognizing the leadership of the AMA, Dr. Sue Bailey, Dr. Barbara McAnenny, Dr. Jack Resneck, and Dr. Jim Madara.  I would also like to acknowledge my HHS colleague, the Surgeon General of the United Sates, Dr. Jerome Adams, who is here today. .  Thank you all for your service and leadership. 

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6/6/19 – CMS Seeks Public Input on Patients over Paperwork Initiative to Further Reduce  Administrative, Regulatory Burden to Lower Healthcare Costs

Today, the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) seeking new ideas from the public on how to continue the progress of the Patients over Paperwork initiative. Since launching in fall 2017, Patients over Paperwork has streamlined regulations to significantly cut the “red tape” that weighs down our healthcare system and takes clinicians away from their primary mission—caring for patients. As of January 2019, CMS estimates that through regulatory reform alone, the healthcare system will save an estimated 40 million hours and $5.7 billion through 2021. These estimated savings come from both final and proposed rules.

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6/5/19 – CMS Statement on Quality of Care in America’s Nursing Home Facilities

Improving safety and quality in America’s nursing homes is one of CMS’ top priorities. CMS welcomes the recent attention on nursing home quality of care that has amplified the important national dialogue. Administrator Verma began working on this issue at the beginning of her tenure in 2017.

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CMS Modernizes Care for Frail, Elderly Individuals Enrolled in PACE  Programs of All-Inclusive Care for the Elderly (PACE)

Final Rule will provide seamless, customized care to meet individual patients’ needs

The Centers for Medicare & Medicaid Services (CMS) finalized a rule today to update and modernize requirements for the Programs of All-Inclusive Care for the Elderly (PACE). The PACE program provides comprehensive medical and social services to certain frail, elderly individuals who qualify for nursing home care but, at the time of enrollment, can still live safely in the community. The policies finalized in this rule reflect the latest standards in caring for PACE participants – many of whom are “dually eligible” for both Medicare and Medicaid – and will strengthen patient protections, improve care coordination, and provide administrative flexibilities and regulatory relief for PACE organizations.

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Click here to view fact sheet


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5/24/19 – New HHS Fact Sheet on Direct Liability of Business Associates under HIPAA 

The HHS Office for Civil Rights (OCR) has issued a new fact sheet that provides a clear compilation of all provisions through which a business associate can be held directly liable for compliance with certain requirements of the HIPAA Privacy, Security, Breach Notification, and Enforcement Rules (“HIPAA Rules”), in accordance with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. In 2013, under the authority granted by the HITECH Act, OCR issued a final rule that, among other things, identified provisions of the HIPAA Rules that apply directly to business associates and for which business associates are directly liable.

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5/24/19 – HHS Proposes to Revise ACA Section 1557 Rule to Enforce Civil Rights in Healthcare, Conform to Law, and Eliminate Billions in Unnecessary Costs

Today, the U.S. Department of Health and Human Services (HHS) proposed regulatory reform related to regulations issued under Section 1557 of the Affordable Care Act (ACA). The proposed rule would maintain vigorous civil rights enforcement on the basis of race, color, national origin, disability, age, and sex, while revising certain provisions of the current Section 1557 rule that a federal court has said is likely unlawful. The proposal also would relieve the American people of approximately $3.6 billion in unnecessary regulatory costs over five years.

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Click here to view the proposed regulation

Click here to view fact sheet


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5/23/19 – Indiana Medical Records Service Pays $100,000 to Settle HIPAA Breach

Medical Informatics Engineering, Inc. (MIE) has paid $100,000 to the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services, and has agreed take corrective action to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules. MIE is an Indiana company that provides software and electronic medical record services to healthcare providers.

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Click here to view resolution agreement


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5/16/19 – CMS Takes Action to Lower Prescription Drug Prices and Increase Transparency

Final rule modernizes the Medicare Advantage & Medicare Part D programs

Today, the Trump Administration finalized improvements to Medicare Advantage and Medicare Part D, which provide seniors with medical and prescription drug coverage through competing private insurance plans. These changes will ensure that patients have greater transparency into the cost of prescription drugs, so patients can compare options and demand value from pharmaceutical companies.

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Click here to view fact sheet on the final rule

Click here to view the final rule


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5/15/19 – CMS Issues New Guidance Addressing Spread Pricing in Medicaid, Ensures Pharmacy Benefit Managers are not Up-Charging Taxpayers

Agency issues guidance for Medicaid Managed Care and CHIP health plans that clarifies how current regulations require “spread pricing” to be accounted in the calculation of Medical Loss Ratios (MLRs)

As part of President Trump’s efforts to lower prescription drug costs in Medicaid, CMS today issued guidance for Medicaid and CHIP managed care plans regarding the calculation of a plan’s Medical Loss Ratio (MLR), which represents the percent of premium revenue that goes toward actual claims and activities that improve healthcare quality, as opposed to administrative costs and profits. 

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Click here to view today's guidance


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5/08/19 – HHS Finalizes Rule Requiring Manufacturers Disclose Drug Prices in TV Ads to Increase Drug Pricing Transparency

On Wednesday, Health and Human Services Secretary Alex Azar announced a final rule from the Centers for Medicare & Medicaid Services (CMS) that will require direct-to-consumer television advertisements for prescription pharmaceuticals covered by Medicare or Medicaid to include the list price – the Wholesale Acquisition Cost – if that price is equal to or greater than $35 for a month’s supply or the usual course of therapy.

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Click here to view final rule

Click here to view fact sheet about final rule


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5/08/19 – Remarks by Administrator Seema Verma at the National Rural Health Association Annual Conference

As prepared for delivery – May 8, 2019

Thank you, Tim for that kind introduction.   I’m excited to be here.  I must admit when I first heard the conference was in Atlanta, my initial reaction was, “Atlanta, that’s not rural!” On a more serious note, I would like to thank the National Rural Health Association and all of you…for your hard work and commitment… to improving healthcare in rural America. Our Administration shares that commitment and our Rethinking Rural Health Initiative is a key strategic focus at CMS.   We apply a rural lens to CMS programs and policies to lower costs, ensure access and improve quality of care for rural Americans.

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5/06/19 – Tennessee diagnostic medical imaging services company pays $3,000,000 to settle breach exposing over 300,000 patients’ protected health information

Touchstone Medical Imaging (“Touchstone”) has agreed to pay $3,000,000 to the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS), and to adopt a corrective action plan to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Security and Breach Notification Rules. Touchstone, based in Franklin, Tennessee, provides diagnostic medical imaging services in Nebraska, Texas, Colorado, Florida, and Arkansas. 

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5/02/19 – HHS Announces Final Conscience Rule Protecting Health Care Entities and Individuals

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) announced today the issuance of the final conscience rule that protects individuals and health care entities from discrimination on the basis of their exercise of conscience in HHS-funded programs. Just as OCR enforces other civil rights, the rule implements full and robust enforcement of approximately 25 provisions passed by Congress protecting longstanding conscience rights in healthcare.  

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Click here to view final rule

Click here to view fact sheet about final rule


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5/02/19 – CMS outlines comprehensive strategy to foster innovation for transformative medical technologies

Today at the Medical Device Manufacturers Association (MDMA) Annual Meeting, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma for the first time walked through the agency’s comprehensive strategy to improve patients’ access to emerging technologies. The future directions outlined in today’s address build on recently released CMS policies to unleash innovation in our healthcare system, reinforcing the Trump Administration’s commitment to encouraging a competitive market that lowers cost and increases the quality of and access to healthcare for all Americans.

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Click here to view Adminstrator Seema Verma's speech


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5/02/19 – CMS Finalizes Rule to Protect Medicaid Provider Payments

Final rule ensures Medicaid providers receive complete payments as required by law

The Centers for Medicare & Medicaid Services (CMS) today released the Medicaid Provider Reassignment Regulation final rule removing a state’s ability to divert portions of Medicaid provider payments to third parties outside of the scope of what the statute allows.

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Click here to view the final rule


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4/30/19 – CMS Proposes to Strengthen Oversight of Accrediting Organizations

Proposed Rule will Increase Transparency of Changes of Ownerships to Safeguard Patient Safety

The Centers for Medicare & Medicaid Services (CMS) today announced a proposed rule that would assure continued quality and safety in healthcare facilities by requiring greater transparency when ownership changes occur at Accrediting Organizations (AOs). The proposed rule establishes a specific process AOs with Medicare-approved accreditation programs must follow if there is a sale, transfer, and/or purchase of assets related to the ownership of an AO, in order to ensure the ongoing effectiveness of approved accreditation programs. Today’s proposal builds on recent work by the agency to strengthen the oversight of AOs and enhance transparency of AO performance.

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Click here to view proposed rule


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4/25/19 – Speech: Remarks by Administrator Seema Verma at the National Association of Accountable Care Organizations (NAACOS) Spring 2019 Conference

As Prepared for Delivery – April 25, 2019

Good morning and thank you for the opportunity to speak today.  I want to start by thanking Clif Gaus for inviting me to be here – and for his partnership.

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4/23/19 – CMS Announces New Opportunities to Test Innovative Integrated Care Models for Dually Eligible Individuals

Letter to State Medicaid Directors Invites States to Partner with CMS to Improve Outcomes for Those Dually Eligible for Medicare and Medicaid

Today, the Centers for Medicare & Medicaid Services (CMS) sent a letter to State Medicaid Directors inviting states to partner with CMS to test innovative approaches to better serve those who are dually eligible for Medicare and Medicaid.  Many of the 12 million dually eligible beneficiaries have complex healthcare issues, including multiple chronic conditions, and often have socioeconomic risk factors that can lead to poor outcomes. CMS and states spend over $300 billion per year on the care of dually eligible individuals, yet still do not achieve acceptable health outcomes. Today’s letter opens new ways to address those complex needs, align incentives, encourage marketplace innovation through the private sector, lower costs, and reduce administrative burdens for dually eligible individuals and the providers who serve them.

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Click here to view State Medicaid Director letter

Click here to view letter from Administrator Verma to the Governors


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4/23/19 – CMS Advances Agenda to Re-Think Rural Health and Unleash Medical Innovation Proposed Changes to Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Would Improve Quality, Expand Access

Today, the Trump Administration proposed changes that build on the progress made over the last two years and further the agency’s priority to transform the healthcare delivery system through competition and innovation while providing patients with better value and results. The proposed rule would update Medicare payment policies for hospitals under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for fiscal year 2020 and advances two key CMS priorities, “Rethinking Rural Health” and “Unleashing Innovation,” by proposing historic changes to the way Medicare pays hospitals.

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Click here to view a fact sheet of the proposed rule

Click here to view the proposed rule


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4/23/19 – Speech: Remarks by Administrator Seema Verma at the CMS National Forum on State Relief and Empowerment Waivers

As Prepared for Delivery – April 23, 2019

It’s truly a pleasure to welcome you to the CMS National Forum on State Relief and Empowerment Waivers. It was just six months ago that President Trump stood where I’m standing today to announce the Administration’s new direction to lower prescription drug prices, making it very clear that in health care, it is not business as usual on his watch.

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

The CMS Primary 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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4/22/19 – Medicare Trustees Report Shows Hospital Insurance Trust Fund Will Deplete in 7 Years

Today, the Medicare Board of Trustees released their annual report for Medicare’s two separate trust funds -- the Hospital Insurance (HI) Trust Fund, which funds Medicare Part A, and the Supplementary Medical Insurance (SMI) Trust Fund, which funds Medicare Part B and D.

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4/19/19 – HHS Announces Next Steps in Advancing Interoperability of Health Information

The U.S. Department of Health and Human Services (HHS) today issued for public comment draft 2 of the Trusted Exchange Framework and Common Agreement (TEFCA) that will support the full, network-to-network exchange of health information nationally. HHS also released a notice of funding opportunity to engage a non-profit, industry-based organization that will advance nationwide interoperability.

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4/18/19 – CMS Issues Final Rule for the 20202 Annual Notice of Benefit and Payment Parameters

Rule Lowers User Fees for First Time, Encourages Use of Lower Cost Generic Drugs , Promotes Market Stability and Consumer Choice

The Centers for Medicare & Medicaid Services (CMS) today released the final annual Notice of Benefit and Payment Parameters for the 2020 benefit year, also known as the 2020 Payment Notice.  The rule reduces user fees for plans offered on HealthCare.gov, and encourages the use of lower-cost generic drugs, while improving market stability and consumer choice. 

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Click here to view final rule

Click here to view fact sheet about rule

Click here to view final 2020 letter to issuers

Click here to view key date charts for the 2019 calendar year


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4/16/19 – Notice of Intent to Apply and Application Cycle Dates for a January 1, 2020 Start Date

ACOs may apply to the Shared Savings Program, for a Skilled Nursing Facility (SNF) 3-Day Rule Waiver, and/or to operate a Beneficiary Incentive Program (BIP). The application cycle follows the process outlined below.

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4/11/19 – Ignite Accelerator Announces 19 Teams Selected for the Eighth Round of the Internal Innovation Training and Incubator Program

The Department of Health and Human Services’ Office of the Chief Technology Officer (CTO) is pleased to announce the teams selected for the eighth round of the HHS IDEA Lab Ignite Accelerator program. The Ignite Accelerator Program stimulates innovative problem-solving across the Department by encouraging and enabling HHS employees at all levels to experiment, test, and validate solutions to key departmental challenges.

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Click here to view list of teams and projects


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4/10/19 – Office of the Assistant Secretary for Health Announces Reorganization

Strengthening Public Health across the Department

Today, the Office of the Assistant Secretary for Health (OASH) announced its new structure aimed at strengthening its public health portfolio with a more streamlined organization poised to provide stronger cross-cutting, science-based, health-promoting leadership on our nation’s most important public health topics.

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4/09/19 – CMS Proposes Expanding Coverage of Ambulatory Blood Pressure Monitoring (ABPM), Proposal Would Increase Access by Expanding Medicare Coverage to Additional Diagnostic Applications

Today the Centers for Medicare & Medicaid Services (CMS) proposed to update 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. Ambulatory monitoring allows blood pressure to be measured over entire days rather than at a single moment in time.  ABPM may measure blood pressure more accurately and lead to the diagnosis of high blood pressure (hypertension) in patients who would not otherwise have been identified as having the condition.

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Click here to view proposed decision


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4/05/19 – CMS Finalizes Policies to Bring Innovative Telehealth Benefit to Medicare Advantage

Final Rule will Strengthen Popular Medicare Private Health Insurance Plans, Expand Telehealth Access for Patients, and Improve Coordination for Dual-Eligible Individuals

Today, the Centers for Medicare & Medicaid Services (CMS) finalized policies that will increase plan choices and benefits, including allowing Medicare Advantage plans to include additional telehealth benefits. These policies continue the agency’s efforts to modernize the Medicare Advantage and Part D programs, unleash innovation and drive competition to improve quality among private Medicare health and drug plans.

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Click here to view a view fact sheet on the CY 2020 Medicare Advantage and Part D Flexibility Final Rule (CMS-4185-F)

Click here to view the final rule


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4/05/19 – Enhanced Direct Enrollment Approved Partner (Updated)

Enhanced direct enrollment (EDE) is a new pathway for consumers to enroll in health insurance coverage through the Federally-facilitated Exchange. This pathway allows CMS to partner with the private sector to provide a more user-friendly and seamless enrollment experience for consumers by allowing them to apply for and enroll in an Exchange plan directly through an approved issuer or web-broker without the need to be redirected to HealthCare.gov or contact the Exchange Call Center.

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Click here to view to view fact sheet

Click here to view FAQs

 

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4/04/19 – Guidance on Unified Rate Review Timeline: Timing of Submission of Rate Filing Justifications for the 2019 Filing Year for Single Risk Pool Coverage Effective on or after January 1, 2020

The Centers for Medicare & Medicaid Services (CMS) is releasing this bulletin establishing the submission deadlines under 45 CFR 154.220 for health insurance issuers to submit Rate Filing Justifications for single risk pool coverage in the individual and small group markets effective on or after January 1, 2020.

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4/01/19 – CMS Finalizes Medicare Advantage and Part D Payment and Policy Updates to Maximize Competition and Coverage

Today, the Centers for Medicare & Medicaid Services (CMS) finalized updates that will take significant steps in continuing the Trump administration’s efforts to increase competition among Medicare Advantage and Part D plans so patients get higher quality care at lower costs. These changes will increase plan choices and benefits, and include important actions to address the opioid crisis.

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Click here to view a fact sheet on the 2020 Rate Announcement and Final Call Letter

Click here to view the 2020 Rate Announcement and Final Call Letter


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3/29/19 – CMS Launches Artificial Intelligence Health Outcomes Challenge

New Competition Seeks Innovative Solutions to Better Predict Healthcare Outcomes

Today, the Centers for Medicare & Medicaid Services (CMS) announced a new competition that aims to accelerate innovative solutions to better predict health outcomes and improve the quality of care for patients. Following President Trump’s executive order to prioritize research and development of America’s artificial intelligence capabilities, the CMS Artificial Intelligence Health Outcomes Challenge will unleash innovative solutions as CMS continues to move the healthcare system towards value.

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Click here to view fact sheet


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3/26/19 – CMS Proposes Updates to Coverage Policy for Transcatheter Aortic Valve Replacement (TAVR)

Proposal Would Expand Access to TAVR in Medicare by Modernizing the Requirements that Providers Must Meet to Perform the Cardiac Procedure Under Coverage with Evidence Development (CED)

Today the Centers for Medicare & Medicaid Services (CMS) proposed to update its national coverage policy for Transcatheter Aortic Valve Replacement (TAVR), a procedure for a condition known as “aortic stenosis” in which the heart valve that propels blood from the heart to the rest of the body becomes narrowed. The current national coverage determination, effective May 1, 2012, established CMS coverage for TAVR under Coverage with Evidence Development (CED). Since the finalization of the 2012 national coverage determination, TAVR programs have been established in over 500 hospitals across the country.

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Click here to view the proposed decision


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3/25/19 – CMS Issues the 2019 Exchange Open Enrollment Period Final Report

Agency Also Extends the Policy Allowing Issuers to Continue “Grandmothered” Plans

The Centers for Medicare & Medicaid Services (CMS) today released the Health Insurance Exchanges 2019 Open Enrollment Report. With the Trump Administration’s focus on making healthcare more affordable, the report confirms another successful open enrollment period coinciding with a stabilization of premiums after years of substantial increases.  Specifically, the report shows plan selections in Exchange plans in the 50 states and D.C. remained steady at 11.4 million. This represents a minimal decline of around 300,000 plan selections from the same time last year. Also, as outlined in the report, average total premiums for plans selected through HealthCare.gov dropped by 1.5 percent from the prior year, the first decline since the Exchanges began operations in 2014. 

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Click here to view the OEP Final Report

Click here to view the guidance on "grandmothered" plans


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3/22/19 – CMS Issues New Guidance on State Implementation of Home and Community Based Services Regulation

Updates Guided by Extensive Stakeholder Process, Focus on Promoting Beneficiary Choice While Maintaining Commitment to Community Living

Today, the Centers for Medicare & Medicaid Services (CMS) issued updated guidance to State Medicaid Directors on implementation of the 2014 Home and Community Based Services (HCBS) regulation.  The HCBS regulation impacts older adults and individuals with disabilities eligible for Medicaid HCBS (including intellectual, developmental and physical disabilities, as well as behavioral health conditions).

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Click here to view FAQs

Click here to view Medicaid.gov HCBS Guidance page


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3/21/19 – FYI 2018 Report to Congress

The Federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office, hereinafter MMCO) was established by statute to improve the coordination between the federal government and states to enhance access to quality services for individuals dually eligible for both Medicare and Medicaid benefits (dually eligible individuals). MMCO is submitting its annual report to Congress.

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3/20/19 – HHS Releases Additional  $487 Million to States, Territories to Expand Access to Effective Opioid Treatment; 2019 SOR Grants will Total $1.4 Billion

Today, the U.S. Department of Health and Human Services (HHS) released an additional $487 million to supplement first-year funding through its State Opioid Response (SOR) grant program. The awards to states and territories are part of HHS’s Five-Point Opioid Strategy and the Trump administration’s tireless drive to combat the opioid crisis.

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3/19/19 – Final 2020 Actuarial Value Calculator Methodology

Under the Essential Health Benefits, Actuarial Value, and Accreditation final rule (EHB Final Rule) that was published in the Federal Register at 78 FR 12834 on February 25, 2013, the Department of Health and Human Services (HHS) generally requires issuers of nongrandfathered health insurance plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges to use an Actuarial Value (AV) Calculator for the purposes of determining levels of coverage. Section 1302(d)(2)(A) of the Patient Protection and Affordable Care Act (PPACA) stipulates that AV be calculated based on the provision of essential health benefits (EHB) to a standard population. The statute groups health plans into four tiers: bronze, with an AV of 60 percent; silver, with an AV of 70 percent; gold, with an AV of 80 percent; and platinum, with an AV of 90 percent.

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3/14/19 – CMS Strengthens Monitoring and Evaluation Expectations for Medicaid 1115 Demonstrations

Tools Set the Stage for More Robust Accountability in Exchange for Policy Design Flexibility

Today, the Centers for Medicare & Medicaid Services (CMS) released new state tools and guidance that provide standard monitoring metrics and recommended research methods geared specifically for section 1115 demonstrations that test innovative approaches to Medicaid eligibility and coverage policies. The Trump Administration has ushered in a new era in Medicaid by restoring balance to the federal and state partnership through more flexibility to address local needs and accountability for program results.  These tools and guidance reflect CMS’ commitment to discern whether reform demonstrations are achieving expected outcomes while testing and evaluating new approaches to improving outcomes for Medicaid beneficiaries. 

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3/14/19 – CMS Updates Drug Dashboards with Prescription Drug Pricing and Spending Data

Dashboards Further the Agency’s Efforts to Increase Price Transparency Throughout the Healthcare System and Create Incentives for Lower List Prices for Prescription Drugs

Today, the Centers for Medicare & Medicaid Services (CMS) updated its Drug Spending Dashboards with data for 2017. This Administration’s version of the drug dashboards, first released in May of last year, adds information on the manufacturers that are responsible for price increases and includes pricing and spending data for thousands more drugs across Medicare Parts B and D and Medicaid.

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3/11/19 – Enhanced Direct Enrollment Approved Partners (Updated)

Enhanced direct enrollment is a new pathway for consumers to enroll in health insurance coverage through the Federally-facilitated Exchange. This pathway allows CMS to partner with the private sector to provide a more user-friendly and seamless enrollment experience for consumers by allowing them to apply for and enroll in an Exchange plan directly through an approved issuer or web-broker without the need to be redirected to HealthCare.gov or contact the Exchange Call Center.

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Click here to view fact sheet

Click here to view frequently asked questions


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3/11/19 – Secretary Azar Statement on President’s Trump’s FY 2020 Budget

Today, Health and Human Services Secretary Alex Azar issued the following statement on President Trump’s Fiscal Year 2020 Budget.

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3/11/19 – Statement on FY2020 Budget Proposal for Ending the HIV Epidemic in America

Today, President Trump proposed $291 million in the FY2020 HHS budget to begin his Administration’s multi-year initiative focused on ending the HIV epidemic in America by 2030. This new initiative aims to reduce new HIV infections by 75 percent in the next 5 years and by 90 percent in the next 10 years, averting more than 250,000 HIV infections in that span.

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Click here to view the HHS Budget in Brief


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3/06/19 – CMS Seeks Recommendations that Allow Americans to Purchase Health Insurance Across State Lines

Administration Continues Efforts to Increase Consumer Choice, Promote Competition and Drive Down Prices in the Health Insurance Market

The Centers for Medicare & Medicaid Services (CMS) issued a request for information (RFI) today that solicits recommendations on how to eliminate regulatory, operational and financial barriers to enhance issuers’ ability to sell health insurance coverage across state lines.  This announcement builds on President Trump’s October 12, 2017 Executive Order, “Promoting Healthcare Choice and Competition Across the United States,” which intends to provide Americans relief from rising premiums by increasing consumer choice and competition. 

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Click here to view the request for information


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3/05/19 – CMS Improving Nursing Home Compare in April 2019

Changes Offer Greater Support to Consumers Looking to Compare Quality of Nursing Homes

Today, the Centers for Medicare & Medicaid Services (CMS) announced updates coming next month to Nursing Home Compare and the Five-Star Quality Rating System to strengthen this tool for consumers to compare quality between nursing homes. The April 2019 updates to Nursing Home Compare are part of a broad range of updates that have been under development for the last several years. The Nursing Home Compare website and Five-Star Quality Rating System were created to help consumers, their families, and caregivers compare nursing homes and identify areas they may want to ask about when looking at nursing home care. The updates further advance CMS’s goals to improve the accuracy and value of the information found on the site and promote quality improvement in nursing home care with the result of better health outcomes for residents.

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Click here to view Nursing Home Compare

 

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3/04/19 – Speech: Remarks by Administrator Seema Verma at the Federation of American Hospitals 2019 Public Policy Conference

As Prepared for Delivery – March 4, 2019

Thank you, Chip (Chip Kahn, President & CEO of the FAH.) I am honored to be with you. As the head of an agency that oversees the care of 130 million Americans, I can tell you that a lot of what I learned about health care, I learned at a hospital.

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2/28/19 – CMS Updates Consumer Resources for Comparing Hospital Quality

New Data Added to CMS Hospital Compare Website

Today, the Centers for Medicare & Medicaid Services (CMS) updated hospital performance data on the Hospital Compare website and on data.medicare.gov to empower patients, families, and stakeholders with important information they need to compare hospitals and make informed healthcare decisions. This data includes specific measures of hospitals’ quality of care, many of which are updated quarterly, and the Overall Hospital Star Ratings, which were last updated in December 2017. The data are collected through CMS’s Hospital Quality Initiative programs. 

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2/22/19 – HHS Releases Final Title X Rule Detailing Family Planning Grant Program

The U.S. Department of Health and Human Services (HHS) today issued the final rule to revise the regulations governing the Title X family planning program, which focuses on serving low-income Americans.

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Click here to view fact sheet

Click here to view final rule


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2/22/19 – Opioid Prescribing Mapping Tool Improved with Medicaid and Rural Data

New Feature Offers Local Communities Greater Transparency into Opioid Prescribing Rates

Today, the Centers for Medicare & Medicaid Services (CMS) released an expanded version of the Opioid Prescribing Mapping Tool, ensuring that CMS and our partners have the most complete and current data needed to effectively address the opioid epidemic across the country. This update to the Opioid Prescribing Mapping Tool further demonstrates the agency’s commitment to opioid data transparency and using data to better inform local prevention and treatment efforts, particularly in rural communities hard hit by the opioid crisis. For the first time, the tool includes data for opioid prescribing in the Medicaid program. Additionally, users can now make geographic comparisons of Medicare Part D opioid prescribing rates over time for urban and rural communities.

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2/20/19 – CMS Health Equity Awards

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02/20/2019 - CMS Releases Updated Data on Geographic Variation in the Medicare Program

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2/19/19 - CMS Launches Podcast to Reach Stakeholders Via Modern Platform

New Podcast “CMS: Beyond the Policy” Offers Regular Episodes that Discuss Agency Updates and Policies in a User-Friendly Medium

Today, the Centers for Medicare & Medicaid Services (CMS) launched “CMS: Beyond the Policy,” a new podcast highlighting updates and changes to policies and programs in an easily accessible and conversational format.  The podcast was created as a new method to explain the agency’s policies and programs.

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2/19/19 – Frequently Asked Questions (FAQs) for Medicare Periodic Data Matching

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2/15/19 - CMS Proposes Coverage with Evidence Development for Chimeric Antigen Receptor (CAR) T-Cell Therapy

Proposed Decision Would Provide Nationwide Consistency in CMS’s Coverage of the Innovative New Cancer Therapy, to Improve Patient Access and Ensure Appropriate Evidence Generation

Today the Centers for Medicare & Medicaid Services (CMS) proposed to cover FDA-approved CAR T-cell therapy, which is a new form of cancer therapy that uses a patient’s own immune system to fight the disease, under “Coverage with Evidence Development” (CED). Currently, there is no national Medicare policy for covering CAR T-cell therapy, so local Medicare Administrative Contractors have discretion over whether to pay for it.

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2/14/19 – HHS Launches Innovative Payment Model with New Treatment and Transport Options to More Appropriately and Effectively Meet Beneficiaries’ Emergency Needs

Supporting Ambulance Triage Options Aims to Allow Beneficiaries to Receive Care at the Right Time and Place

Today, the U.S. Department of Health and Human Services (HHS), Center for Medicare and Medicaid Innovation (Innovation Center), which tests innovative payment and service delivery models to lower costs and improve the quality of care, announced a new payment model for emergency ambulance services that aims to allow Medicare Fee-For-Service (FFS) beneficiaries to receive the most appropriate level of care at the right time and place with the potential for lower out-of-pocket costs. 

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2/14/19 – Emergency Triage, Treat, and Transport (ET3) Model Announced: Voluntary Payment Model that Will Provide Greater Flexibility to Ambulance Teams Addressing 911 Initiated Emergency Calls for Medicare Beneficiaries

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2/12/19 – Speech:  Remarks by Administrator Seema Verma at the 2019 HIMSS Conference

As Prepared for Delivery – February 12, 2019

Thank you Dana [Alexander] for that kind introduction.  As always, it’s a pleasure to join you all at HIMSS.  

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2/11/19 – HHS Proposes New Rules to Improve the Interoperability of Electronic Health Information

New Innovations in Technology Promote Patient Access and Could Make No-Cost Health Data Exchange a Reality for Millions

The U.S. Department of Health and Human Services (HHS) today proposed new rules to support seamless and secure access, exchange, and use of electronic health information. The rules, issued by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), would increase choice and competition while fostering innovation that promotes patient access to and control over their health information. The proposed ONC rule would require that patient electronic access to this electronic health information (EHI) be made available at no cost.

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2/7/19 – OCR Concludes All-Time Record Year for HIPAA Enforcement with $3 Million Cottage Health Settlement

The Office for Civil Rights (OCR) at the U.S Department of Health and Human Services concluded an all-time record year in Health Insurance Portability and Accountability Act (HIPAA) enforcement activity.  In 2018, OCR settled 10 cases and was granted summary judgment in a case before an Administrative Law Judge, together totaling $28.7 million from enforcement actions. This total surpassed the previous record of $23.5 million from 2016 by 22 percent.  In addition, OCR also achieved the single largest individual HIPAA settlement in history of $16 million with Anthem, Inc., representing a nearly three-fold increase over the previous record settlement of $5.5 million in 2016.

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2/05/19 – HHS Secretary Azar Praises President Trump’s Vision for Healthcare

HHS Secretary Alex Azar issued the following statement regarding the President’s State of the Union address.

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Click here to view fact sheet


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1/31/19 – Trump Administration Proposes to Lower Drug Costs by Targeting Backdoor Rebates and Encouraging Direct Discounts to Patients

On Thursday, Health and Human Services Secretary Alex Azar and Inspector General Daniel Levinson proposed a rule to lower prescription drug prices and out-of-pocket costs by encouraging manufacturers to pass discounts directly on to patients and bringing new transparency to prescription drug markets.

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Click here to view fact sheet

 

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1/30/19 – CMS Proposes Medicare Advantage and Part D Payment and Policy Updates to Maximize Competition and Coverage

Today, the Centers for Medicare & Medicaid Services (CMS) released proposed changes that will take significant steps in continuing the agency’s efforts to maximize competition among Medicare Advantage and Part D plans. These proposals will increase plan choices and benefits and include important actions to address the opioid crisis.

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1/29/19 – Speech: Remarks by Administrator Seema Verma at the 2019 CMS Quality Conference

As Prepared for Delivery – January 29, 2019

Thank you, Kate.  And welcome everyone to the CMS quality conference.  Today, we are excited to share the many initiatives CMS is working on.

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1/28/19 – New App Displays What Original Medicare Covers

Newest eMedicare Tool Provides Valuable Information to Mobile Users

Today, the Centers for Medicare & Medicaid Services (CMS) launched a new app that gives consumers a modernized Medicare experience with direct access on a mobile device to some of the most-used content on Medicare.gov.

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1/21/19 – Proposed Key Dates for Calendar Year 2019: QHP Certification in the FFEs; Rate Review; and Risk Adjustment

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1/18/19 – CMS Approves Arizona’s Medicaid Community Engagement Demonstration Amendment

Arizona’s Demonstration Amendment Reflects Commitment to Tribal Consultation

Today, the Centers for Medicare & Medicaid Services (CMS) approved Arizona’s request for an amendment to add a community engagement requirement to its section 1115 Medicaid demonstration project, entitled “Arizona Health Care Cost Containment System (AHCCCS).” Following a thorough tribal consultation at the state and federal level, the Arizona demonstration will be the first to include an exemption to this requirement for members of federally recognized tribes.

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1/18/19 – CMS Announces New Model to Lower Drug Prices in Medicare Part D and Transformative Updates to Existing Model for Medicare Advantage

Models to Provide Seniors with More Benefits while Strengthening Competition among Plans

Today, CMS’s Center for Medicare and Medicaid Innovation (“Innovation Center”), which tests innovative payment and service delivery models to lower costs and improve the quality of care, announced a new payment model and transformative updates to an existing model.  The models are designed to enable Medicare Advantage and Part D plans, which are private plans that provide Medicare beneficiaries with medical and prescription drug coverage, to better serve patients and help them achieve good health.

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Click here to view fact sheet

Click here to view another fact sheet


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1/17/19 – Draft 2020 Actuarial Value Calculator Methodology

Under the Essential Health Benefits, Actuarial Value, and Accreditation final rule (EHB Final Rule) that was published in the Federal Register at 78 FR 12834 on February 25, 2013, the Department of Health and Human Services (HHS) generally requires issuers of nongrandfathered health insurance plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges to use an Actuarial Value (AV) Calculator for the purposes of determining levels of coverage. Section 1302(d)(2)(A) of the Patient Protection Affordable Care Act (PPACA) stipulates that AV be calculated based on the provision of essential health benefits (EHB) to a standard population. The statute groups health plans into four tiers: bronze, with an AV of 60 percent; silver, with an AV of 70 percent; gold, with an AV of 80 percent; and platinum, with an AV of 90 percent.

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1/17/19 – Draft 2020 Letter to Issuers on Federally-Facilitated Exchanges

The Centers for Medicare & Medicaid Services (CMS) is releasing this 2020 Draft Letter to Issuers in the Federally-facilitated Exchanges (2020 Draft Letter). This Letter provides updates on operational and technical guidance for the 2020 plan year for issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally-facilitated Exchanges (FFEs) or the Federally-facilitated Small Business Health Options Programs (FFSHOPs). Issuers should refer to these updates to help them successfully participate in any such Exchange in 2020. Unless otherwise specified, references to the FFEs include the FF-SHOPs.

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1/17/19 – Guidance on Unified Rate Review Timeline: Proposed Timing of Submission of Rate Filing Justifications for the 2019 Filing Year for Single Risk Pool Coverage Effective on or after January 1, 2020

The Centers for Medicare & Medicaid Services (CMS) is releasing this draft bulletin for comment. This bulletin proposes guidance for purposes of establishing the submission deadlines under 45 CFR 154.220 for health insurance issuers to submit Rate Filing Justifications for single risk pool coverage in the individual and small group markets effective on or after January 1, 2020.

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1/17/19 – CMS Issues the Proposed Payment Notice for the 2020 Coverage Year

User Fees for Plans using the Federal Enrollment Platform are Lowered under 2020 Proposal

The Centers for Medicare & Medicaid Services (CMS) today issued the proposed annual Notice of Benefit and Payment Parameters for the 2020 benefit year (proposed 2020 Payment Notice). This rule proposes regulatory and financial parameters applicable to qualified health plans (QHPs) on the Exchanges, plans in the individual, small group, and large group markets, and self-funded group health plans. These changes proposed in the rule would further the Trump Administration’s goals of lowering premiums, enhancing the consumer experience, increasing market stability, reducing regulatory burdens, and protecting taxpayers.

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1/16/19 – CMS Finalizes New Medicare Card Distribution Ahead of Deadline, Accelerating Fight against Medicare Fraud and Abuse

New Medicare Cards Offer Better Identity Protection for Millions of Americans

The Centers for Medicare & Medicaid Services (CMS) recently completed a large-scale effort to provide new Medicare cards without Social Security numbers to people with Medicare. The new cards support the agency’s work to protect personal identity and reduce fraud and abuse. Over the past nine months, CMS sent new cards to more than 61 million people with Medicare across all U.S. states and territories, completing the mailing ahead of schedule. 

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1/03/19 – CMS Releases Final Snapshot for the 2019 Federal Exchange Open Enrollment Period

Final Snapshot Shows Enrollment Remains Steady

Today, the Centers for Medicare & Medicaid Services (CMS) released the final snapshot for the Federal Health Insurance Exchange 2019 Open Enrollment Period, showing steady enrollment with more than 8.4 million consumers enrolled.  By comparison, 8.7 million people had enrolled at the same time last year.  This represents remarkably steady enrollment at a time when a strengthening economy and job market may be reducing the need and demand for subsidized health coverage. 

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Click here to view fact sheet


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12/07/18 – CMS Finalizes Rule on the Risk Adjustment Program for the 2018 Benefit Year

Final Rule Sustains Premiums and Choice in the Exchange

Today, the Centers for Medicare & Medicaid Services (CMS) issued the final rule, “Patient Protection and Affordable Care Act; Methodology for the HHS-operated Permanent Risk Adjustment Program for 2018,” which reissues, with additional explanation, the HHS-operated risk adjustment methodology previously established for the 2018 benefit year. Issuing this rule allows CMS to continue normal operations of the Risk Adjustment program for the 2018 benefit year after a federal judge vacated the use of statewide average premium under the HHS methodology earlier this year.

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Click here to view final rule


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12/06/18 – Secretary Azar Announces Senior Advisor for Drug Pricing Reform 

On Thursday, Health and Human Services Secretary Alex Azar announced that John O’Brien, will serve as Senior Advisor to the Secretary for Drug Pricing Reform. Previously, O’Brien had served as Advisor to the Secretary for health reform and drug pricing, as well as Deputy Assistant Secretary for Health Policy within the Office of the Assistant Secretary for Planning and Evaluation.

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12/06/18 – Weekly Enrollment Snapshot: Week 5

Week 5, Nov 25-Dec 1, 2018

In week five of the 2019 Open Enrollment, 773,250 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.  Consequently, the cumulative totals reported in this snapshot reflect one fewer day than last year.

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12/04/18 – Florida Contractor Physicians’ Group Shares Protected Health Information with Unknown Vendor Without a Business Associate Agreement

Advanced Care Hospitalists PL (ACH) has agreed to pay $500,000 to the Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) and to adopt a substantial corrective action plan to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules. ACH provides contracted internal medicine physicians to hospitals and nursing homes in west central Florida.  ACH provided services to more than 20,000 patients annually and employed between 39 and 46 individuals during the relevant timeframe.

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Click here to view resolution agreement


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12/03/18 – HHS Secretary Azar Declares Public Health Emergency in Alaska Due to Earthquake Damage

Following President Trump’s lead in declaring an emergency in Alaska after the Nov. 30 earthquake, Health and Human Services (HHS) Secretary Alex Azar today declared a public health emergency in Alaska. The declaration triggers other legal authorities that give the HHS Centers for Medicare & Medicaid Services (CMS) beneficiaries, their healthcare providers and suppliers greater flexibility in meeting emergency health needs in the aftermath of the earthquake.

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12/03/18 – Reforming America’s Healthcare System Through Choice and Competition

Dear Mr. President:  On October 12, 2017, through Executive Order 13813, you directed the Administration, to the extent consistent with the law, to facilitate the development and operation of a health care system that provides high-quality care at affordable prices for the American people by promoting choice and competition.  We are pleased to provide you with this report, prepared by the Department of Health and Human Services (HHS) in collaboration with the Departments of the Treasury and Labor, the Federal Trade Commission, and several offices within the White House.  This report describes the influence of state and federal laws, regulations, guidance, and polices on choice and competition in health care markets and identifies actions that states or the Federal Government could take to develop a better functioning health care market.

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Click here to view the report


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12/03/18 – CMS Hospital Value-Based Purchasing Program Results for Fiscal Year 2019

Overview of the Hospital Value-Based Purchasing Program

The Hospital Value-Based Purchasing (VBP) Program adjusts what Medicare pays hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of inpatient care the hospitals provide to patients. For fiscal year (FY) 2019, the law requires that CMS reduce a portion of the base operating Diagnosis-Related Group (DRG) payment amounts otherwise applicable to a participating hospital for each discharge by two percent (2.0%), and that the estimated sum total of these reductions be the amount redistributed to participating hospitals based on their performance on a previously-announced set of quality and cost measures. We estimate that the total amount available for value-based incentive payments in FY 2019 will be approximately $1.9 billion.

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11/29/18 – CMS Administrator Discusses Initiatives to Strengthen Health Insurance Markets

New Policies Empower States and Deliver Flexibility to Make Health Insurance More Affordable and More Accessible for Millions of Unsubsidized Americans

Today, Centers for Medicare & Medicaid Services’ (CMS) Administrator Seema Verma—in an address to the States and Nation Policy Summit of the American Legislative Exchange Council (ALEC) in Washington, D.C.—shared her vision for innovations and reforms that will empower states and provide the flexibility states need to create alternatives to the Affordable Care Act (ACA) that improve health insurance options.

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11/28/18 – HHS Issues Draft Strategy to Reduce Health IT Burden

Public Comment on Draft Encouraged

The U.S. Department of Health and Human Services (HHS) today issued a draft strategy designed to help reduce administrative and regulatory burden on clinicians caused by the use of health information technology (health IT) such as electronic health records (EHRs).

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11/28/18 – Effectuated Enrollment for the First Half of 2018

This report provides average effectuated enrollment and premium data for the Federal and State-Based Exchanges for the first six months of the 2018 plan year. The Centers for Medicare & Medicaid Services (CMS) publishes effectuated enrollment data semiannually to provide a more accurate picture of enrollment trends for the Exchanges than indicated by the number of individuals who simply selected a plan during Open Enrollment. For coverage to be considered effectuated, individuals generally must pay their premium for the given month.

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Click here to view a breakdown of the data by state


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11/28/18 – Weekly Enrollment Snapshot: Week 4

Week 4, Nov 18-24, 2018

In week four of the 2019 Open Enrollment, 500,437 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.  Consequently, the cumulative totals reported in this snapshot reflect one fewer day than last year.

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11/28/18 – Enhanced Direct Enrollment Pathway for Health Insurance Exchange Coverage

The Centers for Medicare & Medicaid Services (CMS) developed a new ‘enhanced’ direct enrollment pathway for consumers to enroll in health insurance coverage through the Federally-facilitated Exchange. This new pathway allows CMS to partner with the private sector to provide a more user-friendly and seamless enrollment experience for consumers by allowing them to apply for and enroll in an Exchange plan directly through an approved issuer or web-broker without the need to be redirected to HealthCare.gov or contact the Exchange Call Center.

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11/27/18 –  Significant Vulnerabilities Exist in the Hospital Wage Index System for Medicare Payments

We observed significant vulnerabilities in the wage index system while conducting 41 reviews of hospitals' wage data, with reports issued from 2004 through 2017. CMS uses area wage indexes to adjust hospital payments annually to reflect local labor prices. CMS calculates each area's wage index based on wage data submitted by acute-care hospitals in their Medicare cost reports. Medicare administrative contractors (MACs) perform limited reviews of these data. Federal law requires that the area wage indexes applied to urban hospitals in a State cannot be lower than the wage index for the rural hospitals in that State. This provision is called the "rural floor." Federal law allows some hospitals to reclassify to areas with higher wage indexes to receive higher payments. "Hold-harmless" provisions in Federal law and CMS policy protect hospitals from having their wage indexes lowered because of the geographic reclassification of other hospitals.

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Click here to view complete report

Click here to view report in brief


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11/26/18 –  Allergy practice pays $125,000 to settle doctor’s disclosure of patient information to a reporter

Allergy Associates of Hartford, P.C. (Allergy Associates), has agreed to pay $125,000 to the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) and to adopt a corrective action plan to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. Allergy Associates is a health care practice that specializes in treating individuals with allergies, and is comprised of three doctors at four locations across Connecticut.

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11/26/18 –  CMS Takes Action to Lower Prescription Drug Costs by Modernizing Medicare

Proposed regulation for Medicare Parts C & D would strengthen negotiations with prescription drug manufacturers to lower costs and increase transparency for patients

Today, the Centers for Medicare & Medicaid Services (CMS) proposed polices for 2020 to strengthen and modernize the Medicare Part C and D programs. The proposal would ensure that Medicare Advantage and Part D plans have more tools to negotiate lower drug prices, and the agency is also considering a policy that would require pharmacy rebates to be passed on to seniors to lower their drug costs at the pharmacy counter.

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11/21/18 –  HHS Activates Aid for Uninsured Californians in Need of Medications Lost in Wildfires

Uninsured citizens in California’s Butte, Los Angeles and Ventura counties are eligible for no-cost replacements of critical medications lost or damaged by the current wildfires in those counties. 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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11/21/18 –  HHS Deputy Secretary Hargan Announces DSIIS Participants and First Meeting Date 

HHS announces private sector leaders to take part in yearlong collaboration

Today, Health and Human Services Deputy Secretary Eric Hargan announced the initial core participants of the Deputy Secretary’s Innovation and Investment Summit (DSIIS) and December 18, 2018 as the date of the first meeting. As announced on September 19, 2018, the DSIIS will be a yearlong collaboration between healthcare innovation and investment professionals and HHS personnel who will meet quarterly to discuss the innovation and investment landscape within the healthcare sector, emerging opportunities, and the government’s role in facilitating more investment and accelerated innovation.
 

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11/20/18 –  CMS Launches Efforts to Improve Patient Safety, Quality of Care in Nursing Homes

Civil Money Penalty Reinvestment Program offers tools, ongoing assistance to nursing home staff

Today, the Centers for Medicare & Medicaid Services (CMS) announced upcoming efforts to support better care and outcomes for nursing home residents under the Civil Money Penalty Reinvestment Program (CMPRP). This three-year initiative aims to improve residents’ quality of life by equipping nursing home staff, administrators and stakeholders with technical tools and assistance to enhance resident care.
 

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11/16/18 –  Artificial Intelligence (AI) Health Outcomes Challenge

It's Time for a Disruption in Healthcare - And CMS Wants to Help Lead It

Welcome to the homepage for the CMS Innovation Center Artificial Intelligence (AI) Health Outcomes Challenge! We are excited about the anticipated launch of the Challenge in 2019.

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11/15/18 –  Remarks by Administrator Seema Verma at the Alliance for Connected Care Telehealth Policy Forum for Health Systems

(As prepared for delivery – November 15, 2018)

Thank you Krista for that kind introduction, and thank you all for joining us today.  It’s a privilege to be here with the Alliance for Connected Care. I’m glad I got to meet with your organization early in my tenure – and I’m particularly happy to continue our conversation on how we can make the promise of connected, coordinated care a reality by building it on a foundation of innovation.
 

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11/14/18 –  CMS strengthens federal support to California residents affected by wildfires

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma today announced that the agency has taken steps and is monitoring conditions in support of California residents displaced and recovering from the wildfires destroying portions of the state. On Nov. 13, 2018, Health and Human Services Secretary Alex Azar declared a public health emergency (PHE) in areas of California retroactive to Nov. 8, 2018. The PHE allows CMS to waive or modify certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements if necessary to provide health services.

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11/14/18 –  Remarks by Administrator Seema Verma at the Biopharma Congress

(As prepared for delivery – November 14, 2018)

Good afternoon, and thank you for having me today.  I want to start by taking a moment to remember Dan Best, who served as Secretary Azar’s Senior Advisor for Drug Pricing Reform.  For those of you who had the privilege of getting to know Dan, you know that he brought tremendous energy and passion to his role.  I am grateful to have had the opportunity to work with him.  We miss Dan, and we are keeping him and his family in our thoughts and prayers.
 

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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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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 - 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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10/1/18 - CMS announces new streamlined user experience for Medicare beneficiaries

Today, the Centers for Medicare & Medicaid Services (CMS) announced a multi-year initiative that will empower patients and update Medicare resources to meet beneficiaries’ expectation of a more personalized customer experience. The eMedicare initiative will modernize the way beneficiaries get information about Medicare and create new ways to help them make the best decisions for themselves and their families.

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9/28/18 - Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

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

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9/27/18 - Remarks by Administrator Seema Verma at the 2018 Medicaid Managed Care Summit

(As prepared for delivery – September 27, 2018)

It is great to be back in front of a room full of professionals dedicated to improving the lives of Medicaid beneficiaries. For me, it’s a little like coming home. I see the faces of the people out working on the front lines, of transforming the American health care system, working to making Medicaid a stronger and more sustainable program.
 
 

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9/21/18 - CMS Awards Funding for Quality Measure Development 

Agency funds new partnerships to develop meaningful measures for the Medicare Quality Payment Program - The Centers for Medicare & Medicaid Services (CMS) today awarded seven organizations new cooperative agreements to partner with the agency in developing, improving, updating, or expanding quality measures for Medicare’s Quality Payment Program (QPP). These cooperative agreements, authorized under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), represent the first funding initiative supporting public-private efforts to develop measures for the Quality Payment Program. Through these partnerships, CMS will work closely with external organizations—such as clinical professional organizations and specialty societies, patient advocacy groups, educational institutions, independent research institutions, and health systems—to develop and implement measures that offer the most promise for improving patient care.

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9/17/18 – SPEECH: Remarks by Administrator Seema Verma about the Burden Reduction Proposed Rule

(As prepared for delivery – September 17, 2018)

Good Morning everyone, and thank you for being here.  Special thanks to Dr. Gregory Argyros, CEO of MedStar Washington Hospital Center, for hosting us at this beautiful hospital, and Rick Pollack, President and CEO from the American Hospital Association for joining us.
 

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9/19/18 – New Medicare Card – Progress Updates

CMS continues to successfully mail newly-designed Medicare cards with the new Medicare number and we are excited to share important progress updates with you.

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9/17/18 – First Comprehensive HHS Data Sharing Report Released

Today, the Office of the Chief Technology Officer published a comprehensive report of the data sharing environment at the U.S. Department of Health & Human Services (HHS). The report explores the challenges of sharing data between HHS agencies: https://www.hhs.gov/idealab/data-insights/
 
 

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9/17/18 – CMS Proposes to Lift Unnecessary Regulations and Ease Burden on Providers 

Proposed rule driven by agency’s Patients Over Paperwork initiative, expected to save U.S. healthcare facilities $1.12 billion per year

Today, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule to relieve burden on healthcare providers by removing unnecessary, obsolete or excessively burdensome Medicare compliance requirements for healthcare facilities. Collectively, these updates would save healthcare providers an estimated $1.12 billion annually. Taking into account policies across rules finalized in 2017 and 2018 as well as this and other proposed rules, savings are estimated at $5.2 billion.
 
 
 

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9/14/18 – SAMHSA’s Annual Mental Health, Substance Use Data Provide Roadmap for Future Action

Today the Substance Abuse and Mental Health Services Administration released the 2017 National Survey on Drug Use and Health (NSDUH). The annual survey comprises highly anticipated data that help provide a statistical context for the country’s opioid crisis and other behavioral health matters.

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9/14/18 – CMS Continues Efforts to help with Hurricane Florence Emergency Response

Agency waivers take effect in Virginia- The Centers for Medicare & Medicaid Services (CMS) today announced efforts underway to support Virginia in response to Hurricane Florence. This week, Health and Human Services Secretary Alex Azar declared a public health emergency in Virginia. With the public health emergency in effect, CMS has taken several actions to provide immediate relief to all those affected by the hurricane along the east coast. The actions 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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9/13/18 – OCR Issues Guidance to Help Ensure Equal Access to Emergency Services and the Appropriate Sharing of Medical Information During Hurricane Florence

As Hurricane Florence makes landfall, the HHS Office for Civil Rights (OCR) and its federal partners remain in close coordination to help ensure that emergency officials effectively address the needs of at-risk populations as part of disaster response.  To this end, emergency responders and officials should consider adopting, as circumstances and resources allow, the following practices to help make sure all segments of the community are served.
 

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9/13/18 – SPEECH: Remarks by Administrator Seema Verma at the FT Pharma Pricing and Value Summit 

(As prepared for delivery – September 13, 2018)

Good afternoon, and thank you for the kind introduction.  It’s a pleasure to be with you today.  I know it’s commonly said that you “save the best for last,” but let’s be real, that’s not always true. Who here watches the closing ceremony of the Olympics? Don’t worry, I’m not going to take up much of your time, I know that I’m standing in between you and cocktail hour, plus you’ve already heard from a handful of great speakers, including my boss Secretary Azar. However there are some things we are doing at CMS that I would like to share with you this afternoon.

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9/13/18 – CMS offers broad support for North Carolina and South Carolina with Hurricane Florence preparation

The Centers for Medicare & Medicaid Services (CMS) today announced efforts underway to support North Carolina and South Carolina in response to Hurricane Florence. Earlier this week, Health and Human Services Secretary Alex Azar declared public health emergencies (PHE) in both states. CMS is working to ensure hospitals and other facilities can continue operations and provide access to care despite the effects of Hurricane Florence. CMS has waived certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements; created special enrollment opportunities for individuals to access healthcare immediately; and taken steps to ensure dialysis patients obtain critical life-saving services.

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9/12/18 – Grants Awarded for the Federally-Facilitated Exchange Navigator Program

Today, the Centers for Medicare & Medicaid Services (CMS) awarded $10 million in Navigator grant awards to 39 organizations who will serve as Navigators in Federally-facilitated Exchange states. These awards will support the work of organizations that offer assistance to consumers navigating, shopping for, and enrolling in health insurance coverage for 2019.

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9/12/18 – CMS Details Additional Process for Providing Relief for Consumers from Individual Mandate

Today’s announcement provides American consumers with the additional option to claim a hardship exemption from the individual mandate

Today, the Centers for Medicare & Medicaid Services (CMS) announced a new, more streamlined way for consumers to claim a hardship exemption from the tax penalty imposed for not maintaining health coverage for 2018 on their federal income tax returns, making it easier for taxpayers across the nation to claim their exemption. Of the $3 billion the Internal Revenue Service (IRS) collected from taxpayers in individual mandate penalties in 2015, over 5 million households, or nearly 80 percent, earned $50,000 a year or less.  The individual mandate penalty is yet another example of how the ACA hurts low and middle income Americans the most, and today’s action reflects our commitment to minimize the impact of Obamacare’s failures.
 
 

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9/11/18 – HHS Awards $21 Million to Support Health Center Participation in NIH’s All of Us Research Program

Today, the Centers for Medicare & Medicaid Services (CMS) announced a new, more streamlined way for consumers to claim a hardship exemption from the tax penalty imposed for not maintaining health coverage for 2018 on their federal income tax returns, making it easier for taxpayers across the nation to claim their exemption. Of the $3 billion the Internal Revenue Service (IRS) collected from taxpayers in individual mandate penalties in 2015, over 5 million households, or nearly 80 percent, earned $50,000 a year or less.  The individual mandate penalty is yet another example of how the ACA hurts low and middle income Americans the most, and today’s action reflects our commitment to minimize the impact of Obamacare’s failures.

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9/4/18 – Data Support Considerations in Medicaid Accountable Care Organization Programs

Medicaid accountable care organizations (ACOs) need data on their attributed populations to successfully improve health outcomes and manage patients’ total cost of care. This includes data on members’ health status; emergency department and inpatient utilization; and risk scores, ideally accounting for social risk factors — such as homelessness, past incarceration, and child protection involvement. State Medicaid agencies have developed a number of approaches to provide data to organizations participating in Medicaid ACO programs. 

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9/4/18 – Tools for Supporting Social Service and Health Care Partnerships to Address Social Determinants of Health

Health care and community-based organizations (CBOs) across the country are increasingly working together to better address the root causes of poor health among low-income and vulnerable populations. Through support from Kaiser Permanente Community Health, the Center for Health Care Strategies and Nonprofit Finance Fund collaborated to identify new strategies and resources to facilitate effective CBO-health care partnerships, building on work done under the Partnership for Healthy Outcomes project made possible by the Robert Wood Johnson Foundation. 

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8/29/18 – Indication-Based Formulary Design Beginning in Contract Year (CY) 2020

CMS Action Will Ensure Medicare Enrollees Receive Individualized Drug Treatment Targeted to Meet Their Needs

Today, the Centers for Medicare & Medicaid Services (CMS) announced additional flexibilities in the Medicare Part D program to allow for innovative formulary design as a valuable approach to expand drug choices and address the challenge of high drug costs for seniors and government programs. As part of the agency’s ongoing efforts to deliver on President Trump’s promises outlined in the HHS drug pricing blueprint, CMS will provide Medicare Part D plan sponsors with additional formulary management tools that will put patients’ needs first by facilitating access to broader formularies while also enabling sponsors to negotiate lower drug prices. Medicare Part D plan sponsors will have the choice of implementing indication-based formulary design beginning in CY 2020.

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Click here to view the Next Generation ACO Model's First Evaluation Report

Click here to view "Findings at a Glance" document


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8/28/18 – Medicaid Directors Selected for 2019 Class of the Medicaid Leadership Institute

National Initiative Enhances the Leadership Capacity of Medicaid Directors to Deliver High-Quality, Cost-Effective Health Care Services

The Center for Health Care Strategies (CHCS) today announced that Medicaid directors from six states — Idaho, Louisiana, Oklahoma, Rhode Island, Texas, and Virginia — have been competitively selected to participate as fellows in the 2019 class of the Medicaid Leadership Institute. CHCS directs this Robert Wood Johnson Foundation-funded initiative, which offers a unique opportunity for Medicaid directors from states across the country to develop the skills and expertise necessary to improve their Medicaid programs and impact key health outcomes in an ever-changing policy and financing environment.

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8/27/18 – ACOs Taking Risk in Innovative Payment Model Generate Savings for Patients and Taxpayers

Today, the Centers for Medicare & Medicaid Services (CMS) released an evaluation report for the first performance year of the Innovation Center’s Next Generation Accountable Care Organization (ACO) Model showing promising early results. Results demonstrated the positive outcomes in terms of quality and costs when providers are responsible for managing to a budget.  For the 2016 performance year, the Next Generation ACO Model generated net savings to Medicare of approximately $62 million while maintaining quality of care for beneficiaries. As part of CMS’s recent “Pathways to Success” proposal, CMS proposed taking many principles from the Next Generation ACO Model and adopting them more broadly for ACOs in the Medicare Shared Savings Program.

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8/23/18 – CMS Announces New Model to Address Impact of the Opioid Crisis for Children

Model to Focus on Children in Medicaid and CHIP Who Have Physical and Behavioral Health Needs, Including Substance Abuse

Today, the Centers for Medicare & Medicaid Services (CMS) announced a new Innovation Center payment and service delivery model as part of a multi-pronged strategy to combat the nation’s opioid crisis. The Integrated Care for Kids (InCK) Model aims to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid and the Children’s Health Insurance Program (CHIP) through prevention, early identification, and treatment of behavioral and physical health needs. The model will empower states and local providers to better address these needs through care integration across all types of healthcare providers.

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Click here to view a fact sheet on the InCK Model


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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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8/22/18 – 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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8/20/18 – 100 Days of Action on the President’s American Patients First Blueprint

“The President’s blueprint for lower drug prices is working, drug prices are coming down, and American patients are going to see the savings in their pocketbook.” — Secretary Alex Azar

Tomorrow, August 21, marks 100 days since the release of President Trump’s American Patients First Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs - PDF. In this short period of time, an unprecedented number of actions have been taken toward structurally rebuilding this entire segment of the economy to lead to enduring lower prices that are sustainable, support innovation, and put American patients first.

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Click here to view the full report

 


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8/20/18 – CMS Awards $8.6 Million in Funding to States to Help Stabilize Markets

The State Flexibility Grant Awards will Help States Strengthen the Private Health Insurance Market Through Innovative Measures

Today, the Centers for Medicare & Medicaid Services (CMS) awarded $8.6 million in funding to 30 states and the District of Columbia to provide State insurance regulators with the opportunity to enhance States’ ability to strengthen their respective health insurance markets through innovative measures that support market reforms and consumer protections under the Patient Protection and Affordable Care Act (PPACA). 

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Click here to see the funding allocated to each state


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8/16/18 – HHS Secretary Azar Meets with Specialty and Patient Groups Regarding Drug Pricing

On Wednesday, Secretary Alex Azar met with representatives of specialty-physician and patient groups to discuss the Trump Administration’s efforts to offer new tools for Medicare Advantage plans to negotiate lower drug prices for patients.

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8/16/18 – CMS Streamlines Medicaid Review Process, Achieves Significant Reduction in Approval Times

Today, the Centers for Medicare and Medicaid Services (CMS) announced significant improvements in managing the Medicaid program in partnership with states.  Identified early as a priority for both the Trump Administration and the National Association of Medicaid Director’s (NAMD), CMS has implemented changes resulting in faster processing of state requests to make program or benefit changes to their Medicaid program through the state plan amendment (SPA) and section 1915 waiver review process.

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8/15/18 – HHS Awards $125 Million to Support Community Health Center Quality Improvement

Today, the U.S. Department of Health and Human Services (HHS) announced $125 million in Quality Improvement grant awards to 1,352 community health centers across all U.S. states, territories and the District of Columbia. Funded by the Health Resources and Services Administration (HRSA), health centers will use these funds to continue to improve quality, efficiency, and the effectiveness of healthcare delivery in the communities they serve. This announcement comes during National Health Center Week, the annual celebration that highlights the critical role community health centers play in providing high-quality, affordable, primary healthcare. 

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8/09/18 – Proposed Pathways to Success for the Medicare Shared Savings Program

On August 9, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would set a new direction for the Medicare Shared Savings Program (Shared Savings Program).  Referred to as “Pathways to Success,” this proposed new direction for the Shared Savings Program would redesign the participation options available under the program to encourage Accountable Care Organizations (ACOs) to transition to two-sided models (in which they may share in savings and are accountable for repaying shared losses), increase savings for the Trust Funds and mitigate losses, reduce gaming opportunity and increase program integrity, and promote regulatory flexibility and free-market principles. This proposed rule would also strengthen beneficiary engagement, ensure rigorous benchmarking, and help improve care for Medicare beneficiaries, with an emphasis on combatting opioid addiction and expanding the use of interoperable electronic health record technology among ACO providers/suppliers.  The proposed policies also include changes to address the additional tools and flexibilities for ACOs established by the Bipartisan Budget Act of 2018 (BBA of 2018), specifically in the areas of new beneficiary incentives, telehealth services, choice of beneficiary assignment methodology, and voluntary alignment refinements.

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8/08/18 – CMS- 9919-P: Patient Protection and Affordable Care Act; Methodology for the HHS-operated Permanent Risk Adjustment Program for 2018 Proposed Rule 

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8/08/18 – CMS Issues Proposed Additional Rule to Address Risk Adjustment Program for the 2018 Benefit Year

Proposed Rule Seeks to Provide Certainty and Sustain Consumer Choices and Affordability - Today’s notice of proposed rulemaking, “Patient Protection and Affordable Care Act; Methodology for the HHS-operated Permanent Risk Adjustment Program for 2018 Proposed Rule,” proposes to adopt the risk adjustment methodology that HHS previously established for the 2018 benefit year which uses the statewide average premium in the payment transfer formula.

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8/7/18 – Trump Administration Gives Medicare New Tools to Negotiate Lower Drug Prices for Patients

Today, delivering on proposals in President Trump’s American Patients First blueprint, HHS announced that Medicare Advantage plans will be able to use tools employed by private-sector insurers to negotiate lower prescription drug prices for patients.

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8/07/18 – CMS Empowers Patients with More Choices and Takes Action to Lower Drug Prices

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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8/6/18 – SPEECH: Remarks by Administrator Seema Verma at the ONC Interoperability Forum in Washington, DC

(As prepared for delivery – August 6, 2018)

Thank you Dr. Rucker. It’s been a pleasure to partner with an innovative medical leader on the path to achieving true interoperability.

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8/2/18 – HHS Announces Grantees for Title X Family Planning Program Services

Today, the U.S. Department of Health and Human Services (HHS) Office of Population Affairs announced the 96 grantees to whom HHS intends to award Title X family planning service grants for fiscal year 2018.  Twelve of the intended awards go to grantees who are new to Title X.

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Click here to view a full list of intended grantees by area served


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8/2/18 – CMS Finalizes Changes to Empower Patients and Reduce Administrative Burden 

Changes in the Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final Rule Will Advance Price Transparency and Electronic Health Records

Today, the Centers for Medicare & Medicaid Services (CMS) finalized a rule to empower patients and advance the White House MyHealthEData initiative and the CMS Patients Over Paperwork initiative. This final rule and others issued earlier this week will help improve access to hospital price information, give patients greater access to their health information and allow clinicians to spend more time with their patients.

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8/2/18 – Fiscal Year (FY) 2019 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Prospective Payment System Final Rule CMS-1694-F

On August 2, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule to help empower patients through better access to hospital price information, improve the use of electronic health records, and make it easier for providers to spend time with their patients. The final rule issued today updates Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS).

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8/1/18 – CMS-9924-F: Short-Term, Limited-Duration Insurance

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8/1/18 – HHS News Release: Trump Administration Delivers on Promise of More Affordable Health Insurance Options

HHS Final Rule on Short-Term, Limited-Duration Insurance Brings More Flexibility and Choices to Consumers - On Wednesday, the departments of Health and Human Services, Labor and the Treasury issued a final rule to help Americans struggling to afford health coverage find new, more affordable options. The rule allows for the sale and renewal of short-term, limited-duration plans that cover longer periods than the previous maximum period of less than three months. Such coverage can now cover an initial period of less than 12 months, and, taking into account any extensions, a maximum duration of no longer than 36 months in total. This action will help increase choices for Americans faced with escalating premiums and dwindling options in the individual insurance market. 

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Click here to view the final rule

Click here to view fact sheet


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8/1/18 – CMS Finalizes Updates to the Wage Index and Payment Rates for the Medicare Hospice Benefit for FY 2019

On August 1, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1692-F) that updates fiscal year (FY) 2019 Medicare payment rates and the wage index for hospices serving Medicare beneficiaries. In addition, this final rule updates the hospice quality reporting requirements.

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7/31/18 – Medicare Issues Fiscal Year 2019 Payment & Policy Changes for Skilled Nursing Facilities

On July 31, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1696-F] outlining Fiscal Year (FY) 2019 Medicare payment updates and quality program changes for skilled nursing facilities (SNFs).

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7/31/18 – Medicare Part D Premiums Continue to Decline in 2019

Today, the Centers for Medicare & Medicaid Services (CMS) announced that, for the second year in a row, the average basic premium for a Medicare Part D prescription drug plan in 2019 is projected to decline. At a time when health insurance premiums are rising across-the-board, basic Part D premiums are expected to fall from $33.59 this year to $32.50 next year.

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7/25/18 - CMS Empowers Patients and Ensures Site-Neutral Payment in Proposed Rule

Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) proposed rule advances CMS commitment to increasing transparency and lowering drug prices

Today, the Centers for Medicare & Medicaid Services (CMS) took steps to strengthen the Medicare program with proposed changes to ensure that seniors can access the care they need at the site of care that they choose. In addition, as part of the agency’s ongoing efforts to lower drug prices as outlined in the President’s Blueprint, CMS included a Request for Information on how best to develop a model leveraging authority provided to the agency under the Competitive Acquisition Program (CAP) to strengthen negotiations for prescription drugs
 
 

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07/24/18 - CMS Adopts the Methodology for the Permanent Risk Adjustment Program under the Patient Protection and Affordable Care Act for the 2017 Benefit Year

Final rule addresses the collection of risk adjustment charges and making of payments for the 2017 benefit year

Today, the Centers for Medicare and Medicaid Services (CMS) posted a final rule that reissues, with additional explanation, the risk adjustment methodology that CMS previously established for transfers related to the 2017 benefit year. This important step fills a void created by a federal district court’s vacating of the previously issued methodology, and enables the agency to resume the CMS-operated risk adjustment program in the individual and small group markets. 
 
 

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07/24/18 - CMS Welcomes New Leadership Team, Makes Additional Staffing Announcement

Today, the Centers for Medicare & Medicaid Services (CMS) announced several new additions to the agency’s leadership team, as well as changes to the portfolios of senior staff in the Office of the Administrator. Since arriving in March 2017, Administrator Seema Verma has been committed to building an experienced and well-qualified team with a broad range of backgrounds and expertise. Today, Administrator Verma welcomes Paul Mango as CMS’s Chief Principal Deputy Administrator and Chief of Staff and Chris Traylor as the agency’s Deputy Administrator for Strategic Initiatives. In addition, the Administrator promoted Deputy Chief of Staff Brady Brookes to Deputy Administrator and Deputy Chief of Staff. 
 

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07/23/18 - New Medicare Card Mailing Update – Wave 4 Begins, Wave 2 Ends

CMS started mailing new Medicare cards to people with Medicare who live in Wave 4 states: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, and Vermont. We continue to mail new cards to people who live in Wave 3 states, as well as nationwide to people who are new to Medicare.
 

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07/17/18 - A Letter to Doctors from CMS Administrator Seema Verma

Dear Doctor,
 
Thank you for the difference you make in your patients’ lives. Many of our nation’s best and brightest students go into medicine – the competition is intense for every spot. To become a practicing physician, you had to put in years of training, hours of studying, and long days and nights on the wards.
 

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7/12/18 – CMS Proposes Historic Changes to Modernize Medicare and Restore the Doctor-Patient Relationship

Proposed Changes to the Medicare Physicians Fee Schedule and Quality Payment Program Would Streamline Clinician Billing and Expand Access to High-Quality Care

Today, the Centers for Medicare & Medicaid Services (CMS) proposed historic changes that would increase the amount of time that doctors and other clinicians can spend with their patients by reducing the burden of paperwork that clinicians face when billing Medicare. The proposed rules would fundamentally improve the nation’s healthcare system and help restore the doctor-patient relationship by empowering clinicians to use their electronic health records (EHRs) to document clinically meaningful information, instead of information that is only for billing purposes.

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7/12/18 – Proposed Policy, Payment, and Quality Provisions Changes to the Medicare Physician Fee Schedule for the Calendar Year 2019

On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.

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7/12/18 – The Medicare Advantage Qualifying Payment Arrangement Incentive Demonstration

The Centers for Medicare & Medicaid Services (CMS) is announcing the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration. The MAQI Demonstration will be tested under the authority of Section 402 of the Social Security Amendments of 1967 (as amended).

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07/10/18 – CMS Proposes Rule Change to Protect Medicaid Provider Payments

Today, the Centers for Medicare & Medicaid Services (CMS) proposed changes to the Medicaid Provider Reassignment regulation that would eliminate state’s ability to divert Medicaid payments away from providers, with the exception of payment arrangements explicitly authorized by statute. This proposed regulatory change is designed to ensure that taxpayer dollars dedicated to providing healthcare services for low-income vulnerable Americans are not siphoned away for other purposes.

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07/09/18 – Summary Report on Permanent Risk Adjustment Transfers for the 2017 Benefit Year

On February 28, 2018, the United States District Court for the District of New Mexico issued a decision invalidating CMS’s use of the statewide average premium in the risk adjustment transfer formula for the 2014 – 2018 benefit years pending further explanation of CMS’s reasons for operating the risk adjustment program in a budget neutral manner in those years. The government has moved the court to reconsider its decision and CMS is currently awaiting the court’s ruling.

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07/07/18 – United States District Court Ruling Puts Risk Adjustment On Hold

On February 28, 2018, the United States District Court for the District of New Mexico issued a decision invalidating use of the statewide average premium by the Center for Medicare & Medicaid Services (CMS) in the risk adjustment transfer formula established under section 1343 of the Patient Protection and Affordable Care Act for the 2014 – 2018 benefit years, pending further explanation of CMS’s reasons for operating the program in a budget neutral manner in those years. The ruling prevents CMS from making further collections or payments under the risk adjustment program, including amounts for the 2017 benefit year, until the litigation is resolved.

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07/06/18 – Guidance on Annual Eligibility Redetermination and Re-enrollment for Exchange Coverage for 2019 and Later Years

45 CFR 155.335(a)(2) provides that a Health Insurance Exchange has three options to redetermine eligibility for enrollment in a qualified health plan (QHP) through the Exchange and insurance affordability programs on an annual basis. 45 CFR 155.335(a)(2)(ii) provides that one of these options is a set of alternative procedures specified by the Secretary for the applicable benefit year.

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07/02/18 – Centers for Medicare and Medicaid Services Releases Reports on the Performance of the Exchanges and Individual Health Insurance Market 

Reports show individual market erosion and increasing taxpayer liability

Today, the Centers for Medicare and Medicaid Services (CMS) released three reports that provide important information on the current condition of the Federal and State-based Exchanges and state individual health insurance markets. Taken together, these reports show that state markets are increasingly failing to cover people who do not qualify for federal subsidies even as the Exchanges remain relatively stable. Steps taken by CMS in 2017, as the reports show, improved the performance of the Exchanges and began addressing market stability issues. However, serious problems persist. Rising premiums have left unsubsidized people with poor health coverage options and dramatically increased the federal cost of premium subsidies.

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07/02/18 – CMS Takes Action to Modernize Medicare Home Health

CMS Action for Home Health Agencies Puts Value Over Volume and Advances MyHealthEData Initiative- Today, the Centers for Medicare & Medicaid Services (CMS) proposed significant changes to the Home Health Prospective Payment System to strengthen and modernize Medicare, drive value, and focus on individual patient needs rather than volume of care. Specifically, CMS is proposing changes to improve access to solutions via remote patient monitoring technology, and to update the payment model for home health care.

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Click here to view fact sheet


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06/29/18 – CMS Advances Demonstration to Waive MIPS Requirements for Clinicians in Certain At-Risk Medicare Advantage Plans

Today, the Centers for Medicare & Medicaid Services (CMS) is advancing the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration, which, when approved and adopted, would waive Merit-Based Incentive Payment System (MIPS) requirements for clinicians who participate sufficiently in certain Medicare Advantage plans that involve taking on risk. CMS seeks public comment on the information collection burdens associated with the demonstration, which is under consideration for formal approval.

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06/27/18 – CMS Approves State Proposal to Advance Specific Medicaid Value-Based Arrangements with Drug Makers

First-of-its-kind approval for Oklahoma Medicaid will drive value

Today, the Centers for Medicare & Medicaid Services (CMS) issued the first-ever approval of a state plan amendment proposal to allow the state of Oklahoma to negotiate supplemental rebate agreements involving value-based purchasing arrangements with drug manufacturers that could produce extra rebates for the state if clinical outcomes are not achieved. The state plan amendment proposal submitted by Oklahoma will be the first state plan amendment permitting a state to pursue CMS-authorized supplemental rebate agreements involving value-based purchasing arrangements with manufacturers.

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Click here to view the state plan amendment


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06/20/18 – CMS Seeks Public Input on Reducing the Regulatory Burdens of the Stark Law

Today, the Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) seeking recommendations and input from the public on how to address any undue impact and burden of the physician self-referral law (also known as the “Stark Law”), focusing in part on how the law may impede care coordination, a key aspect of systems that deliver value.

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06/20/18 - CMS Announces Agency’s First Blue Button 2.0 Developer Conference

Today, the Centers for Medicare & Medicaid Services (CMS) announced it is hosting the first-ever Blue Button® 2.0 Developer Conference. This event is being held in Washington, D.C. at the General Services Administration national headquarters on Monday, August 13, 2018. The Blue Button® 2.0 Developer Conference will provide a networking opportunity that brings together developers to learn, build software, and share insights on how Medicare claims data can be leveraged to improve health outcomes. In addition, the conference will help further advance the work of the MyHealthEData, a government wide initiative led by the White House Office of American Innovation.
 

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06/19/18 - Michigan Medicare-Medicaid Plan Quality Withhold Analysis Results for Demonstration Year 1 (Calendar Years 2015 – 2016)

The Medicare-Medicaid Financial Alignment Initiative (FAI) seeks to better serve people who are dually eligible for Medicare and Medicaid by testing person-centered, integrated care models. In order to ensure that dually eligible individuals receive high quality care and to encourage quality improvement, both Medicare and Medicaid withheld a percentage of their respective components of the capitation rate to each Medicare-Medicaid Plan (MMP) participating in a capitated model demonstration under the FAI. MMPs are eligible for repayment of the withheld amounts subject to their performance on a combination of CMS Core and State-Specific quality withhold measures.

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06/18/18 – Judge Rules in Favor of OCR and Requires a Texas Cancer Center to Pay $4.3 Million in Penalties for HIPAA Violations

A U.S. Department of Health and Human Services Administrative Law Judge (ALJ) has ruled that The University of Texas MD Anderson Cancer Center (MD Anderson) violated the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules and granted summary judgment to the Office for Civil Rights (OCR) on all issues, requiring MD Anderson to pay $4,348,000 in civil money penalties to OCR. This is the second summary judgment victory in OCR’s history of HIPAA enforcement and the $4.3 million is the fourth largest amount ever awarded to OCR by an ALJ or secured in a settlement for HIPAA violations.

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06/15/18 – SAMHSA Announces $930 Million Funding Opportunity to Combat the Opioid Crisis

The Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within the Department of Health and Human Services (HHS), is now accepting applications for $930 million in State Opioid Response Grants. SAMHSA will distribute funds to states and territories in support of their ongoing efforts to provide prevention, treatment and recovery support services to individuals with opioid use disorder.

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06/15/18 – HHS Makes $350 Million Available to Fight the Opioid Crisis in Community Health Centers Nationwide

Today, the Department of Health and Human Services (HHS) announced the availability of $350 million in new funding to expand access to substance use disorder and mental health services at community health centers across the nation.  These funds will support health centers in implementing and advancing evidence-based strategies, including expanded medication-assisted treatment (MAT) services, and are expected to be awarded in September of this year by HHS’s Health Resources and Services Administration (HRSA).

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06/11/18 – CMS Leverages Medicaid Program to Combat the Opioid Crisis - States Provided Guidance in Designing Treatment Options for Opioid Epidemic

Today, the Centers for Medicare & Medicaid Services CMS released guidance aimed at building on our commitment to partner with states to ensure that they have flexibilities and the tools necessary to combat the opioid crisis.  This new guidance provides information to states on the tools available to them, describes the types of approaches they can use to combat this crisis, ensures states know what resources are available, and articulates promising practices for addressing the needs of beneficiaries facing opioid addiction. Notably, CMS released an Informational Bulletin that provides states with information they can use when designing approaches to covering critical treatment services for Medicaid eligible infants with Neonatal Abstinence Syndrome (NAS). Additionally, CMS issued a letter to states on how they may best use federal funding to enhance Medicaid technology to combat drug addiction and the opioid crisis.

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06/05/18 – Declines in Hospital-Acquired Conditions Save 8,000 Lives and $2.9 Billion in Costs

National efforts to improve patient safety showing continued progress

Data released today by the Agency for Healthcare Research and Quality (AHRQ) show continued progress in improving patient safety, a signal that initiatives led by the Centers for Medicare & Medicaid Services (CMS) are helping to make care safer. National efforts to reduce hospital-acquired conditions, such as adverse drug events and injuries from falls helped prevent an estimated 8,000 deaths and save $2.9 billion between 2014 and 2016, according to the report.
 
 

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06/04/18 – CMS Unveils Scorecard to Deliver New Level of Transparency within Medicaid and CHIP Program

New Scorecard highlights CMS’s commitment to a new era of accountability in Medicaid by monitoring and publishing state and federal Medicaid and CHIP outcomes

Today, the Centers for Medicare & Medicaid Services (CMS) released the first ever Medicaid and Children’s Health Insurance Program (CHIP) Scorecard, a central component of the Administration’s commitment to modernize the Medicaid and CHIP program through greater transparency and accountability for the program’s outcomes. For the first time, CMS published state Medicaid and CHIP quality metrics along with federally reported measures in a Scorecard format.

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Click here to view fact sheet

Click here to view scorecard


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05/30/18 – SAMHSA announces $196 million funding opportunity for opioid treatment grants to hardest-hit states and tribes

The Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within the Department of Health and Human Services (HHS) is now accepting applications for $196 million to treat opioid use disorder through its Targeted Capacity Expansion: Medication Assisted Treatment-Prescription Drug Opioid Addiction grant program.

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05/22/18 – HHS Announces Proposed Update to Title X Family Planning Grant Program

The U.S. Department of Health and Human Services (HHS) is issuing a proposal to update the regulations governing the Title X family planning program, which focuses on serving low-income Americans. The proposed update to the regulations ensures compliance with statutory program integrity provisions governing the program and, in particular, the statutory prohibition on funding “programs where abortion is a method of family planning.” (42 U.S.C. § 300a-6) The proposed update to the regulations, which were last revised 18 years ago, would also make notable improvements designed to increase the number of patients served and improve their quality of care.

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05/15/18 – Drug Spending Information Products Fact Sheet

Today, the Centers for Medicare & Medicaid Services (CMS) announced the release of updated information products that provide greater transparency on drug spending in the Medicare and Medicaid programs. CMS is releasing updated versions of the Drug Spending Dashboards and the annual update to the Part D Prescriber Public Use File. These tools and resources, which provide data through 2016, focus on giving consumers, researchers, and other stakeholders across the healthcare system the information they need to understand drug prescribing in CMS programs, with a particular focus on spending.

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05/17/18 – CMS Sends Clear Message to Plans: Stop Hiding Information from Patients

Part of the continued roll-out of American Patients First, CMS sends letter to Part D plans explaining that gag clauses that keep patients from knowing how to get the best deal are completely unacceptable

Today, the Centers for Medicare & Medicaid Services (CMS) sent a letter to companies that provide Medicare prescription drug coverage in Part D explaining that so-called “gag clauses” are unacceptable, as part of the Administration-wide “American Patients First” initiative to lower prescription drug costs.
 

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05/16/18 – Care Coordination Data Snap Shot for the Capitated Model

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05/16/18 – Speech: Remarks by CMS Administrator Seema Verma at the Pharmacy Quality Alliance Annual Meeting (PQA18)

(as prepared)

Good afternoon, it’s a pleasure to be with you today. Pharmacists are on the front lines of patient care and have keen insight to the issues that patients face. We appreciate your hard work, and we look forward to working with you on a goal that I’m sure we share – ensuring that all patients can access their medications at an affordable price.
 

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05/15/18 – CMS Unveils Enhanced “Drug Dashboards” to Increase Transparency on Drug Prices

An important part of the American Patients First initiative, the Dashboards provide new information on changes in spending per drug over time

Today, the Centers for Medicare & Medicaid Services (CMS) released a redesigned version of the Drug Spending Dashboards. For the first time, the dashboards include year-over-year information on drug pricing and highlight which manufactures have been increasing their prices.

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05/11/18 – Trump Administration Releases Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs

Today, the Trump Administration released “American Patients First,” the President’s blueprint to lower drug prices and reduce out-of-pocket costs.  Below is the blueprint’s introductory message from HHS Secretary Alex Azar.

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05/11/18 – 2018 MMP Performance Data Technical Notes

Under the Medicare-Medicaid Financial Alignment Initiative (FAI) capitated model, the Centers for Medicare & Medicaid Services (CMS) is collecting a variety of measures that examine plan performance and the quality of care provided to enrollees. The Medicare-Medicaid Plan (MMP) performance data published here represent currently available data on MMP performance on certain Medicare Parts C and D quality measures as well as select CMS core and state-specific measures that MMPs are required to report. The data show MMP performance on quality measures during 2016 and the results of surveys of MMP enrollees conducted in 2016 or 2017. The measures are organized into six domains that track the potential domains under a future MMP star ratings system described in the Medicare-Medicaid Plan Quality Ratings Strategy published in November 2015.

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05/08/18 – CMS Announces Agency’s First Rural Health Strategy

Interagency effort seeks to improve access and quality of care for rural Americans

Today, the Centers for Medicare & Medicaid Services (CMS) released the agency’s first Rural Health Strategy intended to provide a proactive approach on healthcare issues to ensure that the nearly one in five individuals who live in rural America have access to high quality, affordable healthcare.

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Click here to view the fact sheet


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05/01/18 – Independence at Home Demonstration Announced: Shared Savings and Regression Methodologies Reports Posted 

 

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05/01/18 – Members Appointed to New Pain Management Best Practices Inter-Agency Task Force

The U.S. Department of Health and Human Services (HHS) announced today the appointment of 28 members to the new Pain Management Best Practices Inter-Agency Task Force (Task Force).

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04/27/18 – CMS Drives Patient-Centered Care over Paperwork in Proposals to Modernize Medicare and Reduce Burden

Proposed rules would advance administrative burden reduction, Medicare modernization, and the Meaningful Measures Initiative

Today, the Centers for Medicare & Medicaid Services (CMS) proposed transformative changes to the payment systems for services furnished by a range of medical facilities. The agency’s proposed payment rules also set out to continue to modernize Medicare through innovation in skilled nursing facility payment to drive value, advance meaningful quality measure reporting, and reduce paperwork and administrative costs.

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Click here to view the CMS SNF PPS fact sheet

Click here to view the CMS IRF PPS fact sheet

Click here to view the Hospice Wage Index & Payment fact sheet

Click here to view the IPF fact sheet


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04/26/18 – CMS Administrator Verma Unveils New Strategy to Fuel Data-driven Patient Care, Transparency

New Medicare Advantage data resource released

Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma announced the agency’s new Data Driven Patient Care Strategy as part of the MyHealthEData initiative at the ninth annual Health Datapalooza conference in Washington, D.C. The strategy positions CMS to further support industry innovation in unleashing the power of data to inform patients’ healthcare decisions and transform the healthcare system by enhancing security and privacy, improving quality, increasing efficiency, and reducing costs.
 
 

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04/25/18 – Secretary Azar, Surgeon General Adams Praise Private Sector Support for Naloxone Advisory

Following the early April release of the Surgeon General’s Advisory on Naloxone and Opioid Overdose, which recommended that opioid treatment providers prescribe or dispense naloxone to patients with elevated risk of overdose, two naloxone manufacturers (Adapt Pharma and kaleo, Inc.) announced this week that they will be partnering with the National Council on Behavioral Health to distribute 30,000 doses of donated naloxone to National Council members.

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Click here to view the Surgeon General's Advisory


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04/24/18 – CMS Proposes Changes to Empower Patients and Reduce Administrative Burden

Changes in Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Would Advance Price Transparency and Interoperability

Today, the Centers for Medicare & Medicaid Services (CMS) proposed changes to empower patients through better access to hospital price information, improve patients’ access to their electronic health records, and make it easier for providers to spend time with their patients. The proposed rule issued today proposes updates to Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS).

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Click here to view the fact sheet

Click here to view the proposed rule


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04/24/18 – HHS Takes New Steps in Secretary Azar’s Value-Based Agenda

On Tuesday, HHS’s Centers for Medicare & Medicaid Services (CMS) released the draft Fiscal Year 2019 Inpatient Prospective Payment System rule, which contains proposals to advance HHS Secretary Alex Azar’s agenda for moving to a healthcare system that pays for value, as well as a request for information regarding future value-based reforms.

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04/23/18 – Feedback on New Direction Request for Information (RFI) Released, CMS Innovation Center’s Market-Driven Reforms to Focus on Patient-Centered Care

Request for Information on Provider Contracting Issued

Today, the Centers for Medicare & Medicaid Services (CMS) announced that it has released the comments submitted by patients, clinicians, innovators, and others in response to the CMS Innovation Center’s New Direction Request for Information (RFI). Last fall, CMS released the RFI to collect ideas on a new direction for the agency’s Innovation Center to promote patient-centered care and test market driven reforms that: empower beneficiaries as consumers, provide price transparency, increase choices and competition to drive quality, reduce costs, and improve outcomes. The Innovation Center is a central focus of the Administration’s efforts to accelerate the move from a healthcare system that pays for volume to one that pays for value and encourages provider innovation.

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Click here to view the Direct Provider Contracting RFI


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04/23/18 – HHS Purchases Anthrax Antitoxin for Strategic National Stockpile

Acquisition Augments Anthrax Treatments Currently Stockpiled

The U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR) will purchase an anthrax treatment for $25.2 million from Elusys Therapeutics Inc. of Pine Brook, New Jersey, as part of the department’s ongoing national preparedness efforts.

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04/18/18 – HHS Provides States Second Installment of Grant Awards to Combat Opioid Crisis

57 Grant Awards Totaling an Additional $485 Million

Today, the Department of Health and Human Services (HHS) is releasing the second year of funding to 50 states, four U.S. territories, and the free associated states of Palau and Micronesia, totaling $485 million to continue the Nation’s efforts to combat the opioid crisis.

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04/10/18 – HHS Sponsors its Largest Exercise for Moving Patients with Highly Infectious Diseases

The largest patient movement exercise in U.S. Department of Health and Human Services’ history began today to test the nationwide ability to move patients with highly infectious diseases safely and securely to regional treatment centers.

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04/09/18 – CMS Issues Final Payment Notice Rule to Increase Access to Affordable Health Plans for Americans Suffering from High Obamacare Premiums

Final Rule will Improve Program Integrity, Increase State Flexibility, and Reduce Regulatory Burdens

Today, the Centers for Medicare & Medicaid Services (CMS) issued the HHS Notice of Benefit and Payment Parameters for 2019. The final rule will mitigate the harmful impacts of Obamacare and empower states to regulate their insurance market. The rule will do this by advancing the Administration’s goals to increase state flexibility, improve affordability, strengthen program integrity, empower consumers, promote stability, and reduce unnecessary regulatory burdens imposed by the Patient Protection and Affordable Care Act.

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Click here to view the Final Annual Issuer Letter

Click here to view the Hardship Exemption Guidance

Click here to view the Extended Transitional Policy Guidance

Click here to view the Payment Notice fact sheet associated with this rule

Click here to view the Final Notice on the Federal Register


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04/06/18 – Health and Human Services and the Department of Justice Return $2.6 Billion in Taxpayer Savings from Efforts to Fight Healthcare Fraud

Departments Work to Stamp Out Pill Mills and Opioid Overprescribing

Health and Human Services Secretary Alex Azar and Attorney General Jeff Sessions today released a fiscal year (FY) 2017 Health Care Fraud and Abuse Control Program report showing that for every dollar the federal government spent on healthcare related fraud and abuse investigations in the last three years, the government recovered $4. Additionally, the report shows that the departments’ FY 2017 Takedown event was the single largest healthcare fraud enforcement operation in history.

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04/04/18 – HHS Releases a New Resource to Help Individuals Access and Use Their Health Information

The US Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) today released the ONC Guide to Getting and Using your Health Records, a new online resource for individuals, patients, and caregivers.

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04/03/18 – CMS’ Final Report Shows 11.8 Million Consumers Enroll in Exchange Coverage Nationwide

This Marks Agency’s Most Cost Effective and Successful Open Enrollment to Date

The Centers for Medicare & Medicaid Services (CMS) today released the Final Enrollment Report for the 2018 Health Insurance Exchanges showing approximately 11.8 million consumers selected or were automatically re-enrolled in an Exchange plan in the 50 states, plus DC. This includes 8.7 million consumers in the 39 states using Healthcare.gov and 3 million consumers in State-based Exchanges. Compared to prior years, this year’s open enrollment was the agency’s most cost effective and successful experience for HealthCare.gov consumers to date. While the 2018 open enrollment period ran smoothly, Americans continue to experience skyrocketing premiums and limited choice.

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Click here to view the full report


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04/02/18 – CMS Lowers the Cost of Prescription Drugs for Medicare Beneficiaries

Today, the Centers for Medicare & Medicaid Services (CMS) finalized polices for Medicare health and drug plans for 2019 that will save Medicare beneficiaries money on prescription drugs while offering additional plan choices.

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Click here to view a fact sheet on the 2019 Rate Announcement and Final Call Letter

Click here to view a fact sheet on the final rule


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03/30/18 – Medicare Diabetes Prevention Program (MDPP) Expanded Model Announced: Enrollment Process Timeline and Supplier Requirements Checklist Posted

Diabetes affects more than 25 percent of Americans aged 65 or older, and its prevalence is projected to increase approximately two-fold for all U.S. adults (ages 18-79) by 2050 if current trends continue. We estimate that Medicare spent $42 billion more in the single year of 2016 on beneficiaries with diabetes than it would have spent if those beneficiaries did not have diabetes; per-beneficiary, Medicare spent an estimated $1,500 more on Part D prescription drugs, $3,100 more for hospital and facility services, and $2,700 more in physician and other clinical services for those with diabetes than those without diabetes (estimates based on fee-for-service, non-dual eligible, over age 65 beneficiaries).

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03/22/18 – CMS Proposes Regulation to Alleviate State Burden

Proposed Rule Furthers President Trump’s Commitment to “Cutting the Red Tape” by Relieving States of Burdensome Paperwork Requirements

Today, The Centers for Medicare & Medicaid Services (CMS) issued a notice of proposed rulemaking (NPRM) that would provide state flexibility from certain regulatory access to care requirements within the Medicaid program. Specifically, the NPRM would exempt states from requirements to analyze certain data and monitor access when the vast majority of their covered lives receive services through managed care plans. CMS regulations separately provide for access requirements in managed care programs. Additionally, the NPRM would provide similar flexibility to all states when they make nominal rate reductions to fee-for-service payment rates.

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03/16/18 – CMS Finalizes Coverage of Next Generation Sequencing Tests, Ensuring Enhanced Access for Cancer Patients

A New Opportunity for Cancer Patients as Advanced Diagnostic Laboratory Tests Now Have Expanded Medicare Coverage

Today the Centers for Medicare & Medicaid Services (CMS) took action to advance innovative personalized medicine for Medicare patients with cancer. CMS finalized a National Coverage Determination that covers diagnostic laboratory tests using Next Generation Sequencing (NGS) for patients with advanced cancer (i.e., recurrent, metastatic, relapsed, refractory, or stages III or IV cancer). CMS believes when these tests are used as a companion diagnostic to identify patients with certain genetic mutations that may benefit from U.S. Food and Drug Administration (FDA)-approved treatments, these tests can assist patients and their oncologists in making more informed treatment decisions. Additionally, when a known cancer mutation cannot be matched to a treatment then results from the diagnostic lab test using NGS can help determine a patient’s candidacy for cancer clinical trials.
 

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03/13/18 – HHS Announces Health Data Provenance Challenge Winners

The Department of Health and Humans Services Office of the National Coordinator for Health Information Technology (ONC) today announced the Phase 2 winners of the “Oh the Places Data Goes: Health Data Provenance” Challenge.
 

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03/08/18 – Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma Statement on Enforcement Letter to Idaho

Today, CMS issued a letter to Idaho regarding its Bulletin No. 18-01, Provisions for Health Carriers Submitting State-Based Health Benefit Plans.

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Click here to view the letter to Idaho


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03/07/18 – Medicare Diabetes Prevention Program (MDPP) Expanded Model Announced: Guidance for Medicare Advantage Plans CY 2018 Document Posted

Diabetes affects more than 25 percent of Americans aged 65 or older, and its prevalence is projected to increase approximately two-fold for all U.S. adults (ages 18-79) by 2050 if current trends continue. We estimate that Medicare spent $42 billion more in the single year of 2016 on beneficiaries with diabetes than it would have spent if those beneficiaries did not have diabetes; per-beneficiary, Medicare spent an estimated $1,500 more on Part D prescription drugs, $3,100 more for hospital and facility services, and $2,700 more in physician and other clinical services for those with diabetes than those without diabetes (estimates based on fee-for-service, non-dual eligible, over age 65 beneficiaries).

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03/06/18 – Secretary Azar Statement on UnitedHealthcare Drug Discount Announcement

Health and Human Services Secretary Alex Azar issued the following statement today after UnitedHealthcare announced that they would be sharing manufacturer rebates and discounts with patients at the pharmacy.

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03/06/18 – Trump Administration Announces MyHealthEData Initiative to Put Patients at the Center of the US Healthcare System

CMS Launches “Blue Button 2.0” Tool, Calls on All Health Insurers to Make Data Available to Patients

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

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Click here to view fact sheet


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03/06/18 – Speech: Remarks by CMS Administrator Seema Verma at the HIMSS18 Conference

Thank you Jared for that kind introduction. It has been an honor to work alongside visionaries like you; somebody who really understands at a very personal level as I do, the need and potential of innovation to better serve Americans. Having the Office of American Innovation involved is critical, and I’m grateful for Jared’s involvement, his hard work, and his leadership. It’s an honor to serve with him, and I am grateful for his service to our country.

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02/23/18 – HHS Announces the Availability of $260 Million to Fund the Title X Family Planning Program

The U.S. Department of Health and Human Services (HHS) announced the availability of $260 million in a new funding opportunity for the Title X family planning program to help improve and expand quality care. The funding opportunity will assist in the establishment and/or operation of voluntary family planning projects that will offer a broad range of family planning methods and services, including information, education and counseling related to family planning, preconception care, contraception, natural family planning and infertility services.

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02/21/18 – Third-Party Auditor Operational Readiness Reviews for the Enhanced Direct Enrollment Pathway and Related Oversight Requirements

Beginning with the Open Enrollment Period (OEP) for plan year (PY) 2019, the Centers for Medicare & Medicaid Services (CMS) is implementing an optional program to allow Direct Enrollment (DE) entities (qualified health plan [QHP] issuers and web-brokers) in the Federally-facilitated Exchange (FFE, also referred to as Marketplace) and State-based Exchanges on the Federal Platform (SBE-FPs) to integrate an application for Marketplace coverage through the FFE with the standalone eligibility service (SES) to host application and enrollment services on their own website. The SES is a suite of application program interfaces (APIs) that will allow partners to create, update, submit, and ultimately retrieve eligibility results for an application. The Enhanced Direct Enrollment (EDE) pathway will replace the proxy DE pathway that CMS allowed DE entities to use for PY 2018. CMS will not allow DE entities’ use of, nor will it support, the proxy DE pathway for PY 2019 and beyond.

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02/20/18 – Trump Administration Works to Give Relief to Americans Facing High Premiums, Fewer Choices

Proposed Rule to Allow Short-Term, Limited Duration Coverage for Longer Periods Providing Increased Choice at a Lower Cost

In direct response to President Trump’s October 2017 Executive Order, the Departments of Health and Human Services (HHS), Labor, and the Treasury (the Departments) issued a proposed rule today that is intended to increase competition, choice, and access to lower-cost healthcare options for Americans. The rule proposes to expand the availability of short-term, limited-duration health insurance by allowing consumers to buy plans providing coverage for any period of less than 12 months, rather than the current maximum period of less than three months. The proposed rule, if finalized, will provide additional options to Americans who cannot afford to pay the costs of soaring healthcare premiums or do not have access to healthcare choices that meet their needs under current law.

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Click here to view fact sheet


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02/16/18 – Medicare Diabetes Prevention Program (MDPP) Expanded Model

Diabetes affects more than 25 percent of Americans aged 65 or older, and its prevalence is projected to increase approximately two-fold for all U.S. adults (ages 18-79) by 2050 if current trends continue. We estimate that Medicare spent $42 billion more in the single year of 2016 on beneficiaries with diabetes than it would have spent if those beneficiaries did not have diabetes; per-beneficiary, Medicare spent an estimated $1,500 more on Part D prescription drugs, $3,100 more for hospital and facility services, and $2,700 more in physician and other clinical services for those with diabetes than those without diabetes (estimates based on fee-for-service, non-dual eligible, over age 65 beneficiaries).

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02/14/18 – CMS Office of the Actuary Releases 2017 – 2026 Projections of National Health Expenditures

Today the independent CMS Office of the Actuary released the projected national health expenditures for 2017-2026.

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02/02/18 – HHS Approves New Healthy Indiana Medicaid Demonstration

Indiana is Second State to Receive Waiver for Community Engagement Requirements

On Friday, U.S. Health and Human Services Secretary Alex Azar joined Indiana Governor Eric J. Holcomb to announce the U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services approval of Indiana’s Section 1115 waiver, known as the Healthy Indiana Plan or HIP.

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Click here to view waiver


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02/02/18 – Online Provider Directory Review Report

The Centers for Medicare & Medicaid Services (CMS) completed its second round of Medicare Advantage (MA) online provider directory reviews between September 2016 and August 2017.  The review examined the accuracy of 108 providers and their listed locations selected from the online directories of 64 Medicare Advantage Organizations (MAOs), approximately one-third of MAOs, for a total of 6,841 providers reviewed at 14,869 locations. The review found that 52.20% of the provider directory locations listed had at least one inaccuracy.

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02/01/18 – Five Breaches Add Up to Millions in Settlement Costs for Entity that Failed to Heed HIPAA’s Risk Analysis and Risk Management Rules

Fresenius Medical Care North America (FMCNA) has agreed to pay $3.5 million to the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR), and to adopt a comprehensive corrective action plan, in order to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules. FMCNA is a provider of products and services for people with chronic kidney failure with over 60,000 employees that serves over 170,000 patients. FMCNA’s network is comprised of dialysis facilities, outpatient cardiac and vascular labs, and urgent care centers, as well as hospitalist and post-acute providers.

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02/01/18 – CMS Proposes Medicare Advantage and Part D Payment and Policy Updates to Provide New Benefits for Enrollees, New Protections to Combat Opioid Crisis

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

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Click here to view fact sheet


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01/26/18 – 2016 Medicare Electronic Health Record (EHR) Incentive Program Payment Adjustment Fact Sheet for Critical Access Hospitals

The American Recovery and Reinvestment Act (ARRA) was enacted into law in 2009. It established incentive payments for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) to promote the adoption and meaningful use of Certified Electronic Health Record Technology (CEHRT). Meaningful use is a term defined in the authorizing legislation and by CMS in regulation and describes the use of CEHRT that furthers the goals of information exchange among health care professionals and hospitals.

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01/25/18 – The Newly-Executed MI Three-Way Contract 

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Click here to view summary of contract changes


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01/23/18 – VA, Health and Human Services Announce Partnership to Strengthen Prevention of Fraud, Waste and Abuse Efforts

Today, the U.S. Department of Veterans Affairs (VA) and Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) announced a partnership to share data, data analytics tools and best practices for identifying and preventing fraud, waste and abuse.

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01/17/18 – CMS Announces Additional Special Enrollment Periods to Help Individuals Impacted by Hurricanes in Puerto Rico and the U.S. Virgin Islands

Agency Provides Extended Special Enrollment Periods for 2018 Medicare and Exchange Coverage

The Centers for Medicare & Medicaid Services (CMS) announced additional opportunities for individuals affected by the 2017 hurricanes in Puerto Rico and the U.S. Virgin Islands to enroll in Medicare health and drug plans and health coverage through the Federal Health Insurance Exchange. CMS is providing these special enrollment periods so that certain individuals and families who were impacted can access health coverage on the Exchange and have additional time to join, drop, or switch Medicare health and prescription drug plans. CMS announced initial special enrollment period opportunities in September, this extends these opportunities through March 31, 2018.
 

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01/11/18 – CMS Announces New Policy Guidance for States to Test Community Engagement for Able-Bodied Adults

Will Support States Helping Medicaid Beneficiaries Improve Well-Being and Achieve Self-Sufficiency

CMS today announced new guidance that will support state efforts to improve Medicaid enrollee health outcomes by incentivizing community engagement among able-bodied, working-age Medicaid beneficiaries. The policy responds to numerous state requests to test programs through Medicaid demonstration projects under which work or participation in other community engagement activities – including skills training, education, job search, volunteering or caregiving – would be a condition for Medicaid eligibility for able-bodied, working-age adults. This would exclude individuals eligible for Medicaid due to a disability, elderly beneficiaries, children, and pregnant women.
 
 

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01/10/18 – Bundled Payments for Care Improvement Advanced (BPCI Advanced) Voluntary Bundled Payment Model

To better support healthcare providers who invest in practice innovation, care redesign, and enhanced care coordination, the Center for Medicare and Medicaid Innovation (CMS Innovation Center) has launched the Bundled Payments for Care Improvement Advanced (BPCI Advanced) voluntary bundled payment model. BPCI Advanced qualifies as an Advanced Alternative Payment Model (Advanced APM) under the Quality Payment Program.

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01/09/18 – The Contract Year (CY) 2019 Medicare-Medicaid Plan (MMP) Service Area Expansion (SAE) Application

The Centers for Medicare & Medicaid Services (CMS) is seeking applications from existing Medicare-Medicaid Plans (MMPs) seeking to enter into additional counties in the current capitated financial alignment model demonstrations. Please submit your application according to the process described in Section 2.0.

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01/05/18 – Draft Trusted Exchange Framework Released by HHS

Comment Period Through February 20, 2018

The Department of Health and Human Services today released the draft Trusted Exchange Framework, a significant step towards achieving interoperability, as required by the 21st Century Cures Act of 2016.

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Click here to view the Draft Trusted Exchange Framework


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01/05/18 – CY 2018 MMP Health Service Delivery (HSD) Criteria Reference Table

Network Adequacy Standards Criteria File for all States

This letter is a technical correction to the State Medicaid Director Letter (SMDL) that was published on December 27, 2017.

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01/02/18 – CMS Launches Data Submission System for Clinicians in the Quality Payment Program

Website Makes it Easier for Clinicians to Submit Data by Offering One User-Friendly Site for All Submissions

Today, the Centers for Medicare & Medicaid Services (CMS) announced that doctors and other eligible clinicians participating in the Quality Payment Program can begin submitting their 2017 performance data using a new system on the Quality Payment Program website (qpp.cms.gov). The data submission system is an improvement from the former systems under the CMS legacy programs, which required clinicians to submit data on multiple websites. Now, eligible clinicians will use the new system to submit their 2017 performance data for the Quality Payment Program during the 2017 submission period which runs from January 2, 2018 to March 31, 2018, except for groups using the CMS Web Interface whose submission period is January 22, 2018 to March 16, 2018.

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Click here to view fact sheet


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12/28/17 – Failure to Protect the Health Records of Millions of Persons Costs Entity Millions of Dollars

Failure to protect the health records of millions of persons costs entity millions of dollars 21st Century Oncology, Inc. (21CO) has agreed to pay $2.3 million in lieu of potential civil money penalties to the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) and adopt a comprehensive corrective action plan to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules. 21CO is a provider of cancer care services and radiation oncology. With their headquarters located in Fort Myers, Florida, 21CO operates and manages 179 treatment centers, including 143 centers located in 17 states and 36 centers located in seven countries in Latin America.

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Click here to view the resolution agreement


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12/28/17 – Final Weekly Enrollment Snapshot for 2018 Open Enrollment Period

Approximately 8.7M people selected or were automatically re-enrolled in plans using the HealthCare.gov platform during the 2018 open enrollment period.

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12/28/17 – CMS Approves First 10-Year Section 1115 Demonstration Extension

Mississippi is First State to Receive 10-Year Section 1115 Program Extension Under New Policy

Today, CMS approved for Mississippi the first ever 10-year extension under the Medicaid program demonstration extension to provide further coverage of family planning services in the state. This will extend eligibility for women and men ages 13 through 44, with income up to 194 percent of the federal poverty level (FPL) that are not enrolled in Medicaid, Medicare, the Children’s Health Insurance Program (CHIP) or other creditable health insurance coverage that includes family planning services. Mississippi’s waiver will be the 25th demonstration action approved by CMS since January 21, 2017.

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12/27/17 – 2019 Medicare Advantage Part 1 Advance Notice - Risk Adjustment

Today, the Centers for Medicare & Medicaid Services (CMS) released Part I of the 2019 Advance Notice of Methodological Changes for Medicare Advantage Capitation Rates and Part D Payment Policies (the Advance Notice), which contains key information about proposed updates to the Part C Risk Adjustment Model and the use of encounter data.

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12/21/17 – CMS Updates Website to Compare Hospital Quality

Agency Continues to Incorporate Feedback to Ensure Reliable Information is Reported

The Centers for Medicare & Medicaid Services (CMS) updated data on the Hospital Compare website and on data.medicare.gov to provide patients, families and all stakeholders with the information they need to compare the performance of hospitals where they seek medical care. Along with data on quality measures, CMS will also update the Overall Hospital Star Rating.

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12/21/17 – Federal Exchange Open Enrollment for 2018 Coverage, Most Cost Effective Saving Americans Millions of Dollars While Improving Customer Service and Access to Care

Today, the Centers for Medicare & Medicaid Services (CMS) announced that the fifth open enrollment period for the Health Insurance Exchange was the most cost effective and smooth enrollment experience for consumers, releasing data that shows the highest rates of consumer satisfaction to date at a lower cost. Similar to previous years, there was a surge in the number of consumers contacting the call center and visiting HealthCare.gov during the final days. Despite the increase in volume, both HealthCare.gov and the call center operated optimally and for the first time, a waiting room did not need to be deployed online during the final days of open enrollment. This provided consumers with exceptional site availability when the greatest number of consumers were making plan selections.

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12/21/17 – Weekly Enrollment Snapshot: Week Seven – Week 7

Dec 10 – Dec 15, 2017

In the last week of Open Enrollment for 2018, 4,143,968 people selected plans using the HealthCare.gov platform or were automatically re-enrolled in a plan. As in past years, enrollment weeks are measured Sunday through Saturday.

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12/19/17 – 2018 Medicare Electronic Health Record (EHR) Incentive Program Payment Adjustment Fact Sheet for Eligible Clinicians

As part of the American Recovery and Reinvestment Act of 2009 (ARRA), Congress established payment adjustments under Medicare for certain eligible clinicians(eligible clinicians include doctors of medicine or osteopathy, doctors of dental surgery or dental medicine, doctors of podiatric medicine, doctors of optometry, and chiropractors) that are not meaningful users of Certified Electronic Health Record (EHR) Technology. EPs 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. The Medicare payment adjustments sunset in 2018 for EPs pursuant to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

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12/18/17 – HHS Highlights Office for Civil Rights’ Ongoing Response to the Opioid Crisis, While Implementing the 21st Century Cures Act 

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) today launched an array of new tools and initiatives in response to the opioid crisis, while implementing the 21st Century Cures Act (Public Law 114-255).  OCR continues its work to ensure that patients and their family members can get the information they need to prevent and address emergency situations, such as an opioid overdose or mental health crisis. At the same time, these tools and initiatives also fulfill requirements of the 21st Century Cures Act to ensure that the healthcare sector, researchers, patients, and their families understand how the Health Insurance Portability and Accountability Act (HIPAA) protects privacy and helps improve health and healthcare nationwide.

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12/15/17 – CMS Strengthens Federal Support to California Residents Affected by Wildfires

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma today announced that the agency has taken immediate steps and is monitoring conditions in support of California residents displaced and recovering from the wildfires ravaging southern portions of the state. On Dec.11, 2017, Acting Health and Human Services Secretary Eric D. Hargan declared a public health emergency (PHE) in the state of California retroactive to Dec. 4, 2017. The PHE allows CMS to waive or modify certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements if necessary to provide health services.

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12/14/17 – Interdepartmental Serious Mental Illness Coordinating Committee Releases its First Report to Congress

People in the United States who experience serious mental illness and serious emotional disturbances need greater access to quality, affordable health care, according to a report released by the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC).

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12/14/17 – CMS Adds New Quality Information to the Physician Compare Website

The Centers for Medicare & Medicaid Services (CMS) has added new quality information to the Physician Compare website.

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12/13/17 – Weekly Enrollment Snapshot: Week Six – Week 6, Dec 3 – Dec 9, 2017

In week six of Open Enrollment for 2018, 1,073,921 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.

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12/13/17 – First Half of 2017 Average Effectuated Enrollment Report

Effectuated Enrollment Analysis

According to data as of September 15, 2017, an average of 10.1 million individuals had effectuated their coverage through June 2017, meaning that they selected a plan and paid their premium. This is approximately 300,000 fewer effectuated individuals compared to the effectuated report for the first half of 2016 and about 2.1 million below the number of plan selections at the end of 2017 open enrollment.

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Click here to view a breakdown of the data by state


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12/12/17 – Long-Term Care Hospital (LTCH) Compare Website – New Measures Added

This fact sheet contains information about the Long-Term Care Hospital (LTCH) Compare website that was refreshed with new quality measures added on December 12, 2017

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. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) also requires public reporting of provider performance two years following the specified application date (the date data collection began). Historically, new items are added to the programs in the fall. This Compare refresh release contains data from over 400 LTCHs.

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12/12/17 – Inpatient Rehabilitation Facility (IRF) Compare Website – New Measures Added

This fact sheet contains information about the Inpatient Rehabilitation Facility (IRF) compare website that was refreshed with new quality measures added on December 12, 2017

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. The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) also requires public reporting of provider performance two years following the specified application date (the date data collection began). Historically, new items are added to the programs in the fall. This Compare refresh contains data from over 1,100 IRFs.

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12/11/17 – Medicare Care Choices Model (MCCM): The First Two Years

The Centers for Medicare & Medicaid Services (CMS) is conducting the Medicare Care Choices Model (MCCM) to provide beneficiaries, and their caregivers and providers, with greater flexibility when facing a life-limiting illness. MCCM provides Medicare beneficiaries who qualify for the Medicare hospice benefit, (and dually eligible beneficiaries who may qualify for the Medicaid hospice benefit in their state), the option to receive supportive care services typically furnished under the Medicare hospice benefit, while continuing to receive care from other Medicare providers for their terminal condition. Absent the model, Medicare beneficiaries who elect to receive hospice care cannot also receive curative treatment for their life-limiting condition.

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12/06/17 – CMS Office of the Actuary Releases 2016 National Health Expenditures

In 2016, overall national health spending increased 4.3 percent following 5.8 percent growth in 2015, 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. Following Affordable Care Act (ACA) coverage expansion and significant retail prescription drug spending growth in 2014 and 2015, health care spending growth decelerated in 2016. The report concludes that the 2016 expenditure slowdown was broadly based as growth for all major payers (private health insurance, Medicare, and Medicaid) and goods and service categories (hospitals, physician and clinical services, and retail prescription drugs) slowed in 2016.

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Click here to view highlights of the report


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11/30/17 – CMS Finalizes Changes to the Comprehensive Care for Joint Replacement Model, Cancels Episode Payment Models and Cardiac Rehabilitation Incentive Payment Model

Today, the Centers for Medicare & Medicaid Services (CMS) finalized the cancellation of the mandatory hip fracture and cardiac bundled payment models that were to be operated by the CMS Innovation Center and implemented changes to the Comprehensive Care for Joint Replacement (CJR) Model. These changes will offer greater flexibility and choice for hospitals in providing care to Medicare patients.

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Click here to view a technical fact sheet


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11/30/17 – FDA Announces Approval, CMS Proposes Coverage of First Breakthrough-Designated Test to Detect Extensive Number of Cancer Biomarkers

Agencies’ Parallel Review Process Makes Test for Efficient Identification of Multiple Targeted Therapy Options Available to Health Care Professionals, Patients and Eligible Beneficiaries Sooner

The U.S. Food and Drug Administration today approved the FoundationOne CDx (F1CDx), the first breakthrough-designated, next generation sequencing (NGS)-based in vitro diagnostic (IVD) test that can detect genetic mutations in 324 genes and two genomic signatures in any solid tumor type. The Centers for Medicare & Medicaid Services (CMS) at the same time proposed coverage of the F1CDx. The test is the second IVD to be approved and covered after overlapping review by the FDA and CMS under the Parallel Review Program, which facilitates earlier access to innovative medical technologies for Medicare beneficiaries.

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11/29/17 – Weekly Enrollment Snapshot: Week Four

In week four of Open Enrollment for 2018, 504,181 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.

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11/29/17 – Updated Medicare Part D Opioid Drug Mapping Tool Unveiled

Interactive Tool Adds Extended-Release Opioid Prescribing Rates, County-Level Hot Spots

Today, the Centers for Medicare & Medicaid Services (CMS) released an updated version of the Medicare opioid prescribing mapping tool. This tool is an interactive, web-based resource that visually presents geographic comparisons of Medicare Part D opioid prescribing rates. The tool includes the addition of extended-release opioid prescribing rates and county-level hot spots and outliers, which may identify areas that warrant attention.

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Click here to view tool


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11/28/17 – Market Saturation and Utilization Data Tool

The Centers for Medicare & Medicaid Services (CMS) has developed a Market Saturation and Utilization Data Tool that includes interactive maps and a dataset that shows national-, state-, and county-level provider services and utilization data for selected health service areas. Market saturation, in the present context, refers to the density of providers of a particular service within a defined geographic area relative to the number of the beneficiaries receiving that service in the area.

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Click here to view tool


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11/27/17 – 2019 Draft Letter to Issuers in the Federally-Facilitated Exchanges

The Centers for Medicare & Medicaid Services (CMS) is releasing this 2019 Draft Letter to Issuers in the Federally-facilitated Exchanges (2019 Draft Letter). This Letter provides updates on operational and technical guidance for the 2019 plan year for issuers seeking to offer qualified health plans (QHPs), including stand-alone dental plans (SADPs), in the Federally facilitated Exchanges (FFEs) or the Federally-facilitated Small Business Health Options Programs (FF-SHOPs). Issuers should refer to these updates to help them successfully participate in any such Exchange in 2019. Unless otherwise specified, references to the FFEs include the FFSHOPs.

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11/27/17 – DRAFT Bulletin: Proposed Timing of Submission of Rate Filing Justifications for the 2018 Filing Year for Single Risk Pool Coverage Effective on or after January 1, 2019

The Centers for Medicare & Medicaid Services (CMS) is releasing this draft bulletin for comment.  This bulletin proposes guidance for purposes of establishing the submission deadline under 45 CFR 154.220 for health insurance issuers to submit Rate Filing Justifications for single risk pool coverage in the individual and small group markets.
 

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11/27/17 – Proposed Key Dates Calendar for 2018 – QHP Certification in the Federally-Facilitated Exchanges (FFEs), Rate Review and Risk Adjustment

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11/22/17 – Weekly Enrollment Snapshot: Week Three

In week three of Open Enrollment for 2018, 798,829 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.
 

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11/22/17 – CMS Updates Medicare Advantage Value-Based Insurance Design (VBID) Model for 2019

Expansion of Model to 25 Total States to Provide Medicare Beneficiaries with More Choices and Lower Costs – The Centers for Medicare & Medicaid Services (CMS) today announced several updates to the Medicare Advantage Value-Based Insurance Design (VBID) Model for 2019 that encourages customized benefit designs and flexibilities that meet the health needs of beneficiaries in a total of 25 states.

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11/17/17 – 2018 Medicare Parts A & B Premiums and Deductibles

On November 17, 2017, the Centers for Medicare & Medicaid Services (CMS) released the 2018 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs.
 

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11/16/17 – CMS Releases Proposed Rule to Increase Choices and Lower Premiums for Medicare Advantage Enrollees

Medicare Beneficiaries Will See More Choices and Greater Affordability as a Result of Increased Flexibilities

Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that will result in lower premiums and increased plan choices for Medicare beneficiaries. During this year’s Medicare Advantage Open Enrollment, which started October 15th and runs until December 7th, seniors enrolling in Medicare Advantage have seen average monthly premiums drop by 6%, and CMS is proposing changes to continue to drive affordable options for Medicare beneficiaries that meet their unique health needs.

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Click here to view the fact sheet


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11/16/17 – CMS Proposes Policies to Lower the Cost of Prescription Drugs and Combat the Opioid Crisis

The Proposed Rule Eliminates Administrative Hurtles to Providing More Affordable Prescription Drugs and Will Allow Medicare to Combat Opioid Overprescribing and Abuse

Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes a number of changes that, if finalized, will ensure that Part D Medicare enrollees have access to more affordable prescription drugs and more robust prescription drug coverage at the pharmacy they prefer. The rule also gives health plans a new tool to combat the opioid crisis.

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Click here to view the fact sheet


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11/15/17 – Weekly Enrollment Snapshot: Week Two

In week two of Open Enrollment for 2018, 876,788 people selected plans using the HealthCare.gov platform. As in past years, enrollment weeks are measured Sunday through Saturday.

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Verma Outlines Vision for Medicaid, Announces Historic Steps Taken to Improve the Program

New Policies Help Ensure States Can Focus More Resources, Time Achieving Positive Health Outcomes for Beneficiaries

Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed her vision for the future of Medicaid and unveiled new CMS policies that encourage states to propose innovative Medicaid reforms, reduce federal regulatory burdens, increase efficiency, and promote transparency and accountability during a plenary session at the National Association of Medicaid Directors (NAMD) Fall Conference in Arlington, Virginia.

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Click here to view a copy of Administrator Verma's remarks, as prepared for delivery

Click here to view the new updated Medicaid 1115 Demonstration Project page

Click here to view the Section 115 Demonstration Process Improvements Informational Bulletin

Click here to view the State Plan Amendment and 1915 Waiver Informational Bulletin

 

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Medicare Diabetes Prevention Program (MDPP) Expanded Model Announced

Diabetes affects more than 25 percent of Americans aged 65 or older, and its prevalence is projected to increase approximately two-fold for all U.S. adults (ages 18-79) by 2050 if current trends continue. We estimate that Medicare spent $42 billion more in the single year of 2016 on beneficiaries with diabetes than it would have spent if those beneficiaries did not have diabetes; per-beneficiary, Medicare spent an estimated $1,500 more on Part D prescription drugs, $3,100 more for hospital and facility services, and $2,700 more in physician and other clinical services for those with diabetes than those without diabetes (estimates based on fee-for-service, non-dual eligible, over age 65 beneficiaries).

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Episodic Alternative Payment Model for Radiation Therapy Services Announced

Section 3(b) of the Patient Access and Medicare Protection Act (PAMPA) (P.L. 114-115) directs the Secretary of Health and Human Services to submit a report to Congress on the development of an episodic alternative payment model (APM) for Medicare payment under title XVIII of the Social Security Act (the Act) for radiation therapy services furnished in non-facility settings.1 The Centers for Medicare & Medicaid Services (CMS) has prepared this report to respond to this requirement.

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CMS Hospital Value-Based Purchasing Program Results for Fiscal Year 2018

The Hospital Value-Based Purchasing (VBP) Program adjusts what Medicare pays hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of inpatient care they provide to patients. For fiscal year (FY) 2018, the law requires that the applicable percent reduction, which is the portion of Medicare payments available to fund the program’s value-based incentive payments, remain at 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 2018 discharges will be approximately $1.9 billion.

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CMS Finalizes Policies that Reduce Provider Burden, Lower Drug Prices

2018 Quality Payment Program and Physician Fee Schedule Finalized

Today, the Centers for Medicare & Medicaid Services (CMS) issued a final rule for the 2018 Physician Fee Schedule and final rule with comment period for the Quality Payment Program (QPP). While part of CMS’s broader strategy to relieve regulatory burdens for providers, these rules also reflect the agency’s efforts to promote innovation in healthcare delivery aimed at lowering prices, increasing competition and strengthening the relationship between patients and their doctors.

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Click here for the Physician Fee Schedule final rule

Click here for a fact sheet on the Physician Fee Schedule final rule

Click here for the Quality Payment Program final rule with comment period

Click here for a fact sheet on the Quality Payment Program final rule with comment period


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CMS Announces New Medicaid Policy to Combat the Opioid Crisis by Increasing Access to Treatment Options

Approves Demonstrations in Both New Jersey and Utah

Today, the Centers for Medicare & Medicaid Services (CMS) announced a new policy to allow states to design demonstration projects that increase access to treatment for opioid use disorder (OUD) and other substance use disorders (SUD). CMS’s new demonstration policy responds to the President’s directive and provides states with greater flexibility to design programs that improve access to high quality, clinically appropriate treatment. In addition, CMS is announcing the immediate approval of both New Jersey and Utah’s demonstration waivers under the new policy.

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Click here to view a copy of the SMD # 17-003 Letter to state Medicaid directors


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CMS Announces Payment Changes for Medicare Home Health Agencies for 2018

Today, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1672-F) that updates the calendar year (CY) 2018 Medicare payment rates and the wage index for home health agencies (HHAs) serving Medicare beneficiaries.

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CMS Finalizes Policies that Lower Out-of-Pocket Drug Costs and Increase Access to High-Quality Care

2018 Medicaid Annual Payment Rules Finalized for Outpatient Hospital Departments, Ambulatory Surgical Centers, and Home Health Settings

Today, the Centers for Medicare & Medicaid Services (CMS) finalized two Medicare payment rules moving the agency in a new direction by putting patients first and ensuring that payments support access to high quality, affordable care. Among other things, the Hospital Outpatient payment rule will lower out-of-pocket drug costs for people with Medicare and empower patients with more choices. Both rules finalized today increase access to care. Importantly, the Hospital Outpatient rule takes steps to preserve access in rural communities.

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Click here to view a fact sheet on the OPPS final rule with comment period

Click here to view a fact sheet on the Home Health final rule


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CMS Issues Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System and Quality Reporting Programs Changes for 2018 (CMS-1678-FC)

On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule with comment period (CMS-1678-FC), which includes updates to the 2018 rates and quality provisions, and other policy changes. CMS adopted a number of policies that will support care delivery; reduce burdens for health care providers, especially in rural areas; lower beneficiary out of pocket drug costs for certain drugs; enhance the patient-doctor relationship; and promote flexibility in healthcare.

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CMS Administrator Verma Announces New Meaningful Measures Initiative and Addresses Regulatory Reform; Promotes Innovation at LAN Summit

Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed the agency’s efforts to streamline quality measures, reduce regulatory burden, and promote innovation during a plenary session at the Health Care Payment Learning and Action Network (LAN) Fall Summit in Arlington, Virginia.

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Click here to view fact sheet


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HHS Office for Civil Rights Issues Guidance on How HIPAA Allows Information Sharing to Address the Opioid Crisis

Following President Trump’s call to action yesterday that led to the declaration of a nationwide public health emergency regarding the opioid crisis, the HHS Office for Civil Rights is releasing new guidance on when and how healthcare providers can share a patient’s health information with his or her family members, friends, and legal personal representatives when that patient may be in crisis and incapacitated, such as during an opioid overdose.

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10/25/2017 – Federal Health Insurance Exchange 2018 Open Enrollment

The Federal Health Insurance Exchange Open Enrollment period runs from November 1, 2017, to December 15, 2017, with coverage starting on January 1, 2018. This year the Centers for Medicare & Medicaid Services (CMS) is taking a strategic and cost-effective approach to inform individuals about Open Enrollment. CMS continues to use consumer feedback to drive improvements. Consumers can visit HealthCare.gov and CuidadodeSalud.gov to preview 2018 plans and prices before Open Enrollment begins.

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10/19/2017 – CMS Strengthens Federal Support to California Residents Affected by Wildfires

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma today announced that the agency has taken immediate steps and is monitoring conditions in support of California residents displaced and recovering from the wildfires devastating the state. On Oct. 15, 2017, Acting Health and Human Services Secretary Eric D. Hargan declared a public health emergency (PHE) in the state of California retroactive to Oct. 8, 2017. The PHE allows CMS to waive or modify certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements if necessary to provide health services.

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10/17/2017 – Care for Dialysis Patients a Key Focus of Hurricane Maria Response Efforts in Puerto Rico

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma today released additional details on the agency’s efforts in support of dialysis patients and providers in Puerto Rico. Care for these fragile patients is a top priority as are the agency’s actions to help all of those impacted by the storm. During the past few weeks, CMS has worked to ensure hospitals and other facilities can continue operations by waiving numerous Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements, and has helped individuals and doctors by creating special enrollment opportunities to access healthcare immediately and a hotline for physicians assisting with Hurricane Maria response efforts.

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10/12/2017 – Statement from Centers for Medicare & Medicaid Services Administrator Seema Verma on Signing of Executive Order

“Today’s announcement represents an important step in providing Americans with more affordable health insurance coverage options by offering relief from Obamacare’s oppressive mandates and regulations that are driving up costs and driving down the quality of their healthcare. This Executive Order will promote affordable coverage options for Americans, whether they work for small businesses, large employers, or need to purchase coverage on their own. It will empower employers to offer more affordable health coverage and to provide their employees with the opportunity to exercise greater choice and control over their healthcare.”


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10/11/2017 – Medicare Offers Improved Access to High-Quality Health Coverage Choices in 2018

Agency Releases Star Ratings for 2018 Health and Drug Plans in Advance of Medicare Open Enrollment

Today, the Centers for Medicare & Medicaid Services (CMS) released the Star Ratings for the 2018 Medicare health and drug plans. With the release of the Star Ratings, people with Medicare will have improved access to high-quality health choices for their Medicare coverage in 2018. This news comes on the heels of the recent release of the benefit and premium information for Medicare health and drug plans which shows that there will be more health coverage choices and decreased premiums in 2018.

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10/10/2017 – 2018 Medicare Electronic Health Record (EHR) Incentive Program Payment Adjustment Fact Sheet 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 (EHR) Technology. 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. The payment adjustments began on October 1, 2014 for eligible hospitals. Eligible hospitals that only participate in the Medicaid EHR Incentive Program and do not bill Medicare are not subject to these payment adjustments. Eligible hospitals that participate in both the Medicare and Medicaid EHR Incentive Programs will be subject to the payment adjustments unless they have successfully demonstrated meaningful use under one of these programs. Over 4,800 eligible hospitals may participate in the EHR Incentive Programs.

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10/10/2017 – CMS Takes Steps to Help with Hurricane Nate Emergency Response

Agency Waivers Take Effect in Alabama, Florida, Louisiana and Mississippi

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma today announced agency efforts underway to support Alabama, Florida, Louisiana and Mississippi in response to Hurricane Nate. On Oct. 8, 2017, Acting Health and Human Services Secretary Don Wright, M.D., M.P.H., declared a public health emergency in these four states. With the public health emergency in effect, CMS has taken several actions to provide immediate relief to those affected by the hurricane. The actions include temporarily waiving or modifying certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements.

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10/05/2017 – Medicare-Medicaid Accountable Care Organization (ACO) Model Updated: Request for Letters of Intent Withdrawn

After careful consideration, the Centers for Medicare & Medicaid Services (CMS) is withdrawing its Request for Letters of Intent to states to participate in the Center for Medicare and Medicaid Innovation’s Medicare-Medicaid ACO Model and will not be moving forward with implementation of the Model. CMS is withdrawing the Request for Letters of Intent because, although several states expressed early interest in the Model, CMS did not receive any letters of intent for the 2018 start date and received only one letter of intent for 2019.

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10/02/2017 – CMS Offers Broad Support for Puerto Rico and the U.S Virgin Islands with Hurricane Maria Recovery

Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma today outlined broad agency efforts underway in support of Puerto Rico and the U.S. Virgin Islands in support of the Hurricane Maria recovery efforts. CMS has taken numerous actions to help those impacted by the storm and ensure hospitals and other facilities can continue operations and provide access to care. During the past few weeks, CMS has waived numerous Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements, created special enrollment opportunities for individuals to access healthcare immediately, and helped dialysis patients obtain critical life-saving services. CMS has also created a hotline for doctors assisting with hurricane Maria recovery efforts.

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10/02/2017 – Data Show National Partnership to Improve Dementia Care Achieves Goals to Reduce Unnecessary Antipsychotic Medications in Nursing Homes

The Centers for Medicare & Medicaid Services (CMS) established the National Partnership to Improve Dementia Care in Nursing Homes in 2012. The partnership utilized a multidimensional approach which included public reporting, partnerships and state-based coalitions, research, training for providers and surveyors, and revised surveyor guidance to empower and build upon the efforts of organizations across the country. The Partnership seeks to optimize the quality of care and quality of life for residents in America’s nursing homes by improving care for all residents, especially those with dementia. While the initial focus of the partnership was on reducing the use of antipsychotic medications, the larger mission is to enhance the use of non-pharmacologic approaches and person-centered dementia care practices.

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09/29/2017 – Medicare Offers More Health Coverage Choices and Decreased Premiums in 2018

Medicare Advantage Premiums Decrease, Choices Increase, while Enrollment Hits an All-Time High

Today, the Centers for Medicare & Medicaid Services (CMS) announced that people with Medicare will have more choices and options for their Medicare coverage in 2018. As CMS releases the benefit and premium information for Medicare health and drug plans for the 2018 calendar year, the average monthly premium for a Medicare Advantage plan will decrease while enrollment in Medicare Advantage is projected to reach a new all-time high. Earlier this year, CMS announced new policies that support increased benefit flexibilities allowing Medicare Advantage plans the ability to offer innovative plans that fit the needs of people with Medicare.

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Click here to view a factsheet on Medicare Advantage and Part D in 2018


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09/27/2017 – HHS Office of Minority Health Awards $5 Million to Help Communities Address the Opioid Crisis, Childhood Obesity and Serious Mental Illness

As part of the Administration’s efforts to address the opioid epidemic, childhood obesity and serious mental illness in communities throughout the country, the Office of Minority Health (OMH) at the U.S. Department of Health and Human Services (HHS) today announced just over $5 million in new cooperative agreement awards to 15 organizations. The awards were made through the OMH Empowered Communities for a Healthier Nation Initiative (Empowered Communities Initiative), which was created to help minority and disadvantaged populations in communities disproportionately affected by the opioid epidemic, childhood obesity and serious mental illness.

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09/26/2017 – HHS Brings Medical and Public Health Relief to US Territories Recovering from Hurricanes Maria, Irma

As part of the Trump Administration’s government-wide hurricane relief efforts in impacted U.S. territories, hundreds of medical personnel from the U.S. Department of Health and Human Services are on the ground in Puerto Rico and the U.S. Virgin Islands to help survivors of Hurricanes Maria and Irma. HHS personnel have set up a medical base of operations in hard-hit San Juan following Hurricane Maria, and have begun providing care to local residents since opening the facility on Monday.

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09/26/2017 – The Contract Year (CY) 2018 Medicare-Medicaid Plan (MMP) Explanation of Benefits (EOB) models (Drug-Only and Integrated)

Click here to view Drug-Only Model

Click here to view Integrated Model


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09/22/2017 – Encounter Submission FAQs for Medicare-Medicaid Plans Participating in the Medicare-Medicaid Financial Alignment Initiative

Medicare-Medicaid Plans (MMPs) submit encounter data to CMS for all covered services. Data must be submitted on different files based on whether they are traditionally covered by Medicare vs. Medicaid (see Q1 below), and then further, by file type (see Q3 below). Please note that Prescription Drug Event data for Medicare Part D covered prescriptions must be submitted separately, per standard Medicare requirements for those data.

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09/21/2017 – CMS Announces Efforts to Support Puerto Rico and the US Virgin Islands with Hurricane Maria Emergency Response

Agency Grants Waivers and Helps Patients Evacuated Access Safe Facilities for Care

The Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma today announced the efforts that are underway to support Puerto Rico and the U.S. Virgin Islands in the wake of Hurricane Maria. After Health and Human Services Secretary Tom Price, M.D., declared new public health emergencies in Puerto Rico and the U.S. Virgin Islands this week, CMS has waived or modified certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements to provide immediate relief to those affected by the hurricane. CMS also helped patients being evacuated get access to critical life-saving services.

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09/20/2017 – 2018 Health Insurance Exchanges Issuer County Map

The Centers for Medicare and Medicaid Services today posted an update to the Health Insurance Exchanges Issuer County Map. This map is of projected issuer participation on the Health Insurance Exchanges in 2018 based on the known issuer public announcements through September 20, 2017. Participation is expected to fluctuate and does not represent actual Exchange application submissions.

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09/13/2017 – 2018 Health Insurance Exchanges Issuer County Map

The Centers for Medicare and Medicaid Services today posted an update to the Health Insurance Exchanges Issuer County Map. This map is of projected issuer participation on the Health Insurance Exchanges in 2018 based on the known issuer public announcements through September 13, 2017. Participation is expected to fluctuate and does not represent actual Exchange application submissions.

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09/13/2017 – CMS Announces Ongoing Efforts to Support Hurricane Irma Emergency Response

Agency Waives Provider Screening Requirements in U.S. Virgin Islands, Puerto Rico and Florida – The Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma issued a letter granting 14 waivers to support Florida in response to Hurricane Irma. In the wake of the historic and unprecedented hurricane, Health and Human Services Secretary Tom Price, M.D., declared a public health emergency in Florida. With the public health emergency in effect, CMS has taken several actions to provide immediate relief to those affected by the hurricane. The actions include temporarily waiving or modifying certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) requirements.

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09/07/2017 – CMS Continues Helping Texas and Louisiana with Hurricane Harvey Recovery

Agency Helps Impacted Beneficiaries with Replacement of Medical Equipment and Supplies

Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma today announced new guidance to support people who are impacted by the loss of their durable medical equipment and supplies due to Hurricane Harvey. The ongoing response from CMS is focused on helping Medicare and Medicaid beneficiaries, providers, facilities and the general public with their immediate needs and ensuring access to healthcare services and resources are not interrupted throughout the recovery.

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09/07/2017 – CMS Waives Provider Screening Requirements in TX, LA During Hurricane Harvey Recovery Efforts

The Centers for Medicare & Medicaid Services (CMS) today approved suspending certain Medicare enrollment screening requirements for healthcare providers and suppliers that are assisting with Hurricane Harvey recovery efforts in areas impacted in Texas and Louisiana.

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08/16/2017 - CMS Releases Hospice Compare Website to Improve Consumer Experiences, Empower Patients 

Today, as part of our continuing commitment to greater data transparency, Centers for Medicare & Medicaid Services (CMS) unveiled the Hospice Compare website. The site displays information in a ready-to-use format and provides a snapshot of the quality of care each hospice facility offers to its patients. CMS is working diligently to make healthcare quality information more transparent and understandable for consumers to empower them to take ownership of their health. By ensuring patients have the information they need to understand their options, CMS is helping individuals make informed healthcare decisions for themselves and their families based on objective measures of quality.

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08/16/2017 - 2018 Health Insurance Exchanges Issuer County Map

The Centers for Medicare and Medicaid Services today posted an update to the Health Insurance Exchanges Issuer County Map. This map is of projected issuer participation on the Health Insurance Exchanges in 2018 based on the known issuer public announcements through August 16, 2017. Participation is expected to fluctuate and does not represent actual Exchange application submissions.

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08/15/2017 - CMS proposes changes to the Comprehensive Care for Joint Replacement Model, cancellation of the mandatory Episode Payment Models and Cardiac Rehabilitation Incentive payment model

Proposed rule to offer greater flexibility and choice for hospitals in orthopedic care for Medicare beneficiaries

Today, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule to reduce the number of mandatory geographic areas participating in the Center for Medicare and Medicaid Innovation’s (Innovation Center) Comprehensive Care for Joint Replacement (CJR) model from 67 to 34. In addition, CMS proposes to allow CJR participants in the 33 remaining areas to participate on a voluntary basis. In this rule, CMS also proposes to make participation in the CJR model voluntary for all low volume and rural hospitals in all of the CJR geographic areas.

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08/03/2017 - CMS Approves Florida Medicaid Demonstration Under New Era of State Flexibility

Today, the Centers for Medicare & Medicaid Services (CMS) approved a five-year extension of Florida’s Managed Medical Assistance (MMA) section 1115 demonstration that allows the state to operate a capitated Medicaid managed care program and a low-income pool (LIP) to provide continuing support for the safety net providers that furnish charity care to the uninsured.

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08/02/2017 - 2018 Health Insurance Exchanges Issuer County Map

The Centers for Medicare and Medicaid Services today posted an update to the Health Insurance Exchanges Issuer County Map. This map is of projected issuer participation on the Health Insurance Exchanges in 2018 based on the known issuer public announcements through August 2, 2017. Participation is expected to fluctuate and does not represent actual Exchange application submissions.

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08/02/2017 - CMS Finalizes 2018 Payment And Policy Updates For Medicare Hospital Admissions

Final rule supports transparency, flexibility, program simplification and innovation in the Medicare program

Today, the Centers for Medicare & Medicaid Services (CMS) issued the fiscal year 2018 Medicare Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System final rule, which updates 2018 Medicare payment and policies when patients are discharged from hospitals. The final rule relieves regulatory burdens for providers, supports the patient-doctor relationship in healthcare, and promotes transparency, flexibility, and innovation in the delivery of care for Medicare patients.

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08/02/2017 - FY 2018 Medicare Payment and Policy Updates for Inpatient Psychiatric Facilities

On August 2, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a notice with comment period updating fiscal year (FY) 2018 Medicare payment policies and rates for the Inpatient Psychiatric Facilities Prospective Payment System (IPF PPS).

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08/02/2017 - Medicare Issues Projected Drug Premiums for 2018

This week, the Centers for Medicare & Medicaid Services (CMS) announced that the average basic premium for a Medicare Part D prescription drug plan in 2018 is projected to decline to an estimated $33.50 per month. This represents a decrease of approximately $1.20 below the actual average premium of $34.70 in 2017. 

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08/01/2017 - CMS Updates Medicare Payment Rates, Quality Reporting Requirements

Final rules include policies to be more responsive to patients’ needs

The Centers for Medicare & Medicaid Services (CMS) has issued three final rules outlining 2018 Medicare payment rates for skilled nursing facilities, hospice, and inpatient rehabilitation facilities. The final rules are effective for fiscal year (FY) 2018 and reflect a broader Administration strategy to streamline administrative requirements for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care.

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08/01/2017 - HHS Awards $3.2 Million for a Registry of Residents Affected by Lead Exposure in Flint, Michigan

The U.S. Department of Health and Human Services announced today that Michigan State University (MSU) will receive approximately $3.2 million to establish a registry of Flint residents who were exposed to lead-contaminated water from the Flint Water System during 2014-2015. The funds are the first installment of a 4-year, $14.4 million grant.

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07/31/2017 - Medicare Finalizes Fiscal Year 2018 Payment & Policy Changes For Skilled Nursing Facilities

On July 31, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule [CMS-1679-F] outlining Fiscal Year (FY) 2018 Medicare payment rates and quality programs for skilled nursing facilities (SNFs). Policies in the final rule continue to build on CMS’ commitment to shift Medicare payments from volume to value, with continued implementation of the SNF Value-based Purchasing (VBP) program.

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07/31/2017 - Final Fiscal Year 2018 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities (CMS-1671-F)

On July 31, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a final rule outlining fiscal year (FY) 2018 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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07/28/2017 - Release of Core Quality Measures Collaborative Pediatric Core Measure Set

Today, Centers for Medicare and Medicaid Services (CMS) is announcing the release of a Pediatric measure set as part of the Core Quality Measures Collaborative (CQMC). This set of nine measures is intended for use at the provider level for individual or groups of clinicians and is intended to add focus to quality improvement efforts, reduce the burden of reporting of quality measures, and offer consumers actionable information for decision-making.

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07/25/2017 - CMS Proposes 2018 and 2019 Payment Changes for Medicare Home Health Agencies

Proposed rule creates a more responsive home health payment system to meet patients’ needs

The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would update payment rates and the wage index for home health agencies (HHAs) serving Medicare beneficiaries in 2018 and proposes a redesign of the payment system in 2019. The Home Health Prospective Payment System (HH PPS) proposed rule is one of several proposed rules that would be effective for calendar year 2018 that reflect a broader strategy that CMS is pursuing to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care.

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07/24/2017 - Market Saturation and Utilization Data Tool

The Centers for Medicare & Medicaid Services (CMS) has developed a Market Saturation and Utilization Data Tool that includes interactive maps and a dataset that shows national-, state-, and county-level provider services and utilization data for selected health service areas. Market saturation, in the present context, refers to the density of providers of a particular service within a defined geographic area relative to the number of the beneficiaries receiving that service in the area.

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07/19/2017 - 2018 Health Insurance Exchanges Issuer County Map

The Centers for Medicare and Medicaid Services today posted an update to the Health Insurance Exchanges Issuer County Map. This map is of projected issuer participation on the Health Insurance Exchanges in 2018 based on the known issuer public announcements through July 19, 2017. Participation is expected to fluctuate and does not represent actual Exchange application submissions.

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07/16/2017 - Better Care Reconciliation Act Ensures That Low-Income Adults Receiving Medicaid Have Access To High Quality Affordable Coverage

CMS confirms that BCRA provides support for low-income Americans

The Senate’s healthcare proposal provides funding to ensure that low-income adults will have access to high quality, affordable coverage and care. The proposal provides significant new funding to states, including tax credits, a stability fund with over $180 billion that states can use to help low-income Americans purchase coverage, and $45 billion to address the opioid epidemic. This funding can be combined with states’ existing Medicaid funding to allow states to design a plan to help their low-income population purchase personal private coverage that offers more access to providers and better health outcomes.

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07/15/2017 - HHS Secretary Tom Price and CMS Administrator Seema Verma Address the Summer 2017 National Governors Association Meeting "The Future of Health Care"

Today, Health and Human Services Secretary Tom Price, M.D., and Seema Verma, Administrator of the Centers for Medicare & Medicaid Services addressed the future of healthcare at a meeting with governors at the Summer 2017 National Governors Association Meeting in Providence, Rhode Island.

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07/13/2017 - CMS Proposes 2018 Policy and Rate Changes for Hospital Outpatient, Ambulatory Surgical Center Payment Systems

Proposed rule and Request for Information promote improvements to quality, accessibility and affordability of care

The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that updates payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The proposed rule is one of several for 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility and innovation in the delivery of care. 

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07/13/2017 - CMS Proposes 2018 Payment And Policy Updates For The Physician Fee Schedule

Proposed rule & Request for Information provide flexibility, support strong patient-doctor relationships

The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would update Medicare payment and policies for doctors and other clinicians who treat Medicare patients in calendar year (CY) 2018. The proposed rule is one of several Medicare payment rules for CY 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care. 

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07/13/2017 - Medicare Trustees Report Shows Trust Fund Solvent Through 2029

Independent Payment Advisory Board is not triggered

Today, the Medicare Trustees projected that the trust fund financing Medicare’s hospital insurance coverage will be depleted in 2029, one year later than projected in last year’s report. Lower spending in 2016, lower projected inpatient hospital utilization and slightly better projected hospital insurance deficit in 2017 than in 2016 were the contributing factors to the extended solvency projection. Further, because spending levels in Medicare did not exceed its targets, the Independent Payment Advisory Board (IPAB), set up by the Patient Protection and Affordable Care Act (ACA), was not triggered.

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07/13/2017 - Proposed Policies for the Medicare Diabetes Prevention Program Expanded Model in the Calendar Year 2018 Physician Fee Schedule Proposed Rule

On July 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued the Calendar Year (CY) 2018 Physician Fee Schedule (PFS) proposed rule that would make additional proposals to implement the Medicare Diabetes Prevention Program (MDPP) expanded model starting in 2018.  The MDPP expanded model was announced in early 2016, when it was determined that the Diabetes Prevention Program (DPP) model test through the Center for Medicare and Medicaid Innovation’s Health Care Innovation Awards met the statutory criteria for expansion. Through expansion of this model test, more Medicare beneficiaries will be able to access evidence-based diabetes prevention services, potentially resulting in a lowered rate of progression to type 2 diabetes, improved health, and reduced costs.

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07/10/2017 - Fewer Issuers Apply To Participate In Health Insurance Exchanges For 2018

Less choice for consumers as issuer health plan applications drop 38 percent from last year

The Centers for Medicare & Medicaid Services (CMS) today announced 141 individual market qualified health plan (QHP) issuers submitted initial applications to offer coverage using the Federally-facilitated Exchange eligibility and enrollment platform in 2018. At the initial filing deadline last year, 227 issuers submitted an application compared to 141 this year, a 38 percent drop in filings.

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06/30/2017 - HHS Awards $15 Million To Help Families Affected By Lead Exposure In Flint, MI

The U.S. Department of Health and Human Services today announced approximately $15 million in funding for the Genesee County Healthy Start Program to provide health and social services for women, infants, and their families who have had, or are at risk for, lead exposure in Flint, Michigan and the surrounding community. The Genesee County Health Department oversees the county’s Healthy Start Program.

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06/29/2017 - Changes to the Payment Error Rate Measurement and Medicaid Eligibility Quality Control Programs (CMS-6068-F)

Today, June 29, 2017 the Centers for Medicare & Medicaid Services (CMS) posted a final rule that will publish on July 5, 2017 to implement changes to the Payment Error Rate Measurement (PERM) and Medicaid Eligibility Quality Control (MEQC) programs to reflect changes to the way states adjudicate eligibility for Medicaid and the Children’s Health Insurance Program (CHIP) required by law, as well as to implement other changes to the PERM and MEQC programs.

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06/29/2017 - CMS Proposes 2018 Policy and Payment Rate Changes for End-Stage Renal Disease Facilities

Proposed rule builds patient-centered system of care to increase competition, quality and care - The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule that would update payment policies for the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS). The ESRD PPS proposed rule is one of several for calendar year 2018 that reflect a broader strategy to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care.

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06/27/2017 - CMS Issues Updated County By County Analysis Of Current Projected Issuer Participation In Health Insurance Exchanges

Issuer participation in the Exchanges continues to decline - The Centers for Medicare & Medicaid Services (CMS) is releasing an updated county-level map of projected issuer participation on the Health Insurance Exchanges in 2018 based on the known issuer public announcements through June 27, 2017. This updated map shows that coverage choices on the Exchanges continue to disappear week to week. Plan options are projected to be down from last year and, and in the last two weeks Americans in four additional counties are projected to have no coverage options available to them on the Exchanges.

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06/20/2017 - CMS Proposes Quality Payment Program Updates To Increase Flexibility And Reduce Burdens

Proposed rule aims to simplify reporting requirements and offer support for doctors and clinicians in 2018

Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would make changes in the second year of the Quality Payment Program as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). CMS’s goal is to simplify the program, especially for small, independent, and rural practices, while ensuring fiscal sustainability and high-quality care within Medicare.

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06/14/2017 - CMS Releases 1991-2014 Health Care Spending by State

Data details health care spending for residents by service and major payer - Today, the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary (OACT) released state-level health care spending data for the period 1991-2014. The data shows that while most states experienced faster growth in 2014 due to Medicaid expansion and enrollment in Exchange plans, per capita health spending in Medicaid expansion and non-expansion states grew at similar rates. The report also found that the most recent economic recession, which ended in 2009, and modest recovery since then, had a sustained impact on health spending and health insurance coverage. Every state experienced slower growth in per capita personal health care spending from 2010-2013 than experienced during the period 2004-2009.

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06/13/2017 - County by County Analysis of Current Projected Insurer Participation in Health Insurance Exchanges

The Centers for Medicare & Medicaid Services (CMS) is releasing a county-level map of 2018 projected Health Insurance Exchanges participation based on the known issuer participation public announcements through June 9, 2017. This map shows that insurance options on the Exchanges continue to disappear. Plan options are down from last year and, in some areas, Americans will have no coverage options on the Exchanges, based on the current data.

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06/12/2017 - High Costs, Lack of Affordability Most Common Factors that Lead Consumers to Cancel Health Insurance Coverage

CMS issues two new reports on health insurance enrollment trends

Today, the Centers for Medicare & Medicaid Services (CMS) published two reports, the Effectuated Enrollment report and The Health Insurance Exchanges Trends report. These reports show that after selecting a plan on the Exchanges during open season which ended January 31, 2017, less than two months later nearly 2 million people had not paid their insurance premium to effectuate and maintain their health coverage. This number will be adjusted for individuals who effectuate their coverage in March 2017. Exit survey data also contained in the reports indicate that cost is the top reason cited for ending their coverage. Taken together, these reports provide a better understanding of why consumers are leaving the Exchanges.

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06/08/2017 - The Centers for Medicare & Medicaid Services (CMS) seeks public input on reducing the regulatory burdens of the Patient Protection and Affordable Care Act (PPACA)

The Centers for Medicare & Medicaid Services (CMS) today issued a Request for Information (RFI) seeking recommendations and input from the public on how to create a more flexible, streamlined approach to the regulatory structure of the individual and small group markets. Our goal through this process is to identify and eliminate or change regulations that are outdated, unnecessary, or ineffective; impose costs that exceed benefits; or create inconsistencies that otherwise interfere with regulatory reform initiatives and policies.

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06/05/2017 - CMS Issues Proposed Revision Requirements for Long-Term Care Facilities’ Arbitration Agreements

The Centers for Medicare & Medicaid Services (CMS) issued proposed revisions to arbitration agreement requirements for long-term care facilities. These proposed revisions would help strengthen transparency in the arbitration process, reduce unnecessary provider burden and support residents’ rights to make informed decisions about important aspects of their health care.

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05/31/2017 - HHS Announces The Move Health Data Forward Phase 3 Challenge Winners

Electronic solutions designed to help consumers share personal health data easily and securely

As part of its ongoing efforts to support the interoperable flow of health information, the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) today announced the Phase 3 – and final – winners of the Move Health Data Forward Challenge. The multi-phase challenge focused on the development of applications allowing individuals to share their personal health information safely and securely with their health care providers, family members or other caregivers.

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05/31/2017 - HHS Announces Over $70 Million In Grants To Address The Opioid Crisis

Health and Human Services Secretary Tom Price, M.D., today announced the availability of over $70 million over multiple years to help communities and healthcare providers prevent opioid overdose deaths and provide treatment for opioid use disorder, of which $28 million will be dedicated for medication-assisted treatment (MAT).

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05/30/2017 - New Medicare Cards Offer Greater Protection To More Than 57.7 Million Americans

New cards will no longer contain Social Security numbers, to combat fraud and illegal use

The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars. The new cards will use a unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI), to replace the Social Security-based Health Insurance Claim Number (HICN) currently used on the Medicare card. CMS will begin mailing new cards in April 2018 and will meet the congressional deadline for replacing all Medicare cards by April 2019. Today, CMS kicks-off a multi-faceted outreach campaign to help providers get ready for the new MBI.

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05/23/2017 - HHS REPORT: Average Health Insurance Premiums Doubled Since 2013

The Department of Health and Human Services (HHS) released a new analysis today that shows premiums have doubled for individual health insurance plans since 2013, the year before many of Obamacare’s regulations and mandates took effect. The analysis is based on data compiled by the previous Administration, and the report was produced by the Office of The Assistant Secretary for Planning and Evaluation (ASPE).

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Click here to read the report

 

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05/17/2017 - The Center For Medicare And Medicaid Services (CMS) Announces Streamlined Direct Enrollment Process For Consumers Seeking Exchange Coverage

Today, the Centers for Medicare & Medicaid Services (CMS) announced a new streamlined and simplified direct enrollment process for consumers signing up for individual market coverage through Exchanges that use HealthCare.gov. Consumers applying for individual market coverage during the upcoming open enrollment period through direct enrollment partners will now be able to complete their application using one website. This reduces needless regulatory burden for businesses that provide direct enrollment services and offers consumers easier access to healthcare comparisons and shopping experiences for coverage offered through HealthCare.gov.

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05/16/2017 - Centers for Medicare and Medicaid Services (CMS) Issues Section 1332 State Innovation Waiver Checklist

Checklist Aims to Help Stabilize State Health Insurance Markets for 2018

Today, the Centers for Medicare and Medicaid Services (CMS) released new information to help states seek waivers from requirements in the Affordable Care Act (ACA). The new tool is intended to help states complete waiver applications that allow them to establish high-risk pools/ state-operated reinsurance programs. Section 1332 waivers, generally can be used by states to opt-out of some mandated provisions under ACA.  CMS is helping to provide guidance to states who want to pursue solutions to help lower costs and increase coverage choices for Americans struggling with unaffordable premiums and reduced competition in the insurance market, brought on by the ACA. Individuals obtaining coverage in the ACA marketplace have faced double-digit premium increases and insurance issuer exits.

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05/15/2017 - Centers for Medicare and Medicaid Services Offers New Health Coverage Enrollment Option for Small Business

Today, the Centers for Medicare & Medicaid Services (CMS) announced a plan to change the way that small businesses enroll in insurance coverage through the Federal exchanges, offering employers the help they need to find affordable insurance for their employees.  The Federally-Facilitated Small Business Health Options Program (FF-SHOP) program was mandated under the Affordable Care Act (ACA), but failed to sign-up significant numbers of small employers. Out of the nearly 30 million small businesses in the country, less than 8,000, just .1 percent of small businesses currently participate in the FF-SHOPs in 33 states, which cover less than 40,000 individuals nationwide. SHOP programs are now defunct and do not provide needed insurance coverage for small businesses.

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05/09/2017 - CMS Announces Extension for States under Medicaid Home and Community-Based Settings Criteria

Agency reinforces partnership with states in administering Medicaid Program

Today, the Centers for Medicare & Medicaid Services (CMS) announced a three-year extension for state Medicaid programs to meet the Home and Community Based Services (HCBS) settings requirements for settings operating before March 17, 2014. This extension is in response to states’ request for more time to demonstrate compliance with the regulatory requirements and ensure compliance activities are collaborative, transparent, and timely.

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04/24/2017 - $2.5 Million Settlement Shows That Not Understanding HIPAA Requirements Creates Risk

The U.S. Department of Health and Human Services, Office for Civil Rights (OCR), has announced a Health Insurance Portability and Accountability Act of 1996 (HIPAA) settlement based on the impermissible disclosure of unsecured electronic protected health information (ePHI). CardioNet has agreed to settle potential noncompliance with the HIPAA Privacy and Security Rules by paying $2.5 million and implementing a corrective action plan. This settlement is the first involving a wireless health services provider, as CardioNet provides remote mobile monitoring of and rapid response to patients at risk for cardiac arrhythmias.

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04/17/2017 - Rural Community Hospital Demonstration

Updated April 2017

The Centers for Medicare & Medicaid Services (CMS) is conducting the Rural Community Hospital Demonstration Program, which was originally authorized for a 5-year period by section 410A of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), and extended for another 5-year period by sections 3123 and 10313 of the Patient Protection and Affordable Care Act (Affordable Care Act). Section 15003 of the 21st Century Cures Act, enacted December 13, 2016, again amended section 410A of the MMA to require another 5-year extension period for the demonstration.

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04/14/2017 – CMS Proposes 2018 Payment and Policy Updates for Medicare Hospital Admissions, and Releases a Request for Information

Proposed Rule Seeks Transparency, Flexibility, Program Simplification and Innovation to Transform the Medicare Program

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would update 2018 Medicare payment and policies when patients are admitted into hospitals. The proposed rule aims to relieve regulatory burdens for providers; supports the patient-doctor relationship in health care; and promotes transparency, flexibility, and innovation in the delivery of care.

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04/13/2017 – CMS Issues Final Rule to Increase Choices and Encourage Stability in Health Insurance Market for 2018

The Centers for Medicare & Medicaid Services (CMS) today issued the final Market Stabilization rule, to help lower premiums and stabilize individual and small group markets and increase choices for Americans.  Individuals obtaining coverage in the Marketplace created by the Affordable Care Act have faced double-digit premium increases, fewer plans to choose from, and a market that continues to be threatened by insurance issuer exits. The CMS rule is designed to provide some relief for patients and issuers now.

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Click here to view the final rule


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04/13/2017 – CMS Releases Quality Data Showing Racial, Ethnic and Gender Differences in Medicare Advantage Health Care during National Minority Health Month

In recognition of National Minority Health Month, the Centers for Medicare & Medicaid Services, Office of Minority Health (CMS OMH) released a pair of reports detailing the quality of care received by people enrolled in Medicare Advantage (MA). One report compares quality of care for women and men while the other report looks at racial and ethnic differences in health care experiences and clinical care, among women and men. Each April, in recognition of National Minority Health Month, CMS plans to make additional reports available online on the CMS OMH website. 

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04/13/2017 – Bulletin: Revised Timing of Submission Posting of Rate Filing Justifications for the 2017 Filing Year for ingle Risk Pool Coverage; Revised Timing of Submission for Qualified Health Plan Certification Application

On December 16, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final Unified Rate Review Bulletin: Timing of Submission and Posting of Rate Filing Justifications for the 2017 Filing Year for Single Risk Pool Coverage1, as well as the final 2018 Letter to Issuers. On February 17, 2017, CMS released a draft bulletin for comment on the proposed revised uniform timeline for submission and public release of information about rate filings for single risk pool coverage, consistent with 45 CFR Part 154. CMS separately released an Addendum to the final 2018 Letter to Issuers, which revised the timeline for the submission of Qualified Health Plan (QHP) applications for certification in the Federally-facilitated Exchanges for Plan Year 2018.

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04/13/2017 – Key Dates for Calendar Year 2017: Qualified Health Plan Certification in the Federally-facilitated Exchanges; Rate Review; Risk Adjustment, Reinsurance and Risk Corridors

Revised April 2017

The dates in Table 1 below generally supersede Table 1.1 Timeline for Qualified Health Plan (QHP) Certification in the Federally Facilitated Exchanges (FFM) on pages 7 and 8 from the 2018 Letter to Issuers released on December 16, 2016. The Centers for Medicare & Medicaid Services (CMS) released an Addendum to the 2018 Letter to Issuers to reflect the revised Plan Year 2018 QHP certification timeline consistent with Table 1 below. Table 2 reflects the revisions to the Unified Rate Review timeline, as reflected in the April 13, 2017 Bulletin: Revised Timing of Submission and Posting of Rate Filing Justifications for the 2017 Filing Year for Single Risk Pool Coverage. Table 3 includes the dates for Risk Adjustment and Reinsurance and has been updated to include key dates for Risk Corridors for the 2016 Benefit Year.
 

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04/06/2017 – CMS’ Accountable Health Communities Model Selects 32 Participants to Serve as Local ‘Hubs’ Linking Clinical and Community Services

Last year, the Centers for Medicare & Medicaid Services (CMS) released a Funding Opportunity Announcement (FOA) for applications for the Center for Medicare and Medicaid Innovation’s (Innovation Center) Accountable Health Communities (AHC) model. Over a five-year period, CMS will implement and test the three-track AHC model to support local communities in addressing the health-related social needs of Medicare and Medicaid beneficiaries by bridging the gap between clinical and community service providers. Social needs include housing instability, food insecurity, utility needs, interpersonal violence and transportation.

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04/03/2017 - CMS Finalizes 2018 Payment And Policy Updates For Medicare Health And Drug Plans, And Releases A Request For Information

Rate Announcement supports benefit flexibility, efficiency, and innovation in Medicare Advantage and Part D

The Centers for Medicare & Medicaid Services (CMS) today released final updates to the Medicare Advantage and Part D Prescription Drug Programs for 2018. Through these changes, CMS seeks to support benefit flexibility and efficiency that allows Medicare enrollees to choose the care that best fits their health needs.  “Medicare is committed to strengthening Medicare Advantage and the Prescription Drug Program by supporting flexibility and efficiency,” said CMS Administrator Seema Verma, MPH. “These programs have been successful in allowing innovative approaches that give Medicare enrollees options that best fit their individual health needs.”

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Click here to view the fact sheet

Click here to view the 2018 Rate Announcement and Call Letter


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03/21/2017 - Early Findings on Care Coordination in Capitated Medicare-Medicaid Plans under the Financial Alignment Initiative

This brief provides an overview of care coordination activities and early findings on successes and challenges of providing care coordination services for capitated model demonstrations in nine states (CA, IL, MA, MI, NY, OH, SC, and VA) implemented between October 2013 and February 2015. The brief focuses on major elements of the care coordination process, including care coordination entities and individual care coordinators, health risk assessments, individualized care plans, interdisciplinary care teams, and care coordination data systems.

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03/21/2017 - Beneficiary Experience: Early Findings from Focus Groups with Enrollees Participating in the Financial Alignment Initiative

This brief, made possible with funding from the CMS Office of Minority Health as part of the evaluation of the Financial Alignment Initiative, describes the experiences of beneficiaries who are users of long-term services and supports (LTSS) and/or behavioral health services. Focus groups were conducted between May 2015 and April 2016 and included enrollees of demonstrations in six states (CA, IL, MA, OH, VA, and WA). The brief contains findings on common themes identified by focus groups, including the experiences of racial, ethnic, and linguistic minorities. While participants’ satisfaction with the demonstrations varied, the evaluators found that experiences were generally similar across racial and ethnic groups. 

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03/21/2017 - Special Populations Enrolled in Demonstrations under the Financial Alignment Initiative

This brief, made possible with funding from the CMS Office of Minority Health, examines findings from surveys and focus groups conducted in Massachusetts and Washington from mid to late 2015 and early 2016. It describes the experiences of beneficiaries who are users of LTSS and/or behavioral health services, with a focus on the experience of racial, ethnic, and linguistic minorities. In both Massachusetts and Washington, beneficiary satisfaction did not appear to vary along racial or ethnic lines.  

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03/15/2017 - Connected Care: New Educational Initiative to Raise Awareness of Chronic Care Management 

Today, the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) and the Federal Office of Rural Health Policy at the Health Resources and Service Administration (HRSA) introduced Connected Care, an educational initiative to raise awareness of the benefits of chronic care management (CCM) services for Medicare beneficiaries with multiple chronic conditions and to provide health care professionals with support to implement CCM programs. Connected Care is a nationwide effort within fee-for-service Medicare that includes a focus on racial and ethnic minorities as well as rural populations, who tend to have higher rates of chronic disease.

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