Centers for Medicare & Medicaid Services Encourages Companies to Promote Quality, Affordable Health Coverage for Gig Workers | site |
(Information contained in Centers for Medicare & Medicaid Services press release dated: May 26, 2021)
The Centers for Medicare & Medicaid Services (CMS) is encouraging online platform companies to share information with gig workers on their ability to enroll in affordable, quality, health coverage during the 2021 Marketplace Special Enrollment Period (SEP). Digital platforms – including Delivery Drivers, Inc., DoorDash, Lyft, Postmates, StyleSeat, Uber, and Wonolo – are participating in “Gig Workers’ Week of Action” to promote Marketplace healthcare plans to their workforces.
Workers in the U.S., including those working with gig companies following COVID-19 related unemployment, may now be eligible for reduced premiums and increased savings for health insurance coverage on HealthCare.gov.
Under the American Rescue...
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CMS Encourages Companies to Promote Quality, Affordable Health Coverage for Gig Workers
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Centers for Medicare and Medicaid Services Data Shows Vulnerable Americans Forgoing Mental Health Care During COVID-19 Pandemic
Centers for Medicare and Medicaid Services Data Shows Vulnerable Americans Forgoing Mental Health Care During COVID-19 Pandemic | site |
(Information contained in Centers for Medicare and Medicaid Services press release dated: May 14, 2021)
The Centers for Medicare & Medicaid Services (CMS) released data today highlighting the continued impact the COVID-19 Public Health Emergency (PHE) is having on Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries and utilization of health services. The data show that, from March through October 2020, beneficiaries have foregone millions of primary, preventive, and mental health care visits due to the COVID-19 PHE, compared to the same time period in 2019. Although utilization rates for some treatments have rebounded to pre-pandemic levels, mental health services show the slowest rebound. This decline in utilization is occurring at a time when preliminary evidence shows menta... -
CMS Issues Guidance on American Rescue Plan Funding for Medicaid Home and Community Based Services
Centers for Medicare & Medicaid Services Issues Guidance on American Rescue Plan Funding for Medicaid Home and Community Based Services | site |
Guidance Helps States Access Additional Federal Funds for Critical Services Supporting Older Adults and Individuals with Disabilities
(Information contained in U.S. Department of Health and Human Services [HHS] press release dated: May 13, 2021) The Centers for Medicare & Medicaid Services (CMS) is issuing guidance on how states can receive enhanced funding, provided through the American Rescue Plan Act of 2021 (ARP), to increase access to home and community based services (HCBS) for Medicaid beneficiaries. These benefits provide critical services to millions of older adults and individuals with disabilities, allowing them to receive health services in their homes and communities, rather than in nursing homes and other institutions. Today’s guidance is a key tool to assist s... -
Centers for Medicare and Medicaid Services Increases Medicare Payment for COVID-19 Monoclonal Antibody Infusions
Centers for Medicare and Medicaid Services Increases Medicare Payment for COVID-19 Monoclonal Antibody Infusions | site |
New payment policy for at-home administration
(Information contained in Centers for Medicare and Medicaid Services press release dated: May 6, 2021) As part of the ongoing response to address the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) has increased the Medicare payment rate for administering monoclonal antibodies to treat beneficiaries with COVID-19, continuing coverage under the Medicare Part B COVID-19 vaccine benefit. Beneficiaries pay nothing out of pocket, regardless of where the service is furnished – including in a physician’s office, healthcare facility or at home. Effective today, the national average payment rate will increase from $310 to $450 for most health care settings. In support of providers’ efforts to prevent the spread of COVID-19, CMS will also establish... -
CMS Updates Nursing Home Guidance with Revised Visitation Recommendations
Centers for Medicare & Medicaid Services Updates Nursing Home Guidance with Revised Visitation Recommendations | site |
(Information contained in Centers for Medicare and Medicaid Services press release dated: March 10, 2021) The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), issued updated guidance today for nursing homes to safely expand visitation options during the COVID-19 pandemic public health emergency (PHE). This latest guidance comes as more than three million doses of vaccines have been administered within nursing homes, thanks in part to the CDC’s Pharmacy Partnership for Long-Term Care Program, following the U.S. Food and Drug Administration’s (FDA) authorization for emergency use of COVID-19 vaccines. According to the updated guidance, facilities should allow responsible indoor visitation at all times and for all residents, regardless of vaccination status of the reside... -
Centers For Medicare and Medicaid Services Offers Comprehensive Support to the State of Texas to Combat Winter Storm
Centers For Medicare and Medicaid Services Offers Comprehensive Support to the State of Texas to Combat Winter Storm | site |
(Information contained in Centers for Medicare and Medicaid Services [CMS] press release dated: February 22, 2021)
The Centers for Medicare & Medicaid Services (CMS) announced today that efforts are underway to support Texas in response to severe winter storms that have affected the state over the past several days. On February 17, 2021, Health and Human Services Acting Secretary Norris Cochran declared a public health emergency (PHE) for Texas retroactive to February 11, 2021. CMS is working to ensure hospitals and other facilities can continue operations and provide access to care despite the effects of the storm.
Below are key administrative actions CMS is taking in response to the PHE declared in Texas:
Waivers and Flexibilities for Hospitals and other Healthcare Facilities: CMS has... -
CMS says it Puts Patients Over Paperwork with New Rule that Addresses the Prior Authorization Process
Centers for Medicare and Medicaid Services says it puts Patients Over Paperwork with New Rule that Addresses the Prior Authorization Process | site |
(Information contained in Centers for Medicare and Medicaid Services press release dated: January 15, 2021) Today, the Centers for Medicare & Medicaid Services (CMS) finalized a signature accomplishment of the new Office of Burden Reduction & Health Informatics (OBRHI). This final rule builds on the efforts to drive interoperability, empower patients, and reduce costs and burden in the healthcare market by promoting secure electronic access to health data in new and innovative ways. These significant changes include allowing certain payers, providers and patients to have electronic access to pending and active prior authorization decisions, which should result in fewer repeated requests for prior authorizations, reducing costs and onerous administrative burden to our frontline providers. This final rule ... -
CMS Announces New Model Opportunity for Medicaid Managed Care Organizations Serving Beneficiaries Dually Eligible for Medicare and Medicaid
Centers for Medicare and Medicaid Services Announces New Model Opportunity for Medicaid Managed Care Organizations Serving Beneficiaries Dually Eligible for Medicare and Medicaid | site |
(Information contained in Centers for Medicare and Medicaid Services press release: December 17, 2020)
The Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare & Medicaid Innovation is announcing a new opportunity to enable Medicaid Managed Care Organizations (MCOs) to better serve enrollees who are dually eligible for Medicare and Medicaid. This new Model opportunity is the first CMS initiative designed to harness the power of Medicaid MCOs to coordinate Medicare and Medicaid services and improve health outcomes for the population of dually eligible beneficiaries who are in both Medicaid managed care and Medicare fee-for-service (FFS). Currently, Medicaid MCOs do not have an incentive to coordinate care in a way that reduces Medicare FFS costs f... -
CMS Announces Historic Changes to Physician Self-Referral Regulations
Centers for Medicare & Medicaid Services Announces Historic Changes to Physician Self-Referral Regulations| site |
(Information contained in Centers for Medicare & Medicaid Services press release: November 20, 2020) Today, the Centers for Medicare & Medicaid Services (CMS) finalized changes to outdated federal regulations that have burdened health care providers with added administrative costs and impeded the health care system’s move toward value-based reimbursement. The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity. The old federal regulations that interpret and implement this law were designed for a health care system that reimburses providers on a fee-for-service basis, where the financial incentives are to deliver more services. However, the 21st century American health care... -
CMS publishes Medicaid and Children’s Health Insurance Program Managed Care Final Rule Fact Sheet
Centers for Medicare and Medicaid Services publishes Medicaid and Children’s Health Insurance Program Managed Care Final Rule Fact Sheet | site |
(November 9, 2020) - - On November 9, 2020 the Centers for Medicare and Medicaid Services (CMS) published the following:
Medicaid & Children’s Health Insurance Program (CHIP) Managed Care Final Rule - CMS-2408-F
Overview The announcement of the 2020 Medicaid & CHIP Managed Care final rule highlights the Trump Administration’s continued commitment to reduce administrative burden and cut red tape, support state flexibility, and promote transparency and innovation in the Medicaid and CHIP programs for the growing number of people in Medicaid and CHIP managed care. This final rule finalizes policies from the Notice of Proposed Rule Making issued in November 2018. Based on 2018 state Medicaid and CHIP enrollment data, eighty three percent, or around 66 million people, are enrolled in... -
Centers for Medicare and Medicaid Services Releases Toolkit to Accelerate State Efforts to Rebalance Long-term Care Systems
Centers for Medicare & Medicaid Services Releases Toolkit to Accelerate State Efforts to Rebalance Long-term Care Systems and Enhance Home and Community-Based Services for Eligible Medicaid Beneficiaries | site |
(November 2, 2020) - - Today, November 2, 2020, the Centers for Medicare and Medicaid Services published the following information: The Trump Administration and Centers for Medicare & Medicaid Services (CMS) are delivering on their commitment to foster innovation in Medicaid by providing states with new tools to help beneficiaries return home from institutional settings without sacrificing safety or quality of care. Today, CMS launched a new toolkit designed for state Medicaid agencies to strengthen their infrastructure and develop robust home and community-based services (HCBS) for eligible beneficiaries. This toolkit is the latest in a series of CMS efforts to promote high quality, person-centered HCBS to safely transition older adults and individ... -
CMS’ New One-Stop Nursing Home Resource Center Assists Providers, Caregivers, Residents
Centers for Medicare & Medicaid Services New One-Stop Nursing Home Resource Center Assists Providers, Caregivers, Residents | site |
(October 30, 2020) - - The Centers for Medicare & Medicaid Services published today, October 30, 2020, the following information: Today, the Centers for Medicare & Medicaid Services (CMS) launched a new online platform - the Nursing Home Resource Center - to serve as a centralized hub bringing together the latest information, guidance and data on nursing homes that is important to facilities, frontline providers, residents and their families, especially as the fight against coronavirus disease 2019 (COVID-19) continues. Previously, individuals seeking information specific to nursing homes needed to navigate to several disparate webpages and spent valuable time looking for answers. With the onset of the COVID-19 Public Health Emergency (PHE), quick access to up-to-date information and resources, including the 24 guidance documents r... -
CMS Approves Nebraska Medicaid Demonstration to Provide Pathway to Enhanced Benefits for Eligible Adults
Centers for Medicare and Medicaid Services approves Nebraska Medicaid Demonstration to Provide Pathway to Enhanced Benefits for Eligible Adults | site |
(October 20, 2020) - - The Centers for Medicare and Medicaid Services published today, October 20, 2020, the following information:
Today, the Centers for Medicare & Medicaid Services (CMS) announced its approval of Nebraska’s new Medicaid Section 1115 demonstration called “Heritage Health Adult.” This demonstration is designed to create a pathway for certain Nebraska adults with newly gained Medicaid coverage to access additional benefits if they participate in certain activities to promote health and independence. This demonstration is effective October 20, 2020, through March 31, 2026, with implementation beginning April 1, 2021.
“Governor Ricketts and his team deserve credit for responding to President Trump’s invitation to design innovative state-led solutions that promote... -
Trump Administration Drives Telehealth Services in Medicaid and Medicare
Trump Administration Drives Telehealth Services in Medicaid and Medicare | site |
(October 14, 2020) - - The Centers for Medicare and Medicaid Services published today, October 14, 2020, the following information: Today, the Centers for Medicare & Medicaid Services (CMS) expanded the list of telehealth services that Medicare Fee-For-Service will pay for during the coronavirus disease 2019 (COVID-19) Public Health Emergency (PHE). CMS is also providing additional support to state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their efforts to expand access to telehealth. The actions reinforce President Trump’s Executive Order on Improving Rural Health and Telehealth Access to improve the health of all Americans by increasing access to better care. “Responding to President Trump’s Executive Order, CMS is taking action to increase telehealth adoption across the country,” said CMS Administrator Seema Verma. “Medicaid patients should not be ... -
U.S. Centers for Medicare and Medicaid Services Updates COVID-19 Testing Methodology for Nursing Homes
U.S. Centers for Medicare and Medicaid Services Updates COVID-19 Testing Methodology for Nursing Homes | site |
(September 29, 2020) - - The United States Centers for Medicare & Medicaid Services published today, September 29, 2020, the following information: Today, the Centers for Medicare & Medicaid Services (CMS) announced an update to the methodology the agency employs to determine the rate of coronavirus disease 2019 (COVID-19) positivity in counties across the country. Counties with 20 or fewer tests over 14 days will now move to “green” in the color-coded system of assessing COVID-19 community prevalence. Counties with both fewer than 500 tests and fewer than 2,000 tests per 100,000 residents, and greater than 10 percent positivity over 14 days – which would have been “red” under the previous methodology – will move to “yellow.” This information is critical to nursing homes, which are required to test their staff for COVID-19 at a freque...
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Centers for Medicare & Medicaid Services Encourages Companies to Promote Quality, Affordable Health Coverage for Gig Workers | site |
(Information contained in Centers for Medicare & Medicaid Services press release dated: May 26, 2021) The Centers for Medicare & Medicaid Services (CMS) is encouraging online platform companies to share information with gig workers on their ability to enroll in affordable, quality, health coverage during the 2021 Marketplace Special Enrollment Period (SEP). Digital platforms – including Delivery Drivers, Inc., DoorDash, Lyft, Postmates, StyleSeat, Uber, and Wonolo – are participating in “Gig Workers’ Week of Action” to promote Marketplace healthcare plans to their workforces. Workers in the U.S., including those working with gig companies following COVID-19 related unemployment, may now be eligible for reduced premiums and increased savings for health insurance coverage on HealthCare.gov. Under the American Rescue...05-27-2021, 11:21 AM -
Centers for Medicare and Medicaid Services Data Shows Vulnerable Americans Forgoing Mental Health Care During COVID-19 Pandemic | site |
(Information contained in Centers for Medicare and Medicaid Services press release dated: May 14, 2021)
The Centers for Medicare & Medicaid Services (CMS) released data today highlighting the continued impact the COVID-19 Public Health Emergency (PHE) is having on Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries and utilization of health services. The data show that, from March through October 2020, beneficiaries have foregone millions of primary, preventive, and mental health care visits due to the COVID-19 PHE, compared to the same time period in 2019. Although utilization rates for some treatments have rebounded to pre-pandemic levels, mental health services show the slowest rebound. This decline in utilization is occurring at a time when preliminary evidence shows menta...05-15-2021, 06:25 PM -
Centers for Medicare & Medicaid Services Issues Guidance on American Rescue Plan Funding for Medicaid Home and Community Based Services | site |
Guidance Helps States Access Additional Federal Funds for Critical Services Supporting Older Adults and Individuals with Disabilities
(Information contained in U.S. Department of Health and Human Services [HHS] press release dated: May 13, 2021) The Centers for Medicare & Medicaid Services (CMS) is issuing guidance on how states can receive enhanced funding, provided through the American Rescue Plan Act of 2021 (ARP), to increase access to home and community based services (HCBS) for Medicaid beneficiaries. These benefits provide critical services to millions of older adults and individuals with disabilities, allowing them to receive health services in their homes and communities, rather than in nursing homes and other institutions. Today’s guidance is a key tool to assist s...05-13-2021, 11:02 PM -
Centers for Medicare and Medicaid Services Increases Medicare Payment for COVID-19 Monoclonal Antibody Infusions | site |
New payment policy for at-home administration
(Information contained in Centers for Medicare and Medicaid Services press release dated: May 6, 2021) As part of the ongoing response to address the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) has increased the Medicare payment rate for administering monoclonal antibodies to treat beneficiaries with COVID-19, continuing coverage under the Medicare Part B COVID-19 vaccine benefit. Beneficiaries pay nothing out of pocket, regardless of where the service is furnished – including in a physician’s office, healthcare facility or at home. Effective today, the national average payment rate will increase from $310 to $450 for most health care settings. In support of providers’ efforts to prevent the spread of COVID-19, CMS will also establish...05-06-2021, 09:28 PM -
Centers for Medicare & Medicaid Services Updates Nursing Home Guidance with Revised Visitation Recommendations | site |
(Information contained in Centers for Medicare and Medicaid Services press release dated: March 10, 2021) The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), issued updated guidance today for nursing homes to safely expand visitation options during the COVID-19 pandemic public health emergency (PHE). This latest guidance comes as more than three million doses of vaccines have been administered within nursing homes, thanks in part to the CDC’s Pharmacy Partnership for Long-Term Care Program, following the U.S. Food and Drug Administration’s (FDA) authorization for emergency use of COVID-19 vaccines. According to the updated guidance, facilities should allow responsible indoor visitation at all times and for all residents, regardless of vaccination status of the reside...03-13-2021, 11:04 PM -
Centers For Medicare and Medicaid Services Offers Comprehensive Support to the State of Texas to Combat Winter Storm | site |
(Information contained in Centers for Medicare and Medicaid Services [CMS] press release dated: February 22, 2021)
The Centers for Medicare & Medicaid Services (CMS) announced today that efforts are underway to support Texas in response to severe winter storms that have affected the state over the past several days. On February 17, 2021, Health and Human Services Acting Secretary Norris Cochran declared a public health emergency (PHE) for Texas retroactive to February 11, 2021. CMS is working to ensure hospitals and other facilities can continue operations and provide access to care despite the effects of the storm.
Below are key administrative actions CMS is taking in response to the PHE declared in Texas:
Waivers and Flexibilities for Hospitals and other Healthcare Facilities: CMS has...02-25-2021, 04:14 AM -
Centers for Medicare and Medicaid Services says it puts Patients Over Paperwork with New Rule that Addresses the Prior Authorization Process | site |
(Information contained in Centers for Medicare and Medicaid Services press release dated: January 15, 2021) Today, the Centers for Medicare & Medicaid Services (CMS) finalized a signature accomplishment of the new Office of Burden Reduction & Health Informatics (OBRHI). This final rule builds on the efforts to drive interoperability, empower patients, and reduce costs and burden in the healthcare market by promoting secure electronic access to health data in new and innovative ways. These significant changes include allowing certain payers, providers and patients to have electronic access to pending and active prior authorization decisions, which should result in fewer repeated requests for prior authorizations, reducing costs and onerous administrative burden to our frontline providers. This final rule ...01-18-2021, 11:17 PM -
Centers for Medicare and Medicaid Services Announces New Model Opportunity for Medicaid Managed Care Organizations Serving Beneficiaries Dually Eligible for Medicare and Medicaid | site |
(Information contained in Centers for Medicare and Medicaid Services press release: December 17, 2020)
The Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare & Medicaid Innovation is announcing a new opportunity to enable Medicaid Managed Care Organizations (MCOs) to better serve enrollees who are dually eligible for Medicare and Medicaid. This new Model opportunity is the first CMS initiative designed to harness the power of Medicaid MCOs to coordinate Medicare and Medicaid services and improve health outcomes for the population of dually eligible beneficiaries who are in both Medicaid managed care and Medicare fee-for-service (FFS). Currently, Medicaid MCOs do not have an incentive to coordinate care in a way that reduces Medicare FFS costs f...12-18-2020, 01:21 PM -
Centers for Medicare & Medicaid Services Announces Historic Changes to Physician Self-Referral Regulations| site |
(Information contained in Centers for Medicare & Medicaid Services press release: November 20, 2020) Today, the Centers for Medicare & Medicaid Services (CMS) finalized changes to outdated federal regulations that have burdened health care providers with added administrative costs and impeded the health care system’s move toward value-based reimbursement. The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity. The old federal regulations that interpret and implement this law were designed for a health care system that reimburses providers on a fee-for-service basis, where the financial incentives are to deliver more services. However, the 21st century American health care...11-20-2020, 10:17 PM -
Centers for Medicare and Medicaid Services publishes Medicaid and Children’s Health Insurance Program Managed Care Final Rule Fact Sheet | site |
(November 9, 2020) - - On November 9, 2020 the Centers for Medicare and Medicaid Services (CMS) published the following:
Medicaid & Children’s Health Insurance Program (CHIP) Managed Care Final Rule - CMS-2408-F
Overview The announcement of the 2020 Medicaid & CHIP Managed Care final rule highlights the Trump Administration’s continued commitment to reduce administrative burden and cut red tape, support state flexibility, and promote transparency and innovation in the Medicaid and CHIP programs for the growing number of people in Medicaid and CHIP managed care. This final rule finalizes policies from the Notice of Proposed Rule Making issued in November 2018. Based on 2018 state Medicaid and CHIP enrollment data, eighty three percent, or around 66 million people, are enrolled in...11-16-2020, 01:32 AM -
Centers for Medicare & Medicaid Services Releases Toolkit to Accelerate State Efforts to Rebalance Long-term Care Systems and Enhance Home and Community-Based Services for Eligible Medicaid Beneficiaries | site |
(November 2, 2020) - - Today, November 2, 2020, the Centers for Medicare and Medicaid Services published the following information: The Trump Administration and Centers for Medicare & Medicaid Services (CMS) are delivering on their commitment to foster innovation in Medicaid by providing states with new tools to help beneficiaries return home from institutional settings without sacrificing safety or quality of care. Today, CMS launched a new toolkit designed for state Medicaid agencies to strengthen their infrastructure and develop robust home and community-based services (HCBS) for eligible beneficiaries. This toolkit is the latest in a series of CMS efforts to promote high quality, person-centered HCBS to safely transition older adults and individ...11-05-2020, 11:35 AM -
Centers for Medicare & Medicaid Services New One-Stop Nursing Home Resource Center Assists Providers, Caregivers, Residents | site |
(October 30, 2020) - - The Centers for Medicare & Medicaid Services published today, October 30, 2020, the following information: Today, the Centers for Medicare & Medicaid Services (CMS) launched a new online platform - the Nursing Home Resource Center - to serve as a centralized hub bringing together the latest information, guidance and data on nursing homes that is important to facilities, frontline providers, residents and their families, especially as the fight against coronavirus disease 2019 (COVID-19) continues. Previously, individuals seeking information specific to nursing homes needed to navigate to several disparate webpages and spent valuable time looking for answers. With the onset of the COVID-19 Public Health Emergency (PHE), quick access to up-to-date information and resources, including the 24 guidance documents r...10-31-2020, 03:27 AM -
Centers for Medicare and Medicaid Services approves Nebraska Medicaid Demonstration to Provide Pathway to Enhanced Benefits for Eligible Adults | site |
(October 20, 2020) - - The Centers for Medicare and Medicaid Services published today, October 20, 2020, the following information:
Today, the Centers for Medicare & Medicaid Services (CMS) announced its approval of Nebraska’s new Medicaid Section 1115 demonstration called “Heritage Health Adult.” This demonstration is designed to create a pathway for certain Nebraska adults with newly gained Medicaid coverage to access additional benefits if they participate in certain activities to promote health and independence. This demonstration is effective October 20, 2020, through March 31, 2026, with implementation beginning April 1, 2021.
“Governor Ricketts and his team deserve credit for responding to President Trump’s invitation to design innovative state-led solutions that promote...10-22-2020, 06:20 PM -
Trump Administration Drives Telehealth Services in Medicaid and Medicare | site |
(October 14, 2020) - - The Centers for Medicare and Medicaid Services published today, October 14, 2020, the following information: Today, the Centers for Medicare & Medicaid Services (CMS) expanded the list of telehealth services that Medicare Fee-For-Service will pay for during the coronavirus disease 2019 (COVID-19) Public Health Emergency (PHE). CMS is also providing additional support to state Medicaid and Children’s Health Insurance Program (CHIP) agencies in their efforts to expand access to telehealth. The actions reinforce President Trump’s Executive Order on Improving Rural Health and Telehealth Access to improve the health of all Americans by increasing access to better care. “Responding to President Trump’s Executive Order, CMS is taking action to increase telehealth adoption across the country,” said CMS Administrator Seema Verma. “Medicaid patients should not be ...10-16-2020, 09:06 PM -
U.S. Centers for Medicare and Medicaid Services Updates COVID-19 Testing Methodology for Nursing Homes | site |
(September 29, 2020) - - The United States Centers for Medicare & Medicaid Services published today, September 29, 2020, the following information: Today, the Centers for Medicare & Medicaid Services (CMS) announced an update to the methodology the agency employs to determine the rate of coronavirus disease 2019 (COVID-19) positivity in counties across the country. Counties with 20 or fewer tests over 14 days will now move to “green” in the color-coded system of assessing COVID-19 community prevalence. Counties with both fewer than 500 tests and fewer than 2,000 tests per 100,000 residents, and greater than 10 percent positivity over 14 days – which would have been “red” under the previous methodology – will move to “yellow.” This information is critical to nursing homes, which are required to test their staff for COVID-19 at a freque...10-03-2020, 11:17 PM -
Centers for Medicare and Medicaid Services Announces Innovative Payment Model to Improve Care, Lower Costs for Cancer Patients | site |
(September 18, 2020) - - The Centers for Medicare and Medicaid Services published today (September 18, 2020) the following information:
Today, the Centers for Medicare & Medicaid Services (CMS) finalized a new Innovation Center model expected to improve the quality of care for cancer patients receiving radiotherapy and reduce Medicare expenditures through bundled payments that allow providers to focus on delivering high-quality treatments. The new Radiation Oncology (RO) Model allows this focus on value-based care by creating simpler, more predictable payments that incentivize cost-efficient and clinically effective treatments to improve quality and outcomes. The RO Model, part of a final rule on specialty care models issued by CMS, will begin on January 1, 2021 and is estimated to save Medicare $230 million over...09-21-2020, 06:16 PM -
Centers for Medicare and Medicaid Services posts Guidance for Implementing New Testing Requirements in Nursing Homes and Labs | site |
(August 26, 2020) - - The Centers for Medicare & Medicaid Services published today (August 26, 2020) the following information:
Today, the Centers for Medicare & Medicaid Services (CMS) released guidance for nursing homes and clinical laboratories to assist in enhancing their abilities to prevent the spread of the coronavirus disease 2019 (COVID-19) to nursing home residents and their front line staff.
Nursing homes are particularly vulnerable to the prevalence and spread of COVID-19. CMS continues to take proactive steps to enhance infection control policies, including practices that limit potential transmission, and prevent outbreaks within these facilities to protect residents. Today’s guidance requires all nursing homes to test all residents and staff for COVID-19. A new survey...08-31-2020, 08:21 AM -
Centers for Medicare and Medicaid Services Announces Actions to Address Spread of Coronavirus| site |
CMS calls on all health care providers to activate infection control practices and issues guidance to inspectors as they inspect facilities affected by Coronavirus
(March 4, 2020) - - Today, the Centers for Medicare and Medicaid Services published the following information: Today, the Centers for Medicare & Medicaid Services (CMS) is announcing several actions aimed at limiting the spread of the Novel Coronavirus 2019 (COVID-19). Specifically, CMS is issuing a call to action to health care providers across the country to ensure they are implementing their infection control procedures, which they are required to maintain at all times. Additionally, CMS is announcing that, effective immediately and, until further notice, State Survey Agencies and Accrediting Organizations will focus their facility inspections...03-05-2020, 03:17 AM -
Centers for Medicare and Medicaid Services Office of the Actuary Releases 2018 National Health Expenditures | site |
(December 5, 2019) - - Today, the U.S. Office of Medicare and Medicaid Services published the following information: Total national healthcare spending in 2018 grew 4.6 percent, which was slower than the 5.4 percent overall economic growth as measured by Gross Domestic Product (GDP), according to a study conducted by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) and published today ahead of print by Health Affairs. As a result, the share of the economy devoted to health spending decreased from 17.9 percent in 2017 to 17.7 percent in 2018. Growth in overall healthcare spending has averaged 4.5 percent for 2016-2018, slower than the 5.5 percent average growth for 2014-2015, that was affected by expanded Medicaid and private insurance coverage and increased spending for prescription drugs, particularly for drugs ...12-06-2019, 04:48 PM -
Centers for Medicare and Medicaid Services discuss Delay of Inclusion of Territories in Medicaid Drug Rebate Program; Covered Outpatient Drug Interim Final Rule (CMS 2345-IFC3) | site |
(November 21, 2019) - - Today (November 21, 2019), the Centers for Medicare & Medicaid Services published the following information:
Delay of Inclusion of Territories in Medicaid Drug Rebate Program; Covered Outpatient Drug Interim Final Rule (CMS 2345-IFC3) On February 1, 2016, the Centers for Medicare & Medicaid Services (CMS) published the “Medicaid Program; Covered Outpatient Drug” Final Rule with Comment Period (CMS-2345-FC) in the Federal Register (81 FR 5170). As part of that final rule with comment period, we amended the regulatory definitions of “States” and “United States” to include the U.S. Territories (American Samoa, the Commonwealth of the Northern Mariana Islands, Guam, the Commonwealth of Puerto Rico, and the U.S. Virgin Islands) beginning A...11-30-2019, 03:54 AM -
Remarks by Medicare and Medicaid Administrator Seema Verma at the Alliance for Connected Care Telehealth Policy Forum for Health Systems
(November 15, 2018) - - Today, the Centers for Medicare and Medicaid Services (CMS) published the following "Remarks by Administrator Seema Verma at the Alliance for Connected Care Telehealth Policy Forum for Health Systems":
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...11-15-2018, 11:40 PM -
Centers for Medicare and Medicaid Services 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
(November 8, 2018) - - 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...11-10-2018, 11:35 PM -
Centers for Medicare and Medicaid Services 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
(October 23, 2018) - - 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...10-26-2018, 01:31 AM -
Centers for Medicare and Medicaid Services Administrator Seema Verma Statement on Burden Reduction Accomplishments
(October 17, 2018) - - The Centers for Medicare and Medicaid Services Administrator Seema Verma's Statement on Burden Reduction Accomplishments: “I would like to thank President Trump for his leadership and commitment to reducing burdensome federal regulations and Secretary Azar’s action to moving our healthcare system towards providing value for patients. CMS will continue our efforts to eliminate unnecessary regulations that take providers away from patients and stifle innovation. Every hour saved from reducing needless administrative burden is an hour more that our healthcare system can spend improving Americans’ health outcomes, and every duplicative requirement we eliminate saves patients and taxpayers money. Upon taking office, President Trump made reducing burdensom...10-18-2018, 08:35 PM -
U. S. Centers for Medicare and Medicaid Services 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
(October 9, 2018) - - 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. The Model participants include 832 Acute Care Hospitals and 715 Physician Group Practices – a total of 1,547 Medicare providers a...10-10-2018, 10:41 AM -
Centers for Medicare and Medicaid Services Announces New Streamlined User Experience for Medicare Beneficiaries
(October 1, 2018) - - 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. The eMedicare initiative’s goal is to provide a seamless online health care experience to meet the growing expectations for this generation of Medicare beneficiaries. CMS has a cohesive, multi-year strategy of consumer data integration and web product development to modernize Medicare.gov and improve access to p...10-04-2018, 02:13 AM -
Centers for Medicare and Medicaid Services Continues Efforts to help with Hurricane Florence Emergency Response
Agency waivers take effect in Virginia
(September 14, 2018) - - 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...09-15-2018, 10:02 PM -
Centers for Medicare and Medicaid Services Streamlines Medicaid Review Process, Achieves Significant Reduction in Approval Times
(August 16, 2018) - - 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. “With faster processing times and earlier communication, states now have much greater ability to manage their programs in an effective and predictable manner,” said CMS Administrator Seema Verma. “We want to ease bureaucratic requirement...08-22-2018, 09:41 PM -
Centers for Medicare and Medicaid Services Proposes “Pathways to Success,” an Overhaul of Medicare’s ACO Program
(August 9, 2018) - - Today, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would overhaul the Medicare Shared Savings Program, which is the program established by the Affordable Care Act and launched in 2012 under which the vast majority of Medicare’s Accountable Care Organizations (ACOs) operate. The redesigned program is called “Pathways to Success.” ACOs are groups of health care providers that agree to take responsibility for the total cost and quality of care for their patients. In return, ACOs receive a portion of the savings they achieve, and CMS provides them with waivers to provide the regulatory relief needed to innovate. 10.5 million beneficiaries in Fee-for-Service Medicare (of the 38 million total Fee-f...08-14-2018, 09:39 AM -
Centers for Medicare and Medicaid Services 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
(August 8, 2018) - - 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. “Today’s proposed rule continues our effort to help stabilize the individual and small group markets,” said CMS Administrator Seema Verma. “Our goal has been, and will continue to be, to stabilize the market and provide American consumers with more affordable health cove...08-08-2018, 10:21 PM -
Centers for Medicare & Medicaid Services 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
(May 17, 2018) - - 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. In Part D, Medicare pays prescription drug plans to cover medicines, which beneficiaries buy at a pharmacy. Gag clauses are provisions in contracts that insurance plans and their pharmacy benefit managers enter into with p...05-17-2018, 11:03 PM -
Centers for Medicare & Medicaid Services Reveals New Medicare Card Design
Removing Social Security numbers strengthens fraud protections for about 58 million Americans
(September 4, 2017) - - Today, the Centers for Medicare & Medicaid Services (CMS) gave the public its first look at the newly designed Medicare card. The new Medicare card contains a unique, randomly-assigned number that replaces the current Social Security-based number. CMS will begin mailing the new cards to people with Medicare benefits in April 2018 to meet the statutory deadline for replacing all existing Medicare cards by April 2019. In addition to today’s announcement, people with Medicare will also be able to see the design of the new Medicare card in the 2018 Medicare & You Handbook. The handbooks are being mailed and will arrive throughout September. “The goal of the initiative to re...04-10-2018, 10:16 AM -
U.S. Department of Health and Human Services Secretary Tom Price Committed to Greater Medicaid Flexibility for States
Washington, DC - - (March 10, 2017) - - Health and Human Services Secretary Tom Price, M.D., issued the following statement today committing the U.S. Department of Health and Human Services (HHS) to using its regulatory authority to create greater flexibility in the Medicaid program for states. The Trump Administration has announced a three-pronged approach to repealing and replacing Obamacare – which includes HHS providing essential regulatory relief. “Our states know best how to care for their citizens – particularly their most vulnerable populations who receive healthcare coverage under Medicaid. Pursuant to the vision put forward by President Trump, the Department of Health and Human Services will be committed to doing everything within our authority to provide our nation’s governors and state legislatures with greater flexibility...03-10-2017, 12:21 PM -
Centers for Medicare & Medicaid Services Issues Proposed Rule to Increase Patients’ Health Insurance Choices for 2018
March 1, 2017
(February 15, 2017) - - The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule for 2018, which proposes new reforms that are critical to stabilizing the individual and small group health insurance markets to help protect patients. This proposed rule would make changes to special enrollment periods, the annual open enrollment period, guaranteed availability, network adequacy rules, essential community providers, and actuarial value requirements; and announces upcoming changes to the qualified health plan certification timeline. “Americans participating in the individual health insurance markets deserve as many health insurance options as possible,” said Dr. Patrick Conway, Acting Administrator of the Centers for Medicare & Medicaid Services. “This proposal will take steps ...03-01-2017, 12:44 AM -
Centers for Medicare & Medicaid Services Awards Approximately $100 Million to Help Small Practices Succeed in the Quality Payment Program
New helpline launched to provide additional support
March 1, 2017
(February 17, 2017) - - Today, the Centers for Medicare & Medicaid Services (CMS) awarded approximately $20 million to 11 organizations for the first year of a five-year program to provide on-the-ground training and education about the Quality Payment Program for clinicians in individual or small group practices of 15 clinicians or fewer. CMS intends to invest up to an additional $80 million over the remaining four years.
These local, experienced, community-based organizations will provide hands-on training to help thousands of small practices, especially those that practice in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved...03-01-2017, 12:19 AM -
Centers for Medicare & Medicaid Services Authors and Releases 2016-2025 Projections of National Health Expenditures Data
February 21, 2017
Washington, DC - - (February 15, 2017) - - National health expenditure growth is expected to average 5.6 percent annually over 2016-2025, according to a report published today as a ‘Web First’ by Health Affairs and authored by the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary (OACT). These projections are constructed using a current-law framework and do not assume potential legislative changes over the projection period. National health spending growth is projected to outpace projected growth in Gross Domestic Product (GDP) by 1.2 percentage points. As a result, the report also projects the health share of GDP to rise from 17.8 percent in 2015 to 19.9 percent by 2025. Growth in national health expenditures over this period is largely influenced by projected faster growth in m...02-21-2017, 09:02 PM