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  • 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 ...
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  • 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...
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  • CMS Announces Historic Changes to Physician Self-Referral Regulations

    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...
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  • 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...
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  • 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...
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  • 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...
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  • 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
    ...
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  • Trump Administration Drives Telehealth Services in Medicaid and Medicare

    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 ...
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  • 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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  • CMS Announces Innovative Payment Model to Improve Care, Lower Costs for Cancer Patients

    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...
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  • Centers for Medicare and Medicaid Services posts Guidance for Implementing New Testing Requirements in Nursing Homes and Labs

    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
    ...
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  • Centers for Medicare and Medicaid Services Announces Actions to Address Spread of Coronavirus

    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...
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  • Centers for Medicare and Medicaid Services Office of the Actuary Releases 2018 National Health Expenditures

    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
    ...
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  • 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

    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
    ...
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  • Remarks by Administrator Seema Verma at the Alliance for Connected Care Telehealth Policy Forum for Health Systems

    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...
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  • Staff Reporter 1
    CMS says it Puts Patients Over Paperwork with New Rule that Addresses the Prior Authorization Process
    by Staff Reporter 1
    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 ...
    01-19-2021, 05:17 AM
  • Staff Reporter 1
    CMS Announces New Model Opportunity for Medicaid Managed Care Organizations Serving Beneficiaries Dually Eligible for Medicare and Medicaid
    by Staff Reporter 1
    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, 07:21 PM
  • Staff Reporter 1
    CMS Announces Historic Changes to Physician Self-Referral Regulations
    by Staff Reporter 1
    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...
    11-21-2020, 04:17 AM
  • Staff Reporter 1
    CMS publishes Medicaid and Children’s Health Insurance Program Managed Care Final Rule Fact Sheet
    by Staff Reporter 1
    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, 07:32 AM
  • Staff Reporter 1
    Centers for Medicare and Medicaid Services Releases Toolkit to Accelerate State Efforts to Rebalance Long-term Care Systems
    by Staff Reporter 1
    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, 05:35 PM

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