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  • CMS Encourages Companies to Promote Quality, Affordable Health Coverage for Gig Workers

    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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  • 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...
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  • 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...
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  • 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...
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  • CMS Updates Nursing Home Guidance with Revised Visitation Recommendations

    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...
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  • 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
    ...
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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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  • Staff Reporter 1
    CMS Encourages Companies to Promote Quality, Affordable Health Coverage for Gig Workers
    by Staff Reporter 1
    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, 04:21 PM
  • Staff Reporter 1
    Centers for Medicare and Medicaid Services Data Shows Vulnerable Americans Forgoing Mental Health Care During COVID-19 Pandemic
    by Staff Reporter 1
    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, 11:25 PM
  • Staff Reporter 1
    CMS Issues Guidance on American Rescue Plan Funding for Medicaid Home and Community Based Services
    by Staff Reporter 1
    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...
    05-14-2021, 04:02 AM
  • Staff Reporter 1
    Centers for Medicare and Medicaid Services Increases Medicare Payment for COVID-19 Monoclonal Antibody Infusions
    by Staff Reporter 1
    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...
    05-07-2021, 02:28 AM
  • Staff Reporter 1
    CMS Updates Nursing Home Guidance with Revised Visitation Recommendations
    by Staff Reporter 1
    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...
    03-14-2021, 05:04 AM

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