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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 care a reality by building it on a foundation of innovation.

    At CMS, we’ve been working to lay that foundation, including through supporting innovation in health care on many levels. Its part of our larger vision of moving to a system that is value based—that rewards value over volume by bringing the best to patients. When we start paying for value, we will foster innovation as providers look for ways to compete for patients by providing the highest quality care at the lowest cost.

    We understand that relentless innovation is a crucial driver in creating value across all industries. As Thomas Edison noted, “There’s always a way to do it better—find it.” Healthcare, of course, is no exception.

    Over the past several decades, thanks to improved diagnostic and therapeutic treatments and tools, healthcare has witnessed a myriad of innovations that have brought value, extended our lives, improved them, and created efficiencies in the healthcare system.

    Healthcare innovation is in fact serving as a catalyst to improving quality of care, enhancing access to care, increasing efficiency in the system, and lowering healthcare costs.

    Take the history of knee replacement surgery, for example. Not long ago, knee replacement surgery always required a multi-day hospital stay, and then a lengthy and often painful rehab.

    Today, a patient experiences an entirely different scenario:
    • Innovations in anesthetics have allowed total knee replacement to become outpatient surgery for some patients.
    • Replacement knees, custom-designed through a 3-D scanning and printing process, are allowing some patients to walk shortly after waking up from surgery, which speeds recovery and reduces pain.
    • And doctors can now use a 3D model of a knee taken by a CAT scan to guide a robotic arm during surgery and spare as much of the patient's healthy bone and surrounding tissue as possible.

    We’re also now seeing the same kind of benefits as more surgeries—including full knee replacements—are being moved to the outpatient setting. And some surgeries that used to require hospital care can now safely be done in ambulatory surgery centers. Innovations in the procedures itself resulted in better patient outcomes, and the ability to provide care in a lower-cost and more convenient setting. This is a prime example of how leaning in to technology can better health outcomes, lower costs, and drive efficiencies. And while some technology is specific to healthcare, some is not—such as our ubiquitous smart phones. But healthcare is also leveraging such technology. Innovation is also giving patients more choices – and improving their overall quality of life. When I travelled to California, I saw driverless cars on the road. With driverless technology, older adults could continue to live in their homes late into life. For example, In Japan, rural communities are populated by an increasingly older set of residents, as younger Japanese citizens move to cities. This is leading to a shortage of transportation workers. But driverless technology is slated to eventually address this exact problem, allowing seniors to remain in their homes and communities, using the cars to deliver meals. Technology is also connecting patients to their doctors, even outside of the hospital setting, with devices like new glucose monitors—which we just approved—that can continually monitor vital signs and relay them to a practitioner. When I recently visited the Cleveland Clinic, I saw firsthand innovative ways to use remote patient monitoring from a central hospital command center. Their model uses a “mission control” operation where off-site personnel use sensors and high-definition cameras to monitor patients and assimilate data to trigger on-site intervention. The Cleveland Clinic is also sending paramedics to seniors’ homes and connecting them virtually to doctors, which means doctors can see more patients in less time. This type of approach can dramatically increase efficiency and improve clinical outcomes. Additionally, when remote patient monitoring systems can send live-time data back to clinicians, adjustments to medication can be made for patients with hypertension, or diabetes, as soon as it’s clear these chronic conditions aren’t being controlled through a patient’s prescribed regimen. Wearable technology is also providing new data streams. Patients can wear a watch that tracks their heart rate and can identify irregular heart rhythm, and may be able to perform an EKG, and doctors get insight into what’s going on with their patients outside the exam room. This is truly a whole new world of healthcare. Technological innovations in healthcare have impacted me at a very personal level. You may have already heard my story about my husband’s near death experience last year. Thanks to the bystanders and the medical team that treated him, he was able to survive a very serious cardiac episode. But even before he got the hospital, there at the airport was a defibrillator – and that defibrillator bought us time to get him to that great care. It’s just another great example of technological innovation saving lives. But taking it a step further, maybe we could have predicted his cardiac arrest before it happened if his electronic watch, or some other novel device, had been compiling information about his activities, his heart rate, his breathing, as well as other data – and sending it to his doctor. Ultimately, that’s an illustration of both the current power and the future promise of innovation in healthcare. Undoubtedly, innovation is the fuel that powers the engine of progress and creativity. And while we’re on track for healthcare costs to represent one out of every five dollars of American GDP by 2026, it’s technology that will help ensure the sustainability of our healthcare system. Fostering innovation is a priority for me, and an example is our focus on interoperability through the MyHealthEdata initiative. The MyHealthEdata Initiative, led by Jared Kushner and the White House Office of Innovation, takes a comprehensive approach to ensuring that patients control their health information throughout their healthcare journey. CMS is committed to moving this system forward. The reality is that once information is freely flowing from the patient to the provider, it will help to spur innovation in the entire digital health information ecosystem…and the advances in coordinated, value-based and patient-centric care will be even greater than anything we can imagine today. Imagine if patients could authorize access to their records to researchers from all over the country who could not only develop specific treatments for their needs, but the researchers could also use that information to develop cures that could save millions of lives, like what the National Institutes of Health and ONC, are doing with their Sync for Science program. In order to achieve this vision, machine interoperability must also be addressed. Earlier this year, I visited the Center for Medical Interoperability in Nas...
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  • Centers for Medicare and Medicaid Services Proposes Changes to Streamline and Strengthen Medicaid and CHIP Managed Care Regulations

    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 unnecessarily prescriptive and as adding unnecessary costs and administrative burden to state Medicaid programs without contributing to the improvement of health outcomes.

    As part of CMS’ broader efforts to reduce administrative burden, CMS formed a working group with the National Association of Medicaid Directors (NAMD) and state Medicaid Directors to create a framework to review and prioritize areas of concern within the managed care regulations. Together the working group reviewed and analyzed the regulation to identify opportunities to achieve a better balance between appropriate federal oversight and state flexibility, while also maintaining critical beneficiary protections, ensuring fiscal integrity, and promoting accountability for providing quality of care for Medicaid beneficiaries.

    “Today’s action fulfills one of my earliest commitments to reset and restore the federal-state relationship, while at the same time modernizing the program to deliver better outcomes for the people we serve,” said CMS Administrator Seema Verma. “I want to thank the state workgroup and the CMS team for their diligent work in analyzing these complex regulations and coming forward with a common sense approach to right-size our regulatory oversight and let states focus more on delivering quality health care to their beneficiaries.”

    Managed care is a system where states contract with private health plans to administer Medicaid benefits. Over two thirds (68.1 percent) of all Medicaid beneficiaries were enrolled in comprehensive managed care in 2016, up from 65.5 percent in 2015. As states continue to expand their use of comprehensive managed care to deliver Medicaid services, enrollment in comprehensive managed care reached 54.6 million beneficiaries in 2016. The more states continue moving new populations into managed care that have traditionally received their benefits through Medicaid fee-for-service.

    To reduce state administrative burden and enhance the ability of states to effectively manage s their Medicaid and CHIP programs, these key proposed revisions to the 2016 final rule would include:
    • Promoting Flexibility
      • Providing states with greater flexibility to develop and certify a rate range under specific conditions and limitations, including that the rate range be actuarially sound;
      • Removing barriers that made it difficult to transition new services and populations into managed care because of existing fee-for-service payment arrangements by providing states with a three year transition period to come into compliance with requirements related to pass-through payments;
      • Providing states more flexibility to set meaningful network adequacy standards using quantitative standards that can take into account new service delivery models like telehealth;
      • Removing outdated and overly prescriptive administrative requirements that govern how plans communicate with beneficiaries to better align with standards used across federal programs and enable the use of modern means of electronic communication when appropriate.
    • Strengthening Accountability
      • Requiring CMS to hold ourselves accountable to issue guidance to help states move more quickly through the federal rate review process and to allow for submission of less documentation in certain circumstances while providing appropriate oversight to ensure patient protections and fiscal integrity;
      • Maintaining the requirement for states to develop a Quality Rating System (QRS) for health plans to facilitate beneficiary choice and promote transparency, but with greater ability for states to tailor an alternative QRS to their unique program while requiring a minimum set of mandatory measures to align with the Medicaid and CHIP Scorecard.
    • Maintaining and Enhancing Program Integrity
      • Maintaining the current regulatory framework for program and fiscal integrity, including provisions related to the actuarial soundness of rate setting, provider screening and enrollment standards, and medical loss ratio (MLR) standards;
      • Strengthening federal requirements to protect federal taxpayers from cost shifting by prohibiting states from retroactively adding or modifying risk-sharing mechanisms and ensuring that differences in reimbursement rates are not linked to enhanced federal match.
    Additionally, states expressed their concerns with how the 2016 final rule’s limitation of 15 days on lengths of stay for managed care beneficiaries in an institution for mental disease (IMD) created difficult administrative challenges for states. CMS is not proposing any changes to this requirement at this time; however, it is asking for comment from states for data that could support revisions to this policy. Meanwhile, CMS continues to support state flexibility through section 1115 demonstrations, having approved a total of 15 waivers of the IMD exclusion for states to treat patients with substance use disorder (SUD), to expand access to treatment, and is exploring further options remove barriers to important treatment options.

    "Targeted improvements to the managed care rule have been a top priority for Medicaid Directors,” said Board President of NAMD, Judy Mohr Peterson. “NAMD appreciates the partnership shown by CMS to explore these issues and dialogue with the states, providing an opportunity to share perspectives on how the managed care regulatory framework could be improved. We look forward to reviewing CMS's proposed revisions and submitting formal comments."

    To view a summary of the proposed changes, visit at And to view the proposed rule, visit the Federal Register at: Comments on the proposed rule are due January 14, 2019.

    For more information, you can refer to the fact sheet here:

    Credit: Centers for Medicare and Medicaid Services...
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  • Centers for Medicare and Medicaid Services Model Addresses Opioid Misuse among Expectant and New Mothers

    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 quality of care and reduce expenditures for mothers and infants.

    “Too many barriers impede the delivery of well-coordinated, high-quality care to pregnant and postpartum women struggling with opioid misuse, including lack of access to treatment and a shortage of providers in rural areas, where the opioid crisis is especially destructive,” said HHS Secretary Alex Azar. “The MOM model will support state Medicaid agencies, front-line providers and healthcare systems to help ensure that mothers and infants afflicted by the opioid epidemic get the care they need.”

    Substance use-related illness and death is now a leading cause of maternal death. Pregnant and postpartum women who misuse substances are at high risk for poor maternal outcomes, including preterm labor and complications related to delivery; these problems are frequently exacerbated by malnourishment, interpersonal violence, and other health-related social needs. Infants exposed to opioids before birth are at greater risk for negative health outcomes such as higher risk of being born preterm, having a low birth weight, and experiencing the effects of neonatal abstinence syndrome (NAS), a group of conditions caused when an infant withdraws from certain drugs s/he is exposed to in the womb. In addition, Medicaid pays the largest portion of hospital charges for maternal substance use, as well as a majority of the $1.5 billion annual cost of NAS.

    The primary goals of the model are to:
    • Improve quality of care and reduce expenditures for pregnant and postpartum women with OUD as well as their infants;
    • Increase access to treatment, service-delivery capacity, and infrastructure based on state-specific needs; and
    • Create sustainable coverage and payment strategies that support ongoing coordination and integration of care.

    The CMS Innovation Center will execute up to 12 cooperative agreements with states, whose Medicaid agencies will implement the model with one or more “care-delivery partners” in their communities. The MOM model will serve pregnant Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries with OUD who have elected to participate, during the prenatal, peripartum (i.e., surrounding labor and delivery), and postpartum periods. Awardees will be responsible for ensuring that beneficiaries participating in the model have access to a set of essential physical and behavioral health services, such as medication-assisted treatment (MAT) for OUD, maternity care, relevant primary care services, and other mental and behavioral health services beyond MAT.

    The MOM model will have a five-year period of performance with different types of funding. Specifically, implementation funding, transition funding, and the opportunity for milestone funding will be provided in three distinct model periods: Pre-implementation (Year 1), Transition (Year 2), and Full Implementation (Years 3-5).

    Care delivery will begin in Year 2, or the Transition Period, of the model. During this year, funding for care-delivery services that are not otherwise covered by Medicaid will be provided by Innovation Center funds. By Year 3, the start of the Full Implementation Period, states must implement coverage and payment strategies. This overall structure seeks to balance rapid model initiation and state flexibility, while minimizing administrative burden. In particular, the MOM model design supports each awardee’s ability to quickly begin delivering coordinated and integrated care to pregnant and postpartum women with OUD during the Transition Period, while supporting states in developing a long-term coverage and payment strategy that aligns with their state Medicaid program.

    CMS anticipates releasing a Notice of Funding Opportunity (NOFO) in early 2019 to solicit cooperative agreement applications to implement the MOM model. The state Medicaid agency will be expected to complete the application, which must demonstrate that it has partnered with at least one care-delivery partner. A maximum of $64.6 million will be available across up to 12 state awardees over the course of the five-year model. The NOFO will contain all model requirements and eligibility criteria for potential applicants.

    In August, CMS announced the Integrated Care for Kids (InCK) Model, a child-centered local service delivery and state payment model aimed at reducing expenditures and improving the quality of care for children covered by Medicaid and CHIP through prevention, early identification, and treatment of priority health concerns like behavioral health challenges, including substance abuse. The model will empower states and local providers to better address these needs through care integration across all types of healthcare providers. CMS anticipates releasing a NOFO for the InCK Model at the same time as it does for the MOM Model.

    For more information, please visit or the fact sheet:

    Credit: Centers for Medicare and Medicaid Services...
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  • Centers for Medicare and Medicaid Services Administrator Seema Verma Statement on Burden Reduction Accomplishments

    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 burdensome regulations across the federal government a top priority, establishing his 'Cut The Red Tape Initiative.' At CMS, we took this directive and created our 'Patients Over Paperwork Initiative' last year. For 2018 through 2021, CMS projects final rules and current proposals under the Patients Over Paperwork initiative will eliminate more than 53 million hours of burden for providers and save our healthcare system close to $5.2 billion.”

    Credit: Centers for Medicare and Medicaid Services
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  • U. S. Centers for Medicare and Medicaid Services Announces Participants in New Value-Based Bundled Payment Model

    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 and suppliers, located in 49 states plus Washington, D.C. and Puerto Rico. Of note, BPCI Advanced qualifies as an Advanced Alternative Payment Model (Advanced APM) under MACRA, so participating providers can be exempted from the reporting requirements associated with the Merit-Based Incentive Payment System (MIPS).

    “To accelerate the value-based transformation of America’s healthcare system, we must offer a range of new payment models so providers can choose the approach that works best for them,” said CMS Administrator Seema Verma. “The Bundled Payments for Care Improvement – Advanced model was the Trump Administration’s first Advanced Alternative Payment Model, and today we are proud to announce robust participation. We look forward to launching additional models that will provide an off-ramp to the inefficient fee-for-service system and improve quality and reduce costs for our beneficiaries.”

    Under the traditional fee-for-service payment system, Medicare pays providers and suppliers for each individual service they perform. However, under this new episode payment model, participants can earn an additional payment if all expenditures for a beneficiary’s episode of care are less than a spending target, which factors in measures of quality. Conversely, if the expenditures exceed the target price, the participant must repay money to Medicare.

    The BPCI Advanced Model was publicly announced in January 2018, and runs from October 1, 2018 through December 31, 2023. It builds on the Bundled Payments for Care Improvement (BPCI) Initiative, which ended on September 30, 2018.

    Some key differences between the BPCI initiative and the new BPCI Advanced Model are:
    • BPCI Advanced offers bundled payments for additional clinical episodes beyond those that were included in BPCI, including – for the first time – outpatient episodes.
    • BPCI Advanced provides participants with preliminary target prices before the start of each model year to allow for more effective planning. The target prices are the amount CMS will pay for episodes of care under the model.
    • BPCI Advanced qualifies as an Advanced APM. Participating clinicians assume risk for patients’ healthcare costs and also meet other requirements including meeting quality thresholds, potentially qualifying them for incentive payments and exempting them from the MIPS program.
    BPCI Advanced will initially include 32 bundled clinical episodes - 29 inpatient and 3 outpatient. Currently, the top three clinical episodes selected by participants are: Major joint replacement of the lower extremity, congestive heart failure, and sepsis.

    Today, CMS also released the fifth evaluation report for Models 2-4 of the original BPCI Initiative. To view the report, please use this link -

    To view the accompanying “Findings At-A-Glance” document for the BPCI Initiative Models 2-4 fifth evaluation report, please use this link -

    The BPCI Initiative had encouraging results. CMS designed the BPCI Advanced Model taking into account evaluation results and lessons learned from other Innovation Center models, industry experience with bundled payment, and stakeholder input from healthcare providers at acute care hospitals, physician group practices, and other providers and suppliers.

    For more information about the BPCI Advanced Model, please visit:

    Credit: Centers for Medicare and Medicaid Services...
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  • Centers for Medicare and Medicaid Services Announces New Streamlined User Experience for Medicare Beneficiaries

    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 and improve access to personal health care data. The road map for this program will enhance opportunities to go digital, offer additional self-serve options, and create a seamless multi-channel customer service experience.

    “Since day one, President Trump has been committed to strengthening the Medicare program—eMedicare puts his leadership into action by giving Medicare beneficiaries a simpler, more intuitive customer experience,” CMS Administrator Seema Verma said. “Our intent is not to replace traditional channels that beneficiaries trust and depend on, but to improve and enhance them with the emerging digital options to create a user-centered, seamless consumer experience.”

    Some of the new eMedicare initiatives that CMS is launching ahead of Medicare Open Enrollment are:
    • An improved coverage wizard to help beneficiaries compare options at a deeper level as a way to decide if Original Medicare or Medicare Advantage is right for them;
    • A stand alone, mobile optimized out of pocket cost calculator that will provide information on both overall costs and prescription drug costs;
    • A simplified log in for the Medicare Plan Finder ( tool using their online account (instead of the current process of entering 5 pieces of information to authenticate);
    • A webchat option, which will be available within the Medicare Plan Finder for some beneficiaries; and
    • New easy to use surveys available across so beneficiaries can continue to tell us what they want.
    These changes are building on previous improvements including:
    • Giving beneficiaries the ability to print their Medicare card online;
    • Re-designing the homepage for easier navigation;
    • Launching consumer-facing Blue Button ( features in;
    • Providing an online version of the Medicare & You Handbook ( in a mobile-friendly format. We’ve also added simple, graphical explanations at the beginning of the Medicare & You handbook;
    • Improving email communications. Medicare emails more than 8 million beneficiaries with information about Open Enrollment, preventive benefits, money saving tips, and fraud prevention.
    • Enhancing social media presence—Medicare’s Facebook page ( has grown to almost a half-million followers;
    • Distributing the electronic version of the Medicare Summary Notice, allowing people with Medicare to view their explanation of benefits in a more timely manner online at (; and
    • The eMedicare initiative will expand and improve upon current consumer service options. People with Medicare will continue to have access to paper copies of the Medicare & You handbook and the Medicare Summary Notice.
    CMS launched the initiative with a new video ( that includes insights from Medicare beneficiaries on what they expect from Medicare and remarks from Administrator Verma outlining her vision for modernized program. Approximately 10,000 people join Medicare each day. The Medicare population is expected to increase to more than 80 million beneficiaries in 2030, up from 54 million in 2015. As of 2016, about two-thirds of Medicare beneficiaries indicate they use the Internet daily or almost daily (65%).

    Read a blog about eMedicare: .

    Source: U.S. Centers for Medicare and Medicaid Services...
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  • CMS Continues Efforts to help with Hurricane Florence Emergency Response

    in News

    CMS Continues Efforts to help with Hurricane Florence Emergency Response

    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 life-saving services.

    “We are concerned for the residents of Virginia and, as Hurricane Florence continues to batter the east coast, we are making sure that CMS has policies in place to help support all that are impacted,” CMS Administrator Seema Verma said. “The waivers that are now in effect in Virginia will give healthcare providers, facilities, and suppliers the flexibility to provide continued access to care during this storm. We will continue to monitor the effects of the hurricane and work closely with officials in Virginia.”

    Below are key administrative actions CMS has taken in response to the PHE declared in Virginia:
    • Waivers for Hospitals and other Healthcare Facilities: CMS has temporarily waived or modified certain Medicare, Medicaid, and CHIP requirements. CMS issued a number of blanket waivers, listed on the website below, and the CMS Regional Offices have granted other provider-specific requests for specific types of hospitals and other facilities in Virginia. These waivers work to provide continued access to care for beneficiaries. For more information on the waivers CMS granted, visit:
    • Special Enrollment Opportunities for Hurricane Victims: CMS has made available special enrollment periods for all Medicare beneficiaries and certain individuals seeking health plans offered through the Federal Health Insurance Exchange. This gives people impacted by the hurricane the opportunity to change their Medicare health and prescription drug plans and gain access to health coverage on the Exchange immediately if eligible for the special enrollment period. For more information on these special enrollment periods, visit:
    • Disaster Preparedness Toolkit for State Medicaid Agencies: CMS developed an inventory of Medicaid and CHIP flexibilities and authorities available to states in the event of a disaster. For more information and to access the toolkit, visit:
    • Dialysis Care: CMS is helping patients obtain access to critical life-saving services. The Kidney Community Emergency Response (KCER) program has been activated ahead of the storm and is working with Quality Insights Renal Network 5, ESRD NW 5, to assess the status of dialysis facilities in the potentially impacted areas related to generators, alternate water supplies, education and materials for patients, and more. They are also assisting patients who have evacuated ahead of the storm to receive dialysis services in the location to which they are evacuating. Patients have been educated to have an emergency supply kit on hand including important personal, medical, and insurance information; contact information for their facility, the ESRD NW hotline number, and contact information of those with whom they may stay or for out-of-state contacts in a water proof bag. They have also been instructed to have on hand supplies to follow a three-day emergency diet. The ESRD NW toll-free hotline is 866-651-6272 and the KCER hotline is 866-901-3773. Additional information is available on the NW’s website at or the KCER website
    • Medical equipment and supplies replacements: CMS temporarily suspended certain requirements necessary for Medicare beneficiaries who have lost or realized damage to their durable medical equipment, prosthetics, orthotics, and supplies as a result of the hurricane. This will help to make sure that beneficiaries can continue to access the needed medical equipment and supplies they rely on each day. Medicare beneficiaries can contact 1-800-MEDICARE (1-800-633-4227) for assistance.
    • Suspension of Enforcement Activities: CMS will suspend current survey and enforcement activities for healthcare facilities in Virginia, but will continue to investigate allegations of immediate threat to patient health and safety.
    • Ensuring Access to Care in Medicare Advantage and Part D. During a public health emergency, Medicare Advantage Organizations and Part D Plan sponsors must take steps to maintain access to covered benefits for beneficiaries in affected areas. These steps include allowing Part A/B and supplemental Part C plan benefits to be furnished at specified non-contracted facilities and waiving, in full, requirements for gatekeeper referrals where applicable.
    CMS will continue to work with all geographic areas impacted by Hurricane Florence. We encourage beneficiaries and providers of healthcare services that have been impacted to seek help by visiting CMS’ emergency webpage (

    To read previous updates regarding HHS activities related to it hurricane response and recovery, visit

    Courtesy: The Centers for Medicare and Medicaid Services...
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  • Centers for Medicare and Medicaid Services Streamlines Medicaid Review Process, Achieves Significant Reduction in Approval Times

    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 requirements for both states and our own staff so that we can focus those resources on improving health outcomes rather than pushing paperwork.”

    When states want to make changes to their Medicaid programs, they require approval from CMS. Typically these changes occur through a SPA or section 1915 waiver – even for simple updates, which sometimes require states to endure a months-long federal review process, thus creating a substantial burden for both states and CMS.

    At the end of 2017, CMS issued a bulletin announcing an initiative to revamp these processes, highlighting four specific improvements: 1) a call with states within 15 days of receipt of each submission to review the state’s request and any critical timelines to help expedite the review process; 2) launch of new tools available to states to facilitate the development of complete submissions; 3) implementation of a strategy to reduce a significant backlog of state requests and 4) expanding the use of MACPro, a web-based system for processing requests.

    Today, CMS is following up with a new bulletin that highlights the successes of implementing the above strategies, outlines two additional long-term process improvements CMS is implementing, and highlights specific enhancements made to the review process for SPAs and 1915 waivers. Through extensive collaboration with states on this effort, CMS has achieved the following:
    • Between calendar year 2016 and the first quarter of 2018, a 23 percent decrease in the median approval time for Medicaid SPAs.
    • Eighty-four percent of Medicaid SPA were approved within the first 90-day review period in the first quarter of 2018, a 20 percent increase over calendar year 2016.
    • Between calendar year 2016 and the first quarter of 2018, median approval times for HCBS waivers decreased by 7 percent. HCBS renewal approval times decreased by 38 percent and amendment approval times decreased by 44 percent for long-term care services.
    To achieve this success, CMS undertook a significant effort to understand current processes and collaborated closely with states to understand where there was room for improvement and identify solutions. A work group was formed between CMS and representatives from over a dozen states and representatives of their national associations. The combined focus by both CMS and states on SPA and 1915 waiver processing and implementation of improvement strategies is proving successful.

    “We are appreciative of CMS for reaching out to state agencies for feedback on an improved process for 1915(c) HCBS Waiver applications and amendments and for responding so quickly to address issues identified through that engagement. States have reported that the new practice by CMS to call states within 15 days of a submission has been very beneficial, resulting in better applications and faster approvals” said Mary Lee Fay, Executive Director of the National Association of State Directors of Developmental Disabilities Services (NASDDDS).

    Courtesy: The Centers for Medicare and Medicaid Services
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  • Centers for Medicare and Medicaid Services Proposes “Pathways to Success,” an Overhaul of Medicare’s ACO Program

    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-for-Service beneficiaries) are in a Shared Savings Program ACO.

    “President Trump has promised the American people better healthcare at a lower cost, and delivering this kind of value is a key priority for HHS,” said HHS Secretary Alex Azar. “One piece of our vision for value-based transformation is pioneering bold new payment models. Having more Accountable Care Organizations take on real risk, while offering them the flexibility they need to generate savings, is an important step forward in how Medicare pays for value.”

    “After six years of experience, the time has come to put real ‘accountability’ in Accountable Care Organizations. Medicare cannot afford to support programs with weak incentives that do not deliver value,” said CMS Administrator Seema Verma. “ACOs can be an important component of a system that increases the quality of care while decreasing costs; however, most Medicare ACOs do not currently face any financial consequences when costs go up, and this has to change.”

    CMS recognizes the timing issues associated with the implementation of any final policies and the need for organizations to make decisions about participation in an ACO track. To that end, CMS proposes a 6-month extension for current ACOs whose agreements expire at the end of 2018, along with a special one-time July 1, 2019 start date that will have a spring 2019 application period for the new participation options.

    Pathways to Success was developed based on a comprehensive analysis of the performance of ACOs to date. Despite the program’s intent, the Shared Savings Program has shown increases in net spending for CMS and taxpayers, in part because the majority of ACOs – 460 of the 561 or 82% of all ACOs in the Shared Savings Program in 2018 – are not taking on risk for increases in costs. Data on ACO performance to date has shown that ACOs that are not at risk for cost increases end up increasing Medicare spending in aggregate. Pathways to Success is designed to move in a new direction and advance five goals: Accountability, Competition, Engagement, Integrity, and Quality. The projected financial impact of the proposal would be savings to Medicare of $2.2 billion over ten years.

    Accountability and Competition

    Under the current Shared Savings Program, ACOs have up to six years without taking on risk, while being granted waivers from certain federal requirements. These ACOs receive a shared savings payment from CMS when they keep costs down, but they do not have to pay taxpayers back when costs are high.

    This opportunity for bonus payments if spending is low without any risk of losses if spending goes up – along with the provision of waivers – may be encouraging market consolidation. Such consolidation reduces choices for patients and can ultimately increase costs. Therefore, in response to President Trump’s Executive Order Promoting Healthcare Choice and Competition and in order to drive value, CMS proposes reducing the amount of time that an ACO can remain in the program without taking on risk down to, at most, two years.

    CMS will continue to provide technical assistance to ACOs and support the sharing of best practices through collaboratives. But after six years of experience, the program must evolve to deliver value.

    Beneficiary Engagement

    CMS’s proposal puts the patient in the driver’s seat and provides them with the information they need to make decisions about their care. In Pathways to Success, CMS proposes to require that beneficiaries receive a notification at their first primary care visit of a performance year informing them that they are in an ACO and explaining what that means for their care. To bolster beneficiary engagement, CMS proposes to allow certain ACOs under performance-based risk to provide incentive payments to patients for taking steps to achieve good health.


    As providers take on increasing accountability, CMS intends to reward them by increasing flexibility. Pathways to Success includes proposed changes which would leverage new CMS authorities under the Bipartisan Budget Act of 2018, such as allowing physicians in ACOs that take on risk to receive payment for telehealth services provided to patients regardless of the patient’s location – including at their place of residence. This new flexibility will expand access to high-quality services in a manner that is convenient for patients.

    As part of the Administration’s broader MyHealthEData initiative, this proposed rule promotes interoperability and patient control of their medical data by proposing a new requirement around ACO adoption of the 2015 edition of Certified EHR Technology (CEHRT). And as part of the Administration’s broader Meaningful Measures initiative to reduce burden, the proposal aims to streamline the measures that ACOs are required to report, to ensure that all measures have a meaningful impact on patient care.


    CMS intends to ensure that ACO spending targets accurately reflect spending levels and growth rates in their local market. Therefore, Pathways to Success proposes incorporating regional spending into ACO targets earlier, starting during an ACO’s first agreement period. In addition, the proposal would authorize termination of ACOs with multiple years of poor financial performance.

    For more information regarding Medicare Shared Savings Program Notice of Proposed Rulemaking (CMS-1701-P), “Accountable Care Organizations‑‑Pathways to Success,” please visit and .

    Courtesy: Centers for Medicare and Medicaid Services...
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  • Centers for Medicare and Medicaid Services issues Proposed Additional Rule to Address Risk Adjustment Program for the 2018 Benefit Year

    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 coverage options.”

    On February 28, 2018, the United States District Court for the District of New Mexico issued a decision vacating the use of statewide average premium in the HHS-operated risk adjustment methodology for the 2014 – 2018 benefit years. The government requested the court reconsider its decision and is currently awaiting the court’s ruling.

    This proposed rule further explains the justification for utilizing statewide average premium in the calculation of risk adjustment transfers, and expands on the reasoning behind operating the HHS-operated risk adjustment program in a budget-neutral manner. CMS seeks comment on the proposal to use statewide average premium in the risk adjustment methodology for the 2018 benefit year.

    Previously, CMS issued a final rule which adopted the risk adjustment methodology that CMS formerly established for transfers related to the 2017 benefit year, so that HHS could continue operation of the program to maintain stability and predictability in the individual and small group health insurance markets. However, the rule only allows for the program to continue for the 2017 benefit year. The rule proposed today would allow the program to continue for the 2018 benefit year.

    Courtesy: Centers for Medicare and Medicaid Services
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  • U.S. Department of the Treasury Publishes Fact Sheet - - - Social Security and Medicare Trustees Report

    U.S. Department of the Treasury Publishes Fact Sheet - - - Social Security and Medicare Trustees Report

    Fact Sheet: Social Security and Medicare Trustees Report

    Washington, DC - - (June 5, 2018) - - Today the Social Security and Medicare Boards of Trustees issued their annual financial review of the programs.

    The projections indicate that income is sufficient to pay full scheduled benefits until 2026 for Medicare’s Hospital Insurance program, 2032 for Social Security’s Disability Insurance program, and until 2034 for Social Security’s Old Age and Survivors Insurance program. The Supplementary Medical Insurance (SMI) Trust Fund remains adequately financed throughout the projection period, but only because SMI has unlimited access to general revenues.

    The Trustees project that Medicare costs will grow from approximately 3.7 percent of GDP in 2017 to 5.8 percent of GDP by 2038, and will increase gradually thereafter to about 6.2 percent of GDP by 2092. The costs of the Social Security program equaled 4.9 percent of GDP in 2017 and are expected to rise to 6.1 percent of GDP by 2038, decline to 5.9 percent of GDP by 2052, and then rise slowly to 6.1 percent of GDP by 2092.


    The Social Security program consists of the Old-Age and Survivors Insurance (OASI) Trust Fund and the Disability Insurance (DI) Trust Fund. The Trustees project that the hypothetical combined Trust Funds will be depleted in 2034. The 75-year actuarial deficit for the combined trust funds is estimated at 2.84 percent of taxable payroll, up very slightly from 2.83 percent of taxable payroll estimated in last year’s Report. This reflects a 0.06 percentage point worsening due to extending the projection period and valuation date one year, and a 0.04 percentage point improvement due to new data and improved projection methods.

    While the projections for the combined Trust Funds are essentially unchanged from last year, the near-term projections for the DI Trust Fund are more favorable and the near-term projections for the OASI trust fund are less favorable. It is now projected that the DI will have sufficient funds to pay full scheduled benefits until 2032, four later than projected last year, and that the OASI trust fund will have sufficient funds to pay full scheduled benefits through to 2034, one year earlier than last year. This is the third year in a row that the near term DI cost outlook has appreciably improved, reflecting a continuing favorable experience for DI applications and benefit awards.

    Social Security’s total cost is projected to exceed its total income (including interest) in 2018 for the first time since 1982, and to remain higher throughout the projection period.


    Medicare has two Trust Funds: the Hospital Insurance (HI) Trust Fund and the Supplementary Medical Insurance (SMI) Trust Fund. The Trustees project that the HI Trust Fund will pay full scheduled benefits until 2026, three years earlier than projected in last year’s report. After the HI trust fund is depleted in 2026, the share of scheduled benefits that can be paid from dedicated revenues is 91 percent for the remainder of 2026, declines slowly to 78 percent in 2039, and then rises gradually to 85 percent in 2092.

    The 75-year actuarial deficit in the HI Trust Fund is projected at 0.82 percent of taxable payroll, up from 0.64 percent projected in last year’s report.

    The changed outlook for HI is attributable to adverse changes in both program income and costs. HI income is projected to be lower than last year’s estimates due to lower payroll taxes attributable to lowered wages in 2017 and lower levels of projected GDP, and reduced income from the taxation of Social Security benefits as a result of legislation. HI expenditures are expected to be higher than last year’s estimates due to higher-than anticipated spending in 2017, legislation that increases hospital spending, and higher Medicare Advantage payments.

    The SMI Trust Fund, which includes Medicare Part B and Medicare Part D, remains adequately financed into the future due to financing being derived from general revenues and beneficiary premiums. The aging population and rising health care costs cause SMI projected costs to grow steadily from 2.1 percent of GDP in 2017 to approximately 3.6 percent of GDP in 2037, and to then increase more slowly to 3.9 percent of GDP by 2092. About three-quarters of these costs will be financed from general revenues, and the remaining will be financed from premiums paid by beneficiaries.

    After the Reports are transmitted to Congress, the Social Security report and the Medicare report will be posted at:

    Social Security Report

    Medicare Report

    Courtesy: U.S. Department of the Treasury
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  • Centers for Medicare and Medicaid Services Sends Clear Message to Plans - - - Stop Hiding Information from Patients

    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 pharmacies. These clauses prevent pharmacists from telling patients when they could pay less for a drug by paying cash, instead of billing their insurance and paying the required copay or deductible.

    “President Trump and Secretary Azar are committed to lowering drug prices, and CMS today took another important step to help patients who are feeling the pain,” said CMS Administrator Seema Verma. “Many patients don’t know that some drugs are actually more expensive when they use their insurance. What’s worse is that some pharmacy benefits managers are preventing pharmacists from telling patients when this is happening, because they get a share of the transaction when the patient uses their insurance. Today we are taking a significant step towards bringing full transparency to all the back-end deals that are being made at the expense of patients.”

    A copy of the letter that was sent to all Part D Plan Sponsors today is included below, and to learn more about the President’s blueprint to lower prescription drug costs, please visit: .

    To view Unacceptable Pharmacy Gag Clauses letter click here

    Courtesy: U.S. Centers for Medicare and Medicaid Services
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  • CMS Drives Patient-Centered Care over Paperwork in Proposals to Modernize Medicare and Reduce Burden

    CMS Drives Patient-Centered Care over Paperwork in Proposals to Modernize Medicare and Reduce Burden

    Centers for Medicare & Medicaid Services (CMS) proposed rules would advance administrative burden reduction, Medicare modernization, and the Meaningful Measures Initiative

    (April 27, 2018) - - Today, the Centers for Medicare & Medicaid Services (CMS) proposed transformative changes to the payment systems for services furnished by a range of medical facilities. The agency’s proposed payment rules also set out to continue to modernize Medicare through innovation in skilled nursing facility payment to drive value, advance meaningful quality measure reporting, and reduce paperwork and administrative costs.

    “We envision all elements of CMS’ healthcare delivery system working to reward value over volume and decisively focus on patients receiving quality care from their Medicare benefits,” said Administrator Seema Verma. “For skilled nursing facilities, we are taking important steps through proposed payment improvements that will reduce administrative burden, and foster innovation to improve care and quality for patients. As people face rising healthcare costs in other clinical settings, we need to leverage advances in technology that help to modernize our programs in a way that benefits patients.”

    The proposed payment rules issued today will update Medicare policies and rates under the Skilled Nursing Facilities Prospective Payment System (SNF PPS), Inpatient Rehabilitation Facilities Prospective Payment System (IRF PPS), Hospice Wage Index and Payment Rate Update, and Inpatient Psychiatric Facility Prospective Payment System (IPF PPS). These payment policy proposals for Fiscal Year 2019 further advance the agency’s priority of creating a patient-driven healthcare system that fosters innovation of efficient and accountable programs while removing waste, fraud, and abuse.

    As part of the SNF PPS, the agency is proposing a Patient Driven Payment Model (PDPM), an innovative new system for SNF payment that ties payment to patients’ conditions and care needs rather than volume of services provided. PDPM would simplify complicated paperwork requirements for performing patient assessments by significantly reducing reporting burden, savings facilities approximately $2.0 billion over 10 years. The proposed new PDPM is designed to improve the incentives to treat the needs of the whole patient, instead of focusing on the volume of services the patient receives, which requires substantial paperwork to track over time. This approach advances CMS’ efforts to build a patient-driven healthcare system beginning with innovation throughout Medicare’s payment systems. Under the new SNF PPS case-mix model, patients will have more opportunity to choose a skilled nursing facility that offers services tailored to their condition and preferences, as the payment to nursing homes will be more based on the patient’s condition rather than the specific services provided by each skilled nursing facility.

    In the proposed rules announced today, the agency is also responding to comments from stakeholders and seeking to incorporate its Patients over Paperwork Initiative through avenues that reduce unnecessary burden on providers by easing documentation requirements and offering more flexibility. In SNF settings, the proposed new case-mix model, PDPM, is designed to improve the incentives to treat the needs of the whole patient, instead of focusing on the volume of services the patient receives. Today’s IRF PPS rule reflects advances in telecommunications technology and would remove obstacles that may prevent rehabilitation physicians from conducting certain meetings without being physically in the room. For these facilities, the rules would also remove overly prescriptive documentation requirements for admission orders.

    “We are taking action in the following proposed rules to reduce paperwork, while maintaining patient safety and program integrity by focusing on meaningful measures,” Verma said.

    Taken together, the modernizing proposals to advance CMS’ Meaningful Measures Initiative released today and the proposals in the recently released FY 2019 Hospital Inpatient Prospective Payment System (IPPS)/Long-Term Care Hospital (LTCH) proposed rule are projected to save providers close to four million hours and more than $144 million as they take effect in 2019 and 2020.

    Proposed rules for updating Medicare policies and payments under both inpatient rehabilitation and inpatient psychiatric facilities include proposed removal of certain measures. Patient safety and program quality and integrity are top priorities for the agency and are the core of the meaningful measures initiative. The IRF and IPF proposed rules released today include measures that are patient-centered and outcome-driven rather than process-oriented. Where applicable, these changes will allow providers to work with a smaller set of more meaningful healthcare measures and spend more time on patient care.

    Advancing My HealthEData: Request for Information from stakeholders

    In addition to payment and policy proposals, CMS is releasing a Request for Information (RFI) to obtain feedback on positive solutions to better achieve interoperability or the sharing of healthcare data between providers. Specifically, CMS is requesting stakeholder feedback through an RFI on the possibility of revising Conditions of Participation related to interoperability as a way to increase electronic sharing of data by providers. This will inform next steps to advance this critical initiative.

    In responding to the RFI, commenters should provide clear and concise proposals that include data and specific examples. CMS will not respond to RFI comment submissions in the final rule, but rather will actively consider all input in developing future regulatory proposals or future sub-regulatory guidance.

    To view the Fiscal Year 2019 proposed rules posted today at the Federal Register and a CMS fact sheet on each of the proposed rules, please visit the appropriate links:

    Courtesy: U.S. Centers for Medicare & Medicaid Services
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  • Centers for Medicare and Medicaid Services Reveals New Medicare Card Design

    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 remove Social Security numbers from Medicare cards is to help prevent fraud, combat identify theft, and safeguard taxpayer dollars,” said CMS Administrator Seema Verma. “We’re very excited to share the new design.”

    CMS has assigned all people with Medicare benefits a new, unique Medicare number, which contains a combination of numbers and uppercase letters. People with Medicare will receive a new Medicare card in the mail, and will be instructed to safely and securely destroy their current Medicare card and keep their new Medicare number confidential. Issuance of the new number will not change benefits that people with Medicare receive.

    Healthcare providers and people with Medicare will be able to use secure look-up tools that will allow quick access to the new Medicare numbers when needed. There will also be a 21-month transition period where doctors, healthcare providers, and suppliers will be able to use either their current SSN-based Medicare Number or their new, unique Medicare number, to ease the transition.

    This initiative takes important steps towards protecting the identities of people with Medicare. CMS is also working with healthcare providers to answer their questions and ensure that they have the information they need to make a successful transition to the new Medicare number. For more information, please visit:
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  • Centers for Medicare and Medicaid Services Issues Proposed Rule to Increase Health Insurance Choices for Patients for 2018

    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 to stabilize the Marketplace, provide more flexibility to states and insurers, and give patients access to more coverage options. They will help protect Americans enrolled in the individual and small group health insurance markets while future reforms are being debated.”

    The rule proposes a variety of policy and operational changes to stabilize the Marketplace, including:

    • Special Enrollment Period Pre-Enrollment Verification: The rule proposes to expand pre-enrollment verification of eligibility to individuals who newly enroll through special enrollment periods in Marketplaces using the platform. This proposed change would help make sure that special enrollment periods are available to all who are eligible for them, but will require individuals to submit supporting documentation, a common practice in the employer health insurance market. This will help place downward pressure on premiums, curb abuses, and encourage year-round enrollment.

    • Guaranteed Availability: The rule proposes to address potential abuses by allowing an issuer to collect premiums for prior unpaid coverage, before enrolling a patient in the next year’s plan with the same issuer. This will incentivize patients to avoid coverage lapses.

    • Determining the Level of Coverage: The rule proposes to make adjustments to the de minimis range used for determining the level of coverage by providing greater flexibility to issuers to provide patients with more coverage options.

    • Network Adequacy: The proposed rule takes an important step in reaffirming the traditional role of states to serve their populations. In the review of qualified health plans, CMS proposes to defer to the states’ reviews in states with the authority and means to assess issuer network adequacy. States are best positioned to ensure their residents have access to high quality care networks.

    • Qualified Health Plan (QHP) Certification Calendar: In the rule, CMS announces its intention to release a revised proposed timeline for the QHP certification and rate review process for plan year 2018. The revised timeline would provide issuers with additional time to implement proposed changes that are finalized prior to the 2018 coverage year. These changes will give issuers flexibility to incorporate benefit changes and maximize the number of coverage options available to patients.

    • Open Enrollment Period: The rule also proposes to shorten the upcoming annual open enrollment period for the individual market. For the 2018 coverage year, we propose an open enrollment period of November 1, 2017, to December 15, 2017. This proposed change will align the Marketplaces with the Employer-Sponsored Insurance Market and Medicare, and help lower prices for Americans by reducing adverse selection.

    The proposed rule can be found, here:

    Information source: Centers for Medicare & Medicaid Services...
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