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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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  • Trump Administration Finalizes Policies to Give Medicare Beneficiaries More Choices around Surgery

    Trump Administration Finalizes Policies to Give Medicare Beneficiaries More Choices around Surgery | site |


    (Information contained in Centers for Medicare and Medicaid Services press release: December 2, 2020) Today, the Centers for Medicare & Medicaid Services (CMS) is finalizing policy changes that will give Medicare patients and their doctors greater choices to get care at a lower cost in an outpatient setting. The Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rules will increase value for Medicare beneficiaries and reflect the agency’s efforts to transform the healthcare delivery system through competition and innovation. These changes implement the Trump Administration’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors, and will take effect on January 1, 2021. “President Trump’s term in office has been marked by an unrelenting drive to level the playing field and boost competi...
    See more | Go to post

  • CMS Announces Comprehensive Strategy to Enhance Hospital Capacity Amid COVID-19 Surge

    Centers for Medicare & Medicaid Services Announces Comprehensive Strategy to Enhance Hospital Capacity Amid COVID-19 Surge | site |




    (Information contained in Centers for Medicare and Medicaid press release dated: November 25, 2020) Today, the Centers for Medicare & Medicaid Services (CMS) outlined unprecedented comprehensive steps to increase the capacity of the American health care system to provide care to patients outside a traditional hospital setting amid a rising number of coronavirus disease 2019 (COVID-19) hospitalizations across the country. These flexibilities include allowances for safe hospital care for eligible patients in their homes and updated staffing flexibility designed to allow ambulatory surgical centers (ASCs) to provide greater inpatient care when needed. Building on CMS’s previous actions to expand the availability of telehealth across the nation, these actions are aimed at allowing health care services to be provided outside a h...
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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 Takes Steps to Ensure Medicare Beneficiaries Have Wide Access to COVID-19 Antibody Treatment

    Centers for Medicare and Medicaid Services Takes Steps to Ensure Medicare Beneficiaries Have Wide Access to COVID-19 Antibody Treatment | site |


    (November 10 - 13, 2020) - - In a release dated November 10, 2020 and updated November 13, 2020, the Centers for Medicare and Medicaid Services (CMS) published the following information: The Centers for Medicare & Medicaid Services announced that starting today, Medicare beneficiaries can receive coverage of monoclonal antibodies to treat coronavirus disease 2019 (COVID-19) with no cost-sharing during the public health emergency (PHE). CMS’ coverage of monoclonal antibody infusions applies to bamlanivimab, which received an emergency use authorization (EUA) from the U.S. Food and Drug Administration yesterday. “Today, CMS is announcing a historic, first-of-its kind policy that drastically expands access to COVID-19 monoclonal antibodies to beneficiaries without cost sharing,” said CMS Administrator Seema Verma. “Our tim...
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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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  • Provider Groups urge Congress to Extend the Medicare Sequester Cuts

    Provider Groups urge Congress to Extend the Medicare Sequester Cuts

    Provider Groups urge Congress to Extend the Medicare Sequester Cuts | site |




    (October 21, 2020) - - Today, October 21, 2020, the American Hospital Association (AHA) published the following information:




    Provider groups urge Congress to extend the Medicare sequester cuts



    Washington, D.C., October 21, 2020

    Joint AHA, AMA, AHCA and NAHC Statement on Medicare Sequester Cuts


    The American Hospital Association, the American Medical Association, the American Health Care Association and the National Association for Home Care and Hospice wrote congressional leaders today urging them to extend the congressionally enacted moratorium on the application of the Medicare sequester cuts into 2021 and through the duration of the public health emergency. Together, these organizations provide health care to more than 62 million Medicare patients, and the persistently high COVID-19 rates across
    ...
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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 Announces Historically Low Premiums and New Insulin Benefit as Medicare Open Enrollment Begins

    Trump Administration Announces Historically Low Premiums and New Insulin Benefit as Medicare Open Enrollment Begins | site |



    Medicare Parts A & B


    (October 15, 2020) - - Today, October 15, 2020, the Centers for Medicare & Medicaid Services published the following information: Today, the Centers for Medicare & Medicaid Services (CMS) announced that 2021 Medicare Open Enrollment is officially open and will run through December 7, 2020. More than 60 million people with Medicare can review health and drug plans, and make changes to their healthcare coverage for next year, based on their financial and medical needs, from the comfort of their homes. With Medicare Advantage (or private Medicare health plans) and Part D prescription drug plan premiums at historic lows – and hundreds of healthcare plans now offering $35 monthly co-pays for insulin – there are plenty of reasons to compare coverage options. As part of this year’s open enro...
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  • CMS Survey Data Illustrates Impact of COVID-19 on Medicare Beneficiaries’ Daily Life and Experiences

    Centers for Medicare and Medicaid Services Survey Data Illustrates Impact of COVID-19 on Medicare Beneficiaries’ Daily Life and Experiences | site |



    (October 16, 2020) - - The Centers for Medicare and Medicaid Services published today, October 16, 2020, the following information: Today, the Centers for Medicare & Medicaid Services (CMS) released data showing that 21% of Medicare beneficiaries report forgoing non-coronavirus disease 2019 (COVID-19) care due to the pandemic, and nearly all - 98% - of beneficiaries have taken preventative measures to keep themselves safe from the virus. According to the survey, the most common type of forgone care because of the pandemic was dental care (43%), followed by regular check-up (36%), treatment for ongoing condition (36%), and diagnostic or medical screening test (32%). The most common reason cited for forgoing care was not wanting to risk being at a medical facility (45%). Regarding COVID-19 preventative health behavi...
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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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  • 2021 Medicare Advantage and Part D Plan Information Now Available on Medicare.gov Ahead of Medicare Open Enrollment

    2021 Medicare Advantage and Part D Plan Information Now Available on Medicare.gov Ahead of Medicare Open Enrollment | site |


    (October 1, 2020) - - Today, October 1, 2020, the Centers for Medicare and Medicaid Services (CMS) published the following information:

    Following last week’s announcement of historically low premiums in Medicare Advantage, starting today, seniors can begin to compare their Medicare coverage options for 2021. CMS has released the 2021 benefit and cost-sharing information for Medicare Advantage and Part D prescription drug plans on Medicare.gov. Additionally, for the first time, seniors will be able to find through Medicare Plan Finder on Medicare.gov more than 1,600 prescription drug plans to choose from that will offer insulin at no more than a $35 monthly copay beginning in January. Average 2021 premiums for Medicare Advantage plans are expected to decline 34.2 percent from 2017 while plan choice, benefits, and enrollment continue to
    ...
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  • U.S. Centers for Medicare and Medicaid Services Updates COVID-19 Testing Methodology for Nursing Homes

    U.S. Centers for Medicare and Medicaid Services Updates COVID-19 Testing Methodology for Nursing Homes | site |



    (September 29, 2020) - - The United States Centers for Medicare & Medicaid Services published today, September 29, 2020, the following information: Today, the Centers for Medicare & Medicaid Services (CMS) announced an update to the methodology the agency employs to determine the rate of coronavirus disease 2019 (COVID-19) positivity in counties across the country. Counties with 20 or fewer tests over 14 days will now move to “green” in the color-coded system of assessing COVID-19 community prevalence. Counties with both fewer than 500 tests and fewer than 2,000 tests per 100,000 residents, and greater than 10 percent positivity over 14 days – which would have been “red” under the previous methodology – will move to “yellow.” This information is critical to nursing homes, which are required to test their staff for COVID-19 at a freque
    ...
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  • CMS Announces Innovative Payment Model to Improve Care, Lower Costs for Cancer Patients

    Centers for Medicare and Medicaid Services Announces Innovative Payment Model to Improve Care, Lower Costs for Cancer Patients | site |



    (September 18, 2020) - - The Centers for Medicare and Medicaid Services published today (September 18, 2020) the following information:

    Today, the Centers for Medicare & Medicaid Services (CMS) finalized a new Innovation Center model expected to improve the quality of care for cancer patients receiving radiotherapy and reduce Medicare expenditures through bundled payments that allow providers to focus on delivering high-quality treatments. The new Radiation Oncology (RO) Model allows this focus on value-based care by creating simpler, more predictable payments that incentivize cost-efficient and clinically effective treatments to improve quality and outcomes. The RO Model, part of a final rule on specialty care models issued by CMS, will begin on January 1, 2021 and is estimated to save Medicare $230 million over...
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  • Staff Reporter 1
    CMS Announces New Model Opportunity for Medicaid Managed Care Organizations Serving Beneficiaries Dually Eligible for Medicare and Medicaid
    by Staff Reporter 1
    Centers for Medicare and Medicaid Services Announces New Model Opportunity for Medicaid Managed Care Organizations Serving Beneficiaries Dually Eligible for Medicare and Medicaid | site |



    (Information contained in Centers for Medicare and Medicaid Services press release: December 17, 2020)

    The Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare & Medicaid Innovation is announcing a new opportunity to enable Medicaid Managed Care Organizations (MCOs) to better serve enrollees who are dually eligible for Medicare and Medicaid. This new Model opportunity is the first CMS initiative designed to harness the power of Medicaid MCOs to coordinate Medicare and Medicaid services and improve health outcomes for the population of dually eligible beneficiaries who are in both Medicaid managed care and Medicare fee-for-service (FFS). Currently, Medicaid MCOs do not have an incentive to coordinate care in a way that reduces Medicare FFS costs f...
    12-18-2020, 07:21 PM
  • Staff Reporter 1
    Trump Administration Finalizes Policies to Give Medicare Beneficiaries More Choices around Surgery
    by Staff Reporter 1
    Trump Administration Finalizes Policies to Give Medicare Beneficiaries More Choices around Surgery | site |


    (Information contained in Centers for Medicare and Medicaid Services press release: December 2, 2020) Today, the Centers for Medicare & Medicaid Services (CMS) is finalizing policy changes that will give Medicare patients and their doctors greater choices to get care at a lower cost in an outpatient setting. The Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rules will increase value for Medicare beneficiaries and reflect the agency’s efforts to transform the healthcare delivery system through competition and innovation. These changes implement the Trump Administration’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors, and will take effect on January 1, 2021. “President Trump’s term in office has been marked by an unrelenting drive to level the playing field and boost competi...
    12-06-2020, 04:47 AM
  • Staff Reporter 1
    CMS Announces Comprehensive Strategy to Enhance Hospital Capacity Amid COVID-19 Surge
    by Staff Reporter 1
    Centers for Medicare & Medicaid Services Announces Comprehensive Strategy to Enhance Hospital Capacity Amid COVID-19 Surge | site |




    (Information contained in Centers for Medicare and Medicaid press release dated: November 25, 2020) Today, the Centers for Medicare & Medicaid Services (CMS) outlined unprecedented comprehensive steps to increase the capacity of the American health care system to provide care to patients outside a traditional hospital setting amid a rising number of coronavirus disease 2019 (COVID-19) hospitalizations across the country. These flexibilities include allowances for safe hospital care for eligible patients in their homes and updated staffing flexibility designed to allow ambulatory surgical centers (ASCs) to provide greater inpatient care when needed. Building on CMS’s previous actions to expand the availability of telehealth across the nation, these actions are aimed at allowing health care services to be provided outside a h...
    12-01-2020, 03:14 PM
  • Staff Reporter 1
    CMS Announces Historic Changes to Physician Self-Referral Regulations
    by Staff Reporter 1
    Centers for Medicare & Medicaid Services Announces Historic Changes to Physician Self-Referral Regulations| site |



    (Information contained in Centers for Medicare & Medicaid Services press release: November 20, 2020) Today, the Centers for Medicare & Medicaid Services (CMS) finalized changes to outdated federal regulations that have burdened health care providers with added administrative costs and impeded the health care system’s move toward value-based reimbursement. The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity. The old federal regulations that interpret and implement this law were designed for a health care system that reimburses providers on a fee-for-service basis, where the financial incentives are to deliver more services. However, the 21st century American health care...
    11-21-2020, 04:17 AM
  • Staff Reporter 1
    CMS Takes Steps to Ensure Medicare Beneficiaries Have Wide Access to COVID-19 Antibody Treatment
    by Staff Reporter 1
    Centers for Medicare and Medicaid Services Takes Steps to Ensure Medicare Beneficiaries Have Wide Access to COVID-19 Antibody Treatment | site |


    (November 10 - 13, 2020) - - In a release dated November 10, 2020 and updated November 13, 2020, the Centers for Medicare and Medicaid Services (CMS) published the following information: The Centers for Medicare & Medicaid Services announced that starting today, Medicare beneficiaries can receive coverage of monoclonal antibodies to treat coronavirus disease 2019 (COVID-19) with no cost-sharing during the public health emergency (PHE). CMS’ coverage of monoclonal antibody infusions applies to bamlanivimab, which received an emergency use authorization (EUA) from the U.S. Food and Drug Administration yesterday. “Today, CMS is announcing a historic, first-of-its kind policy that drastically expands access to COVID-19 monoclonal antibodies to beneficiaries without cost sharing,” said CMS Administrator Seema Verma. “Our tim...
    11-13-2020, 10:24 PM

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