On August 30, 2022, the Centers for Medicare & Medicaid Services (CMS) announced that the Medicare Shared Savings Program (MSSP) had saved the Medicare program $1.66 billion in 2021 as compared to spending targets, while...more
The Centers for Medicare and Medicaid Services (CMS), as part of 2023 Physician Fee Schedule proposed rule, has proposed significant revisions to the Medicare Shared Savings Program (MSSP). The revisions to the MSSP in the...more
On April 27,2022, the Office of Inspector General of the Department of Health and Human Services (OIG), Office of Evaluations and Inspections, issued a report on the performance of Medicare Advantage Organizations (MAOs) in...more
The Centers of Medicare and Medicaid Services (CMS) issued a Final Rule (the Rule) on April 29, 2021 extending and making various revisions to the Comprehensive Care for Joint Replacement Model (the CJR Model). The CJR Model...more
On July 10, 2019, President Trump issued an Executive Order entitled Advancing American Kidney Health. The Executive Order stated that the “state of care for patients with chronic kidney disease and end-stage renal disease...more
On July 10, 2019, the Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare & Medicaid Innovation (Innovation Center) released a much awaited proposal for a new bundled payment model for radiation...more
8/6/2019
/ Bundled Payments ,
Cancer ,
Centers for Medicare & Medicaid Services (CMS) ,
CMMI ,
Department of Health and Human Services (HHS) ,
Health Care Providers ,
Hospitals ,
Medicare ,
NPRM ,
Proposed Rules ,
Quality of Care Standards
The Centers for Medicare and Medicaid Services (CMS) issued a final rule (the Rule) on December 21, 2018, which reshapes the Medicare Shared Savings Program (MSSP). Termed “Pathways to Success,” the Rule, among other...more
On August 9, 2018, CMS introduced a proposed rule that would substantially overhaul the Medicare Shared Savings Program (MSSP), requiring Accountable Care Organizations (ACOs) that participate in the MSSP to accept some...more
CMS recently announced that it wants to launch a new demonstration program, the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration. If approved and adopted as a demonstration project, the MAQI...more
On April 23, 2018, the Center for Medicare and Medicaid Innovation issued a Request for Information (the RFI) on a direct provider contracting model for primary care. The RFI seeks input on how direct provider contracting...more
On December 20, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (the Final Rule) which includes three new mandatory episode-based payment programs for cardiac care, as well as the expansion of the...more
Approximately 800 hospitals in 67 Metropolitan Statistical Areas will begin mandatory participation in the Comprehensive Care for Joint Replacement (CJR) Model on April 1, 2016. The CJR bundled payment program applies to...more
Accountable Care Organizations (ACOs) can share costs of telehealth and remote patient monitoring services among their hospitals, providers/suppliers, and other ACO participants, according to federal regulations under the...more
11/3/2015
/ ACOs ,
Alternative Payment Models (APM) ,
Centers for Medicare & Medicaid Services (CMS) ,
Fee-for-Service ,
Fraud and Abuse ,
Health Care Providers ,
Health Information Technologies ,
Healthcare ,
Healthcare Reform ,
Hospitals ,
Medicare ,
Medicare Shared Savings Program ,
OIG ,
Suppliers ,
Telehealth ,
Telemedicine ,
Value-Based Purchasing ,
Waivers
The Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) of the Department of Health and Human Services just issued a final rule setting forth waivers of specified fraud and abuse laws...more
11/2/2015
/ ACOs ,
Centers for Medicare & Medicaid Services (CMS) ,
Final Rules ,
Fraud and Abuse ,
Gainsharing ,
Healthcare ,
Home Health Care ,
Medicare ,
Medicare Shared Savings Program ,
OIG ,
Required Documentation ,
Waivers
The Centers for Medicare and Medicaid Services (CMS) released, on August 25, 2015, the quality and financial performance results for Medicare Accountable Care Organizations for 2014. CMS touted that Medicare ACOs continued to...more
9/10/2015
/ ACOs ,
Alternative Payment Models (APM) ,
Bundled Payments ,
Centers for Medicare & Medicaid Services (CMS) ,
Electronic Medical Records ,
Health Care Providers ,
Healthcare Costs ,
Medicare ,
Medicare Shared Savings Program ,
Physician Medicare Reimbursements ,
Quality of Care Standards
CMS, through the Center for Medicare and Medicaid Innovation, announced on September 1, 2015, the introduction of the Medicare Advantage Value-Based Insurance Design (VBID) Model as part of the Health Plan Innovations...more
9/4/2015
/ Beneficiaries ,
Centers for Medicare & Medicaid Services (CMS) ,
Comment Period ,
Cost-Sharing ,
Health Insurance ,
HMOs ,
Innovation ,
Medicare ,
Medicare Advantage ,
PPOs ,
Quality of Care Standards ,
Supplemental Benefits ,
Value-Based Purchasing
This is the fifth post in Health Care Law Today’s series on the final rule.
The final Medicare Shared Savings Program (“MSSP”) rule released on June 4, 2015, contains a number of modifications to the financial...more
This is the second post in Health Care Law Today’s series on the final rule. This post addresses Eligibility Requirements, and the Application and the Renewal Process.
ACO Eligibility Requirements -
Under the...more
6/24/2015
/ ACO Participant Agreements ,
ACOs ,
Applications ,
Board of Directors ,
Centers for Medicare & Medicaid Services (CMS) ,
Compliance ,
Corporate Governance ,
Duty of Loyalty ,
Eligibility ,
Fiduciary Duty ,
Final Rules ,
Governance Standards ,
Health Care Providers ,
Healthcare ,
Medicaid ,
Medicare ,
Medicare Shared Savings Program ,
Renewal Options ,
Suppliers ,
Transparency
CMS announced a new ACO payment initiative on March 10, 2015, the Next Generation ACO Model, designed for entities experienced in coordinating care for populations of patients. The announcement reflects CMS’ commitment to...more
The American Hospital Association (AHA) submitted a letter to the Centers for Medicare and Medicaid Services (CMS) on April 17, 2014, recommending modifications to the Medicare Shared Savings Program (MSSP) and the Pioneer...more
On January 30, 2014, CMS released results on the Medicare Shared Savings Program (“MSSP”) and the Pioneer Accountable Care Organization Program (“Pioneer ACO Program”) for 2012, the initial performance year of each program....more
On July 16, 2013, CMS announced results from the first performance year of the Pioneer Accountable Care Organization (ACO) Model. In the release, CMS reported that the Pioneer ACO participants held Medicare cost increases...more