Centers for Medicare & Medicaid Services

News & Analysis as of

CMS Call Letter: Changes to and Implications of Star Ratings

In its February 20, 2015 Advance Notice of Methodological Changes for Calendar Year (CY) 2016 for Medicare Advantage Capitation Rates, Part C and Part D Payment Policies and 2016 Call Letter, CMS addressed a variety of issues...more

Washington Healthcare Update

This Week: Ways and Means Advances Four Health-Related Measures... Senate Commerce Committee Clears Legislation on E-Cigarette Packaging... CMS Pushes Back Deadline on Meaningful Use for Physicians....more

Medicaid Managed Care: What’s Ahead in 2015

Managed care is the dominant delivery model in state Medicaid programs, and is rapidly growing with the Affordable Care Act bringing over 8 million new beneficiaries into Medicaid in 2014. Today, 39 states (including the...more

CMS Releases Updates to Its Medicare Advantage and Part D Plan Audit Protocols and Processes

On February 12, 2015, the Centers for Medicare & Medicaid Services (“CMS”) released an updated version of its Medicare Advantage (“MA”) and prescription drug benefit (“Part D”) plan audit protocols and also announced the...more

CMS Seeks Public Input On Advanced Primary Care Model Concepts

On February 13, 2015, CMS published a Request for Information (RFI) seeking input on the design of the next generation of advanced primary care models. Comments on the RFI are due on March 16, 2015. ...more

CMS Extends Eligible Professional Attestation Deadline for 2014 Medicare EHR Incentive Program

The Centers for Medicare and Medicaid Services (CMS) has extended the deadline for eligible professionals to attest to meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program 2014 reporting year. The...more

CMS Releases 2016 Draft Call Letter

Last week, the Centers for Medicare & Medicaid (CMS) released its 2016 Advance Rate Notice and draft Call Letter (2016 Call Letter) for the Medicare Advantage (MA) and Medicare Part D programs. The 2016 Call Letter outlines...more

Medicare RAC Program Improvements Delayed Until 2016 - Shorts on Long Term Care February 2015

The Centers for Medicare and Medicaid Services (CMS) had planned to award new contracts to companies that act as Medicare’s recovery audit contractors (now referred to as recovery auditors) (RAs) for operation of the Medicare...more

Final Medicare Advantage/Part D Rule for Contract Year (CY) 2016

CMS has published a final rule revising Medicare Advantage (MA) and Part D prescription drug benefit regulations for CY 2016. Among other things, the final rule...more

CMS Releases Proposed Advance Notice and Draft Call Letter for 2016

On Friday, February 20, 2015, CMS released its Advance Notice of Methodological Changes for Calendar Year 2016 for Medicare Advantage (MA) Capitation Rates, Part C and Part D Payment Policies and 2016 Call Letter (the...more

Shorts on Long Term Care - February 2015

In this issue: - Document Retention in a Long Term Care Facility - Medicare RAC Program Improvements Delayed Until 2016 - “Bring Your Own Device” To Work Programs - NLRB Upends Legality of Employer Email...more

CMS Raises the Bar for Nursing Home Quality Ratings under "Nursing Home Compare 3.0"

CMS has made revisions to the measurements used in the Nursing Home Compare Five Star Quality Rating System that have resulted in a decline in the star rating for about one-third of nursing homes. Specifically, on February...more

GAO Evaluates CMS Activities to Prepare Health Industry for ICD-10 Launch

According to a recent GAO report, CMS has taken numerous steps to prepare industry for the October 1, 2015 transition to ICD-10 codes, such as developing checklists, timelines, and other educational materials and hosting...more

Hospital Engagement Network Contract Solicitation

CMS is requesting proposals for Hospital Engagement Network (HEN) contracts from qualified entities to work on reducing preventable hospital acquired conditions and readmissions through the Partnership for Patients...more

CMS Issues New Audit Protocols for Medicare Advantage Organizations and Part D Sponsors

On February 13, 2015, CMS announced new audit protocols and process updates for the 2015 Program Audit Cycle for Medicare Advantage (MA) organizations and Part D sponsors. According to the memorandum, 2015 begins a new...more

Manatt on Health Reform: Weekly Highlights - February 2015 #4

Wrapping up the 2015 enrollment period, Healthcare.gov and State-based Marketplaces in seven states have announced special enrollment periods (SEPs) for people who were uninsured in 2014 and discover they owe a “shared...more

Health Update - February 2015

Cyber Risk Insurance Policies: What You Need to Know - Editor’s Note: As data breach incidents and related cyber risks continue to increase and gain publicity—and government agencies become more actively involved in...more

Health Care Update - February 2015 #3

In This Issue: - IRS in the ACA Spotlight - DOJ and FTC Examine Competition - Implementation of the Affordable Care Act - Other Federal Regulatory Initiatives - Congressional Initiatives - Other...more

CMS Corrects 2015 Medicare OPPS/ASC Final Rule, Impacts Rates

Today CMS published a notice correcting its November 10, 2014 final rule updating the Medicare Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgical Center (ASC) Payment System rates and policies...more

CMS Takes a Measured Approach to Medicare Advantage and Part D Plan Payment Rates and Policy Changes for 2016

Increased Part D Drug Costs Set the Stage for Higher Beneficiary Premiums - The Advance Notice (“Advance Notice”) of Methodological Changes for Calendar Year (“CY”) 2016 for Medicare Advantage (“MA”) Capitation Rates,...more

CMS Delays 60-Day Rule, But Overpayment Case Law Emerging

The Centers for Medicare & Medicaid Services (CMS) recently announced a one-year delay in finalizing the long-awaited and closely watched rule addressing the 60-day deadline to return Medicare and Medicaid overpayments (the...more

Changes to CMS' Five-Star Ratings System Turn Up the Heat on Nursing Homes and Increase Risks for Psychotropic Use

On Feb. 20, 2015, the Centers for Medicare & Medicaid (CMS) unveiled Version 3.0 of its Nursing Home Compare, which updates the current 5-Star Quality Rating System to reflect higher performance standards. Because of these...more

Roadmap to Prison: Lessons Learned from the Criminal Prosecution of Alpha Ambulance’s Leaders

No one running an ambulance company ever planned to go to prison for doing his or her job. But that is a real possibility if the government knocks on the door, and the owner or manager is dishonest in his or her response to...more

Washington Healthcare Update

This Week: Upcoming Hearing: HHS Sec. Burwell Appearing Before E&C Committee on FY2016 Budget... CMS Issues 2016 Payment and Policy Updates for Medicare Health and Drug Plans... CMS Releases Improved Rating System for Nursing...more

Black Tuesday Falls on a Friday for Nation’s Nursing Homes

If you think of CMS quality ratings as the Dow Jones index, then last Friday, February 20, was the equivalent of Black Tuesday, October 29, 1929, the day the stock market collapsed. Why? ...more

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