Medicare Centers for Medicare & Medicaid Services

News & Analysis as of

Medicare and Medicaid Drug Policy Provisions in the Obama Administration’s Proposed FY 2017 Budget

The Obama Administration’s proposed fiscal year (FY) 2017 budget, released on February 9, 2016, includes a number of legislative proposals that would revise Medicare and Medicaid policies to achieve budget savings and make...more

Breaking News: 60-Day Overpayment Rule Finalized

The Centers for Medicare and Medicaid Services (CMS) released its final rule implementing Section 6402(a) of the Affordable Care Act that requires Medicare providers and suppliers to report and return overpayments within 60...more

Also In The News - Health Headlines - January 2016 #4

CBO Projects Medicare Spending Growth – In a report published January 25, 2016, the Congressional Budget Office (CBO) estimates that expenditures for Medicare, Medicaid, and other major healthcare programs will equal...more

CMS Posts Revised Application for Meaningful Use Hardship Exceptions

On January 22, CMS posted a revised application and instructions for a hardship exception from the Meaningful Use program penalties in 2015. Under the new, streamlined application process, which CMS says is a temporary...more

CMS Issues Guide on Avoiding Readmissions in Diverse Medicare Populations

The CMS Office of Minority Health has released a “Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries.” The guide highlights data indicating that racial and ethnic minority...more

CMS Releases Guide to Preventing Readmissions Among Racially and Ethnically Diverse Medicare Beneficiaries

On January 26, 2016, the CMS Office of Minority Health released a new Guide to Preventing Readmissions among Racially and Ethnically Diverse Medicare Beneficiaries (Guide). The purpose of the Guide is to assist hospital...more

CMS Announces Changes to Medicare Meaningful Use Hardship Exception Application Process

On Jan. 22, 2016, CMS issued a new application and sweeping changes to the Medicare Electronic Health Records (EHR) Incentive Program hardship exception application process. The changes are intended to temporarily ease the...more

CMS Announces Extension of Moratoria on Enrollment of HHAs, Ambulance Suppliers in Designated Areas

CMS published a notice February 2, 2016 announcing an additional 6-month extension of its current temporary Medicare enrollment moratoria for new ground ambulance suppliers and home health agencies (HHAs), subunits, and...more

Progress on Medicare Payment Reform

HHS is gearing up to design and implement a revised Medicare payment system. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has designated a merit based incentive payment system (MIPS) as a goal. CMS is...more

Further CMS Clarification on EHR Hardship Exceptions

As we reported, the Centers for Medicare & Medicaid Services (CMS) posted revised instructions and application forms on January 22, 2016, for health care providers unable to meet electronic health records (EHR) “meaningful...more

Manatt on Health Reform: Weekly Highlights - January 2016 #3

Louisiana's Governor pushes ahead on Medicaid expansion, while expansion is blocked by Wyoming's Legislature; Massachusetts plans to submit a 1332 waiver application to preserve its merged markets; and CBO lowers its 2016...more

CMS Call: IMPACT Act Measure Alignment and Outcomes (Feb. 2)

On February 2, 2016, CMS is hosting a Special Open Door Forum call to discuss implementation of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). The call will cover standardized quality...more

CMS Posts Update to 2016 MPFS Rates

CMS has posted corrections to the 2016 Medicare physician fee schedule payment files. Among other things, CMS has revised the conversion factor, reducing it slightly from $35.8279 to $35.8043. CMS has also made changes to...more

Deadline Looms for EHR Hardship Exceptions

The Centers for Medicare & Medicaid (CMS) expect 209,000 health care providers to face Medicare payment reductions for failing the electronic health records (EHR) “meaningful use” requirements in 2014. CMS puts the estimated...more

Important Changes for Physicians from the 2016 Medicare Physician Fee Schedule: Part I (Stark Changes)

On November 16, 2015 the Centers for Medicare and Medicaid Services (CMS) published the final Medicare Physician Fee Schedule (Final MPFS). The Final MPFS addresses changes to the physician fee schedule and related policies,...more

DMEPOS Prior Authorization Rules Expand

On December 30, 2015, CMS published a final rule entitled: "Medicare Program; Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies," implementing Section 1834(a)(15) of the...more

CMS Signals that Meaningful Use Program Will Change Significantly for Physicians

On January 11, 2016, CMS Administrator Andy Slavitt announced that the Medicare Electronic Health Record Incentive Program will be replaced significantly in 2017 by the new Merit-Based Incentive Payment System (MIPS) for...more

Length of funded training: Initial Residency Period (IRP) issues

The payment rules for Medicare graduate medical education (GME) reimbursement inherently incentivize training during a resident's "initial residency period" (IRP), which is defined as the minimum accredited length for each...more

Washington Healthcare Update

This Week: The House is not in session this week... The Senate returns today... Committees in the Senate will hold hearings on co-ops and mental health... Vice President Biden will attend the World Economic Forum in...more

Medicare: Congress Ends 2015 With Some Last-Minute Reforms

Congress chose to end 2015 with some last-minute Medicare reforms impacting healthcare providers. Significantly, the Patient Access and Medicare Protection Act, signed into law by President Obama on December 28, 2015,...more

CMS Issues Final Rule Implementing Mandatory Bundled Payment Program for Lower Extremity Joint Procedures

The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule (Final Rule) that implements the Comprehensive Care for Joint Replacement model (CJR Model), a new bundled payment program covering certain...more

CMS Launches New “Accountable Health Communities” Innovation Model

CMS’s latest innovation model, the Accountable Health Communities model, will test whether screening for health-related social needs, providing community service referral and navigation, and encouraging partner alignment...more

Senate Workgroup’s Proposals Address Chronic Illness Through Medicare

The Senate Finance Committee chronic care working group recently released a Policy Options Document continuing an effort that started with a hearing titled, “Chronic Illness: Addressing Patients’ Unmet Needs” in the summer of...more

Final Stark Rule Changes Adopt New Exceptions For Hospitals and Significant Clarifications - Corridors January 2016

In the Medicare Fee Schedule Final Rule with Comment Period for calendar year 2016, the Centers for Medicare & Medicaid Services (CMS) adopted two new exceptions to the Stark physician self-referral law affecting hospitals,...more

CMS Finalizes New Medicare Prior Authorization Rules for DMEPOS Subject to “Unnecessary Utilization,” But Policy Questions Remain

The Centers for Medicare & Medicaid Services (CMS) has issued a final rule to require Medicare prior authorization (PA) for certain durable medical equipment (DME), prosthetics, orthotics, and supplies (DMEPOS) items that the...more

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