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CMS Scraps Cardiac/Hip Fracture Episode Payment Model, Downsizes CJR Program

The Centers for Medicare & Medicaid Services (CMS) has officially cancelled a planned program to require certain hospitals to participate in Medicare episode payment models (EPMs) for acute myocardial infarction, coronary...more

Congressional Hearings Focus on Health Policy Issues

A number of Congressional panels have scheduled or held recent hearings on health policy issues, including the following: On November 30, 2017, the House Energy & Commerce Committee is holding a hearing on implementation...more

House Approves IPAB Repeal Legislation

The House of Representatives has voted 307 – 111 to approve HR 849, Protecting Seniors’ Access to Medicare Act, to repeal the Independent Payment Advisory Board (IPAB). Under the ACA, the IPAB must submit Medicare spending...more

President Signs Metabolic Syndrome Support Legislation, Emergency Medication Act

President Trump has signed into law S 920, the National Clinical Care Commission Act, which establishes a national clinical care commission to improve coordination of federal programs that support care for people with complex...more

OIG: Medicare Program Integrity at the Top of HHS Management Challenges

The OIG’s latest compilation of top HHS management and performance challenges flags vulnerabilities in key HHS health and social services programs, including includes the following: 1. Ensuring Program Integrity in...more

HHS Announces New Appeals Settlement Initiatives

The HHS Departmental Appeals Board (DAB) is inviting the public to submit recommendations for precedential Medicare Appeals Council (Council) decisions that will be binding on all CMS, HHS, and Social Security Administration...more

11/29/2017  /  Appeals , CMS , HHS , Medicare , OMHA

CMS Proposes Changes to Medicare Advantage, Part D Programs for 2019

CMS has issued a proposed rule to update the Medicare Advantage (MA) program and Part D prescription drug benefit rules for contract year 2019. The proposed rule would, among many other things: Implement a Comprehensive...more

CMS Modifies Medicare Physician Quality Payment Program Rules for 2018

CMS has issued a final rule with comment period making changes to the Quality Payment Program (QPP) for 2018, the second performance year for the reformed physician payment framework mandated by the Medicare Access and CHIP...more

Medicare Home Health Payments to Drop by $80 Million under Final 2018 Rule

The final CMS calendar year (CY) 2018 Medicare home health prospective payment system (HH PPS) rule cuts Medicare payments by 0.4% ($80 million) in 2018 compared to 2017 levels, but CMS did not adopt a more sweeping case mix...more

CMS Finalizes Medicare Clinical Lab Fee Schedule for 2018

CMS has issued final 2018 Medicare clinical laboratory fee schedule (CLFS) rates, which are based on private payer data as mandated by the Protecting Access to Medicare Act of 2014 (PAMA). A companion document explains...more

11/22/2017  /  CLFS , Clinical Laboratories , CMS , Medicare , PAMA

CMS Releases 2018 HCPCS Update

The 2018 update to the alphanumeric Healthcare Common Procedure Coding System (HCPCS) files is now available on the CMS website. The files include the Level II alphanumeric HCPCS procedure and modifier codes, their long and...more

11/22/2017  /  CMS , HCPCS , Health Care Providers , Medicare

HHS Secretary Nominee Azar to Face Senate HELP Committee after Thanksgiving

President Trump has nominated Alex Azar to be Secretary of Health and Human Services, which would fill the vacancy created when Tom Price, MD resigned the post in September. Mr. Azar, an attorney who previously served in...more

11/22/2017  /  HELP , HHS , Trump Administration

CMS Finalizes Medicare Physician Fee Schedule Update for 2018

The Centers for Medicare & Medicaid Services (CMS) has published its final Medicare physician fee schedule (PFS) rule for CY 2018. In addition to updating rates for 2018, the rule includes important policy changes, including...more

CMS Finalizes Medicare OPPS, ASC Rates and Policies for CY 2018

CMS has published a final rule updating Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System rates and policies for calendar year (CY) 2018. In addition to rate...more

CMS Boosting Medicare ESRD Facility Payments by 0.5% for 2018

The Centers for Medicare & Medicaid Services (CMS) has issued its final Medicare end-stage renal disease (ESRD) prospective payment system (PPS) rates and policies for calendar year 2018. CMS projects that the final rule will...more

CMS to Help SNFs Prepare for Value-Based Purchasing Program Rules (Nov. 16)

A November 16, 2017 CMS call will focus on how the Medicare SNF Value-Based Purchasing Program will affect Medicare’s payments to SNFs beginning October 1, 2018. Among other things, the call will cover how CMS will translate...more

10/31/2017  /  CMS , Health Care Providers , Medicare , SNF

Learn What is New Regarding the Medicare Hospital “Primarily Engaged” Requirement (Nov. 2)

CMS is hosting an educational call November 2, 2017 on new State Operations Manual guidance that discusses the Medicare definition of a hospital, including the requirement for hospitals to be primarily engaged in providing...more

OIG Wants CMS to Track Medicare Costs from Device Failures

A recent Office of Inspector General (OIG) report suggests that the lack of medical device-specific information on Medicare claim forms complicates CMS efforts to identify and track Medicare costs related to the replacement...more

10/30/2017  /  CMS , FDA , Medical Devices , Medicare , OIG

Final Medicare Provider Payment Rules in the Pipeline

The White House Office of Management and Budget (OMB) is reviewing several CMS rules that would finalize CY 2018 Medicare payment policies for various types of providers and suppliers. Specifically, OMB is reviewing final...more

New Laws Extend IVIG Demonstration and Expiring Public Health Programs, Promote Early Hearing Detection and Intervention

President Trump has signed into law a bill (P.L. 115-63) that extends the Medicare Intravenous Immune Globulin (IVIG) Demonstration through December 31, 2020. The law also extends through the first quarter of FY2018 (1) the...more

Congressional Health Policy Hearings

Recent Congressional hearings focusing on health policy issues include the following: House Energy and Commerce Committee hearings on how covered entities use the 340B drug pricing program, ways to address the opioid...more

10/30/2017  /  FDA , HHS , Opioid , Prescription Drugs , Section 340B

Ways & Means Committee Advances IPAB Repeal Bill

The House Ways and Means Committee has approved by a 24-13 vote HR 849, Protecting Seniors’ Access to Medicare Act, to repeal the Independent Payment Advisory Board (IPAB). The IPAB was established by the ACA to submit...more

Senate Advances Emergency Medicine Access Legislation

On October 24, 2017, the Senate approved HR 304, the Protecting Patient Access to Emergency Medicines Act, which would clarify that emergency medical services professionals may administer controlled substances pursuant to...more

Congress Clears Bill to Improve Metabolic Syndrome Support Programs

The House of Representatives and Senate have both approved S 920, the National Clinical Care Commission Act, clearing the measure for the President. The bill would establish a national clinical care commission to improve...more

Committees Approve Bills to Boost Medicare Penalties, Revise Part B Policies, Extend CHIP Funding

The House Energy and Commerce Committee has approved by voice vote the following bipartisan bills addressing the Medicare Part B program: HR 3245, which would significantly increase various Medicare civil and criminal...more

10/30/2017  /  CHIP , Medicare , Medicare Part B , Telemedicine
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