Archive for Centers for Medicare & Medicaid Services

 

CMS Reports on Medicaid Long-Term Care Spending

The Centers for Medicare & Medicaid Services has issued a report on FY 2016 spending for Medicaid-covered long-term services and supports.  The highlights of the $167 billion in state and federal spending include:

 

  • Home and community-based services have accounted for almost all Medicaid long-term services and supports growth in recent years.
  • Home and community-based services spending increased 10 percent in FY 2016, greater than the five percent average annual growth from FY 2011 through 2015.
  • Institutional spending remained close to the FY 2010 amount.
  • Institutional service spending decreased two percent in FY 2016 following an average annual increase of 0.3 percent over the previous five years.
  • Long-term services and supports provided through managed care continued to grow as states expanded their use of managed long-term services and supports delivery systems.
  • Managed long-term services and supports spending amounted to $39 billion in FY 2016, a 24 percent increase from $32 billion in FY 2015.

Learn more about Medicaid spending and trends for long-term care and long-term services and supports in the new CMS report “Improving the Balance: The Evolution of Long Term Services and Supports, FY 1981-2014,” which can be found here.…

CMS Introduces Medicaid “Scorecard”

The Centers for Medicare & Medicaid Services has unveiled a “scorecard” through which interested parties will be able to monitor outcomes for state Medicaid programs, state CHIP programs, and CMS itself while also comparing the performance of states to one another.

The purpose of the scorecard, according to CMS, is “to modernize the Medicaid and CHIP program through greater transparency and accountability for the program’s outcomes.”

CMS also explained that

The first version of the Scorecard includes measures voluntarily reported by states, as well as federally reported measures in three areas: state health system performance; state administrative accountability; and federal administrative accountability. The metrics included in the first Scorecard reflect important health issues such as well child visits, mental health conditions, children’s preventive dental services, and other chronic health conditions. The Scorecard represents the first time that CMS is publishing state and federal administrative performance metrics – which include measures like state/federal timeliness of managed care capitation rate reviews, time from submission to approval for Section 1115 demonstrations, and state/federal state plan amendment processing times.

It is not clear at this time how CMS will use the scorecard or what its value might be.

Learn more about the new CMS …

CMS Mulls Direct Provider Contracting for Medicare

The Centers for Medicare & Medicaid Services is seeking public input on a proposal to permit Medicare beneficiaries to enter into direct contracts with primary care and multi-specialty providers.

According to CMS,

A DPC [direct provider contracting] model would aim to enhance the beneficiary-physician relationship by providing a platform for physician group practices to provide flexible, accessible, and high quality care to beneficiaries that have actively chosen this type of care model.

The request for information, issued earlier this week, seeks public input on experience with direct provider contracting and asks interested parties to describe how Medicare might structure such a model, including addressing considerations such as provider and state participation, beneficiary participation, payments, program integrity, and beneficiary protection.

Comments are due May 25.

To learn more about the CMS request for information, a news release describing the request, and a copy of the RFI itself, go here.

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GAO: CMS Needs to Do Better Job on Demonstration Evaluations

The federal government needs to do a better job of evaluating Medicaid demonstration programs, according to the U.S. Government Accountability Office.

Demonstration programs, on which the federal government spends more than $300 billion a year, exempt states from selected federal Medicaid requirements and regulations so they can test new approaches to providing and paying for care for their Medicaid population.  As part of waiving these requirements, the Centers for Medicare & Medicaid Services requires the states to perform or commission evaluations of the effectiveness of those new approaches.

According to a new GAO study, however, those reports are not always performed in a timely manner, are sometimes too limited in scope, and their results are not sufficiently publicized so that others may learn lessons from the demonstration.  The GAO recommended that CMS establish written procedures for such matter and CMS agreed with this recommendation.

Learn more about the GAO’s review of Medicaid demonstration program evaluations in the GAO report Medicaid Demonstrations:  Evaluations Yielded Limited Results, Underscoring Need for Changes to Federal Policies and Procedures, which can be found here.…

Administration Slows Movement Toward Medicare Quality Payments

The Trump administration is slowing Medicare’s movement toward making greater use of quality in its payment system.

The Obama administration’s goal of having 50 percent of Medicare payments made through a quality or alternative payment model by the end of 2018 now appears to be out of sight.  Instead, the Centers for Medicare & Medicaid Services has partially canceled two bundled payment programs – one for joint replacement and another for cardiac rehabilitation programs – and announced that before introducing new programs it wants to take a closer look at the successes and failures of the alternative payment model programs that have been implemented in recent years.

The Washington Post’s “The Health 202” feature offers an in-depth look at CMS’s current approach to Medicare quality programs and reimbursement system changes.  See it here.…