Archive for Centers for Medicare & Medicaid Services

 

Stakeholders Respond to CMS “Patients Over Paperwork” RFI

More than 400 stakeholders responded to the federal government’s request for ideas to reduce the administrative burden associated with serving publicly insured patients.

The request was disseminated via a Centers for Medicare & Medicaid Services request for information that was part of the agency’s “Patients over Paperwork” initiative.  Among the groups that responded were the American Hospital Association, The American Association of Colleges of Nursing, the Critical Access Hospital Coalition, the Coalition of Long-Term Acute-Care Hospitals, the National Rural Association of Rural Health Clinics, the American Academy of Ophthalmology, the American Academy of Family Physicians, the American Hospital Association, and others.

Among the suggestions they offered were reconsideration of quality  metrics, changes in the merit-based incentive payment system (MIPS), the inclusion of social determinants of health in quality metrics, changes in star rating systems, greater efficiency in prior authorization processes, changes in interoperability requirements, and others.

Learn more about who submitted comments in response to this RFI and what they proposed in their comments in the Healthcare Dive article “CMS says it wants to cut paperwork. Providers have ideas.”

CMS Chief Criticizes Health Care Proposals

In an address to the Better Medicare Alliance 2019 Medicare Advantage Summit, Centers for Medicare & Medicaid Services Administrator Seema Verma criticized Medicare for All proposals, said Medicare “public option” proposals are no better, and called the Affordable Care Act a failure,.

Verma also insisted that greater reliance on market forces would improve Medicare and Medicaid, said the 340B prescription drug program is harming the health care system, and called for a reduction of federal regulations that limit how and where people can receive care.  She said reduced regulations have spurred hundreds of new plans to participate in the Medicare Advantage program, have led to reduced health care premiums, and have fostered a greater focus on the quality of care providers deliver rather than on the quantity of services they provide.

Learn more by reading Verma’s prepared remarks.

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CMS Proposes Easing Medicaid Access Protections

States would have to do less to ensure access to Medicaid-covered services for their Medicaid population under a new regulation proposed by the Centers for Medicare & Medicaid Services.

In 2015, CMS required states to track their Medicaid fee-for-service payments and submit them to the federal government as part of a process to ensure that Medicaid payments were sufficient to ensure access to care for eligible individuals.  Now, CMS proposes rescinding this requirement, writing in a news release that

This proposed rule is designed to help streamline federal oversight of access to care requirements that protect Medicaid beneficiaries.  CMS anticipates that the proposed rule would, if finalized, result in overall cost savings for State partners that could be redirected to better serve the needs of their beneficiaries.

The proposed regulation itself explains that

While we believe the process described in the current regulatory text is a valuable tool for states to use to demonstrate the sufficiency of provider payment rates, we believe mandating states to collect the specific information as described excessively constrains state freedom to administer the program in the manner that is best for the state and Medicaid beneficiaries in the state.

CMS also notes that …

CMS Outlines New Medicaid Program Integrity Activities

The federal government will introduce a number of initiatives to combat Medicaid waste, fraud, and abuse in the coming months.

In an article on the Centers for Medicare & Medicaid Services’ blog, CMS administrator Seema Verma outlined her agency’s major Medicaid program integrity efforts of the past year, including:

  • Oversight of state Medicaid claiming and program integrity
  • Disallowing unallowable claims of federal funding
  • Increased audits and oversight
  • Data sharing and partnerships
  • Education, technical assistance, and collaboration
  • Reducing improper payments

Initiatives to be introduced in the coming months include (as described in the blog post):

  • A proposed comprehensive update to Medicaid’s fiscal accountability regulations, to increase states’ accountability for supplemental payments. The update includes additional state reporting, clearer financial definitions, and stronger federal guidance to ensure that states use supplemental payments properly.
  • A proposed regulation to further strengthen the integrity of the Medicaid eligibility determination process, including enhanced requirements around verification, monitoring changes in beneficiary circumstances, and eligibility redetermination.
  • Additional guidance on the Medicaid Managed Care Final Rule from 2016 to further state implementation and compliance with program integrity safeguards, such as reporting overpayments and possible fraud.
  • Release of improvements to the Medicaid and CHIP Scorecard—a dashboard of program measures that

MedPAC Weighs in on Proposed Medicare Payment Changes

The Medicare Payment Advisory Commission has submitted formal comments to the Centers for Medicare & Medicaid Services in response to the latter’s publication of a proposed regulation that would govern how Medicare will pay for acute-care hospital inpatient services and long-term hospital care in the coming 2020 fiscal year.

The 14-page MedPAC report addresses four aspects of the proposed Medicare payment regulation:

  • inpatient- and outpatient drug- and device related payment proposals
  • proposed changes in the hospital area wage index
  • the reporting of hospitals’ uncompensated care on the Medicare cost report’s S-10 worksheet
  • the long-term hospital prospective payment system

MedPAC is an independent congressional agency that advises Congress on issues involving the Medicare program.  While its recommendations are not binding on either Congress or the administration, MedPAC is highly influential in governing circles and its recommendations often find their way into legislation, regulations, and new public policy.

See MedPAC’s letter to CMS here.…