Archive for Centers for Medicare & Medicaid Services


CMS Proposes New Medicaid Managed Care Regulation

Just two years after a major overhaul of Medicaid managed care regulations, the Centers for Medicare & Medicaid Services is again proposing changes in how the federal government regulates the delivery of managed care services to Medicaid beneficiaries.

Under the newly proposed regulation, states would:

  • be free to implement more changes in their managed care programs without seeking federal permission;
  • have slightly more flexibility in how supplemental payments are made to hospitals through managed care plans and implement some such changes without federal approval;
  • be permitted to redefine what constitutes an adequate provider network for managed care plans; and
  • not be required to publicize beneficiary grievance and appeals processes as prominently as they currently do.

Overall, the proposed regulation appears to help managed care insurers a great deal, states a little, and hospitals barely at all.

Stakeholders have until January 14 to submit formal comments about the proposal to CMS.

To learn more about the proposed Medicaid managed care regulation, go here to see CMS’s news release presenting the regulation, go here to see a more detailed CMS fact sheet, and go here to see the proposed regulation itself.…

New Home Health Reg Brings Changes

A new home health care regulation finalized by the Centers for Medicare & Medicaid Services brings major changes in how Medicare will pay for home health services in the future.

In addition to updating Medicare payment rates, the new rule also:

  • introduces a new home health payment system called the Patient-Driven Groupings Model that de-emphasizes the volume of care provided;
  • authorizes Medicare payments for remote patient monitoring;
  • adds a new home infusion therapy benefit; and
  • reduces the amount of quality data home health providers must report.

To learn more about the new regulation, which takes effect on January 1, 2019, go here to see a CMS news release, here to see a CMS fact sheet, or here to see the 682-page regulation itself.…

Physicians Push Back Against Medicare Telemedicine Proposal

A proposal to enable Medicare to make greater use of telemedicine as a means of serving patients is receiving surprising pushback from physicians.

The Centers for Medicare & Medicaid Services has proposed paying doctors $14 for what would amount to a five-minute telephone “check-in” call with patients.

Some physicians note that they already have such telephone conversations patients – and do not charge for those calls.  Others fear the new service will increase their patients’ health care costs because they would incur a co-pay for such conversations.  The chairman of the Medicare Payment Advisory Commission (MedPAC), himself a physician, has written that “Direct-to-consumer telehealth services…appear to expand access, but at a potentially significant cost and without evidence of improved quality.”

Learn more about CMS’s telemedicine proposal, what Medicare hopes to accomplish by expanding access to telehealth services, and why some providers do not share CMS’s enthusiasm for telemedicine in this Kaiser Health News article.


CMS Proposes Easing Regulatory Requirements

In a newly proposed rule, the Centers for Medicare & Medicaid Services proposes easing the regulatory burden on health care providers.

The proposed regulation, which weighs in at 285 pages, covers a broad range of government regulation of health care providers and would, CMS projects, save hospitals more than $1 billion a year while cutting millions of hours of administrative work.

Learn more about what CMS proposes by reading its fact sheet on the proposed regulation or going here to see the proposed regulation itself.


Medicare Joint Replacement Program Produces Savings

The first reporting period for Medicare’s Comprehensive Care for Joint Replacement Model found that participating providers cut costs for episodes of care by more than $900, or 3.3 percent.

Most of the savings, the Centers for Medicare & Medicaid Services reports, were achieved by sending patients to less-expensive post-acute-care settings or by reducing patients’ length of stay in such facilities.

CMS also found that the program’s mandatory participants, located in 67 metropolitan statistical areas, achieved these savings without compromising quality of care as measured by post-discharge emergency room visits, hospital readmissions, and deaths.

Learn more about CJR’s early results in this report in Becker’s Hospital Review or go here to see the report CMS commissioned on the program’s first nine months in operation.…