Archive for Centers for Medicare & Medicaid Services

 

MedPAC Issues Annual Report to Congress

The Medicare Payment Advisory Commission has sent its mandatory annual report to Congress.

Included in the report are sections on:

  • Beneficiary enrollment in Medicare: eligibility notification, enrollment process, and Part B late enrollment penalties.
  • Restructuring Medicare Part D for the era of specialty drugs.
  • Medicare payment strategies to improve price competition and value for Part B drugs.
  • MedPAC’s mandated report to Congress on clinician payments.
  • Issues in Medicare beneficiaries’ access to primary care.
  • Assessment of the Medicare Shared Savings Program’s effect on Medicare spending.
  • Ensuring the accuracy and completeness of Medicare Advantage encounter data.
  • Redesigning the Medicare Advantage quality bonus program.
  • Payment issues in post-acute care.
  • MedPAC’s mandated report to Congress on changes in post-acute and hospice care after implementation of the long-term care hospital dual payment rate structure.
  • Options for slowing the growth of Medicare fee-for-service spending for emergency department services.
  • Promoting integration in dual-eligible special needs plans.

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.

Learn more from …

CMS Seeks Help With Reducing Administrative and Regulatory Burdens

Reducing administrative and regulatory burdens is the subject of a new request for information issued last week by the Centers for Medicare & Medicaid Services.

In the RFI, CMS explains that it is especially interested in “…innovative ideas that broaden perspectives on potential solutions to relieve burden and ways to improve”

  • reporting and documentation requirements
  • coding and documentation requirements for Medicare or Medicaid payment
  • prior authorization procedures
  • policies and requirements for rural providers, clinicians, and beneficiaries
  • policies and requirements for dually enrolled (Medicare and Medicaid) beneficiaries
  • beneficiary enrollment and eligibility determination
  • CMS processes for issuing regulations and policies

Comments are due to CMS by August 12.

For further information, see the CMS news release “CMS Seeks Public Input on Patients over Paperwork Initiative to Further Reduce Administrative, Regulatory Burden to Lower Healthcare Costs” or go here to see the RFI itself.…

PACE Regulation Updated

PACE programs will have new flexibility under a recent update of regulations governing Programs of All-Inclusive Care.

As described by the National Association of Medicaid Directors, the new regulation

  • Allows PACE team members to fulfill multiple roles on the care team;
  • Allows certain non-physician providers to serve in the place of primary care physicians on the care team;
  • Clarifies that PACE programs offering prescription drug benefits are subject to Medicare Part D regulations;
  • Eliminates requirements for PACE organizations to seek waivers for several of the most commonly waived aspects of PACE regulation; and
  • Updates CMS’s enforcement actions to promote accountability in PACE.

PACE, as described in the CMS fact sheet announcing the regulation update,

… provides comprehensive medical and social services to certain frail, elderly individuals who qualify for nursing home care but, at the time of enrollment, can still live safely in the community. The majority of participants served by PACE are dually eligible for both Medicare and Medicaid. More than 45,000 older adults are currently enrolled in more than 100 PACE organizations in 31 states…

Learn more from the CMS fact sheet describing the updated regulation or go here to see the regulation itself.

More Medicaid Matching Funds for Only Partial Medicaid Expansion?

The federal government is considering providing an unusual amount of federal Medicaid matching funding for only partial state Medicaid expansion.

At least that’s what Centers for Medicare & Medicaid Services administrator Seema Verma told a health care conference in Georgia last week.

The state of Georgia has proposes partially expanding its Medicaid population.  Under the Affordable Care Act, states that fully expand their Medicaid programs under the terms established by the 2010 health care law receive nine dollars in federal matching funds for every one dollar they spend on their Medicaid expansion population.  States that only partially expand their Medicaid programs, on the other hand, currently are eligible to receive only their usual federal matching rate:  generally one federal dollar for every state dollar, with states with higher poverty rates receiving as much as slightly more than three dollars for every state dollar they spend.

Last week, however, CMS’s Verma said that when Georgia submits its Medicaid waiver application to CMS seeking only partial expansion of its Medicaid program, the federal agency will consider providing Affordable Care Act-level Medicaid matching funds rather than the traditional federal Medicaid matching rate.

Learn more about the Georgia plan for partial Medicaid expansion and …

CMS Speeds Up Medicaid Review Process

The federal government has greatly increased the speed with which it is reviewing and approving state applications to modify their Medicaid programs.

Most often, such applications involve Medicaid state plan amendments and section 1915 waiver requests.

According to a recent post on the CMS blog (in CMS’s own words),

  • Between calendar years 2016 and 2018, there was a 16 percent decrease in the median approval time for Medicaid SPAs [note:  state plan amendments].
  • Seventy-eight percent of SPAs were approved within the first 90 day review period during calendar year 2018, a 14 percent increase over 2016.
  • Between calendar year 2016 and 2018, median approval times for 1915(b) waivers decreased by 11 percent, 1915(c) renewal approval times decreased by 38 percent, and 1915(c) amendment approval times decreased by 28 percent.
  • The backlog of pending SPA and 1915 waiver actions pending additional information from the states was reduced 80 percent from previous years.

Learn more in the CMS blog entry “CMS Streamlines Medicaid Review Process and Reduces Approval Times so States Can More Effectively Manage Their Programs.”