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Medicare Shared Savings Program: Submit Notice of Intent to Apply by June 28

Health Policy
Centers for Medicare and Medicaid (CMS), Payment, Accountable Care Organization (ACO), Practice Management, Practitioners
June 14, 2019

The Centers for Medicare & Medicaid Services (CMS) is accepting Notices of Intent to Apply (NOIAs) via the Accountable Care Organization (ACO) Management System (ACO-MS) for a January 1, 2020, start date. You must submit a NOIA if you intend to apply to the BASIC or ENHANCED track of the Medicare Shared Savings Program, for a Skilled Nursing Facility (SNF) 3-Day Rule Waiver, and/or to establish and operate a Beneficiary Incentive Program:

  • NOIA submissions are due no later than June 28 at noon ET
  • An NOIA submission
    • ...

CMS Seeks Comments on Patients over Paperwork Initiative

Health Policy
Centers for Medicare and Medicaid (CMS), Patient Centered, Practitioners
June 14, 2019

The Centers for Medicare & Medicaid Services (CMS) created the Patients over Paperwork initiative to eliminate outdated, duplicative, and overly burdensome regulations so clinicians and providers can focus on their primary mission: patient care. Savings to providers and clinicians are estimated at $5.7 billion and 40 million burden hours through 2021. Estimated savings come from both final and proposed rules. This includes the elimination of 79 overly burdensome, redundant, or low-value measures for a projected savings of $128 million and anticipated reduction of 3.3 million burden...

Senators Release List of Poorly Performing Nursing Homes After Inquiry

Health Policy
Centers for Medicare and Medicaid (CMS)
June 7, 2019

Recently the Centers for Medicare & Medicaid Services (CMS) responded to an inquiry from Sens. Bob Casey (D-PA) and Pat Toomey (R-PA) regarding underperforming nursing homes. CMS sent them a list of nursing homes with a recorded pattern of poor care and the senators released the information to the public along with a report and additional background information.

Under the Special Focus Facility (SFF) program, overseen by CMS, those facilities are made public; however, SFF...

Society Urges Congress to Further Improve MACRA

Health Policy
Centers for Medicare and Medicaid (CMS), Payment, Medicare Access and CHIP Re-authorization Act (MACRA), Merit-Based Incentive Program Payment System (MIPS), Practice Management, Practitioners
June 7, 2019

In a letter sent this week to congressional leaders, the Society joined the American Medical Association and other national medical societies in urging Congress to make further refinements to improve the Medicare Access and CHIP Reauthorization Act (MACRA). The groups called on Congress to replace the 2020-2025 physician payment update freeze with positive payment adjustments for physicians, extend the Advanced APM bonus payments for an additional six years, and implement several additional technical improvements to MACRA.

MACRA included modest positive payment updates in the...

The Society Submits Comments on HIT Proposed Rule

Health Policy
Electronic Health Records (EHR), Health Information Technology (HIT)
June 7, 2019

This week the Society submitted comments on the Centers for Medicare & Medicaid Services (CMS) proposed rule on the Medicare and Medicaid Programs, Issuers of Qualified Health Plans in the Federally-Facilitated Exchanges and Health Care Providers (proposed rule), and the Office of the National Coordinator for Health Information Technology (ONC) on the Interoperability, Information Blocking, and the ONC Health Information Technology (Health IT) Certification Program.

The Society supported the overall intent and direction of the proposed rule and pushed to ensure that...

CMS Announces New RFI on Patients over Paperwork

Health Policy
Centers for Medicare and Medicaid (CMS), Medicare, Payment, Practitioners
June 7, 2019

The Centers for Medicare & Medicaid Services (CMS) issued a Request for Information (RFI) seeking new ideas from the public on how to continue the progress of the Patients over Paperwork initiative. As of January 2019, CMS estimates that through regulatory reform alone, the health care system will save an estimated 40 million hours and $5.7 billion through 2021. These estimated savings come from both final and proposed rules.

The RFI on Reducing Administrative Burden to Put Patients over Paperwork invites patients and their families, the medical community, and other health care...

The Society Urges Congress to Protect Patients from Surprise Medicare Billing

Health Policy
Centers for Medicare and Medicaid (CMS), Practitioners
May 30, 2019

During a hearing on Protecting Patients from Surprise Medical Bills, the Society—through its membership in the National Observation Stays Coalition—recently urged members of the House Ways and Means Health Subcommittee to take note how surprise billing affects Medicare patients in the hospital who are classified at observation status. “Although the medically necessary care they need and receive is no different from the medically necessary care provided to formally admitted...

Programs of All-Inclusive Care for the Elderly Final Rule

Health Policy
Centers for Medicare and Medicaid (CMS), Practitioners
May 30, 2019

On May 28, the Centers for Medicare & Medicaid Services (CMS) finalized a rule to update and modernize the Programs of All-Inclusive Care for the Elderly (PACE). PACE 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 are dually eligible for both Medicare and Medicaid.

The final rule revises and updates the requirements for the PACE program under Medicare and Medicaid, including:

  • Strengthening
    • ...

CMS Releases Final Rule on Lowering Drug Prices and Out-of-Pocket Spending

Health Policy
Centers for Medicare and Medicaid (CMS), Practitioners
May 30, 2019

Recently the Centers for Medicare & Medicaid Services (CMS) released its final rule on Modernizing Part D and Medicare Advantage to Lower Drug Prices and Reduce Out-of-Pocket Expenses. These changes will ensure that patients have greater transparency into the cost of prescription drugs in Part D and will also enable Medicare Advantage plans to negotiate better prices for physician-administered medicines in Part C.

Part D Protected Classes

Current Part D policy requires sponsors to include on their formularies all drugs in six categories or classes...

In Case You Missed It: CDC Guideline for Prescribing Opioids

Health Policy
Centers for Medicare and Medicaid (CMS), Opioids, Practitioners
May 30, 2019

The Centers for Disease Control and Prevention (CDC) is raising awareness of the risk to patient health and safety due to misapplication of the opioid guideline for chronic pain.  Please read the recent commentary in the New England Journal of Medicine, where authors of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain advise against misapplication of the guideline that can put patients’ health and safety at ...