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Policy Snapshot
August 26, 2016

The Society, along with the American Medical Association (AMA) and 89 other organizations, sent The Centers for Medicare & Medicaid Services (CMS) a letter this week urging them to restore the Refinement Panel to serve as the relative value appeals process that was appropriately in place prior to 2011.

The AMA reviewed the need for an appeals process at this year’s AMA House of Delegates Annual Meeting and determined that having an objective, transparent, and consistently-applied formal appeals...

Policy Snapshot
August 26, 2016

SNF Quality Reporting Program Webcast — September 14

Wednesday, September 14 from 1:30 to 3 pm ET

To register or for more information, visit MLN Connects® Event Registration. Space may be limited, register early.

Learn about the reporting requirements for the new Skilled Nursing Facility (SNF) Quality Reporting Program (QRP), effective October 1, 2016. The Improving Medicare Post-Acute Care Transformation Act of 2014...

Policy Snapshot
August 26, 2016

An MLN Matters Special Edition Article on Next Generation Accountable Care Organization - Implementation is available. Learn about the benefit enhancement waiver initiatives and supplemental claims processing direction.

Policy Snapshot
August 19, 2016

As a result of the passage of Medicare Access and CHIP Reauthorization Act (MACRA), the Centers for Medicare & Medicaid Services (CMS) is now required to establish and use classification code sets: care episode and patient condition groups and codes, and patient relationship categories and codes. CMS recently issued request for feedback to addresses the patient relationship categories...

Policy Snapshot
August 19, 2016

On August 10, the Centers for Medicare & Medicaid Services (CMS) updated the popular Nursing Home Compare Five-Star Quality Ratings to incorporate new measures. These new measures look at successful discharges, emergency visits, and re-hospitalizations. Nursing homes receive four different star ratings on the Nursing Home Compare website (each ranging from 1 to 5 stars): one for each of the components – health inspections, staffing, and quality measures – and one for an overall rating, which is...

Policy Snapshot
August 19, 2016

The public has until September 1 to comment on the revised Medicare Outpatient Observation Notice (MOON) under the Paperwork Reduction Act (PRA). The information collection requirements are not effective until approved under a valid Office of Management and Budget (OMB) control number. We expect PRA approval around the time the implementing regulations, part of the FY 2017 Inpatient Prospective Payment System final rule, are effective. Hospitals and critical access hospitals should begin using the MOON no later than 90 calendar days from the date of final PRA approval by OMB. View the...

Policy Snapshot
August 19, 2016

Open Payments 2015 data was published on June 30; however, you can still review and dispute it. Check your data every year, even if you think nothing was reported about you. If drug or device companies submitted new data from previous years, you can dispute it in the Open Payments system until the end of the year. You can also nominate staff to act on your behalf. If you need help or have any questions, contact the CMS Open Payments Help Desk at ...

Policy Snapshot
August 19, 2016

The Programs of All-Inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that provides comprehensive medical and social services that enable older adults to live in the community instead of a nursing home or other care facility. More than 34,000 older adults are currently enrolled in about 100 PACE organizations in 31 states, and enrollment in PACE has increased by over 60 percent since 2011.

On August 11, the Centers for Medicare & Medicaid Services proposed a rule to update and modernize the PACE program, including:

  • Strengthening protections
  • ...
Policy Snapshot
August 12, 2016

The Department of Health & Human Services (HHS) announced a model that will test the effects of payments that encourage the use of cardiac rehabilitation services. The cardiac rehabilitation incentive payment model would test the impact of providing an incentive payment to hospitals where beneficiaries are hospitalized for a heart attack or bypass surgery, which would be based on beneficiary utilization of cardiac rehabilitation and intensive cardiac rehabilitation services in the 90-day care period following hospital discharge. Increasing the use of cardiac rehabilitation services has...

Policy Snapshot
August 12, 2016

On July 29, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (CMS-1645-F) outlining FY 2017 Medicare payment policies and rates for the Skilled Nursing Facility (SNF) Prospective Payment System (PPS), the SNF Quality Reporting Program (QRP), and the SNF Value-Based Purchasing (VBP) Program. CMS projects that aggregate payments to SNFs will increase in FY 2017 by $920 million, or 2.4 percent, from payments in FY 2016. This estimated increase is attributable to a 2.7 percent market basket increase reduced by 0.3 percentage points, in accordance with the multifactor...