Centers for Medicare & Medicaid Services Archives - Page 2 of 3

CMS Demonstration to Tie Medical, Service Needs

A new federal demonstration program will attempt to help low-income Medicare and Medicaid recipients gain access to services that ultimately will improve their health.
The Accountable Health Communities project, developed by the Center for Medicare and Medicaid Innovation and launched by the Centers for Medicare & Medicaid Services (CMS), is a $157 million demonstration program that
… aims to identify and address beneficiaries’ health-related social needs in at least the following core areas:

Housing instability and quality,
Food insecurity,
Utility needs,
Interpersonal violence, and
Transportation needs beyond medical transportation.

The federal government intends to provide grants of up to $4.5 million to as many of 44 projects that pursue better ways to identify selected patients’ non-medical needs and connect those patients with available services in their communities. The grant funding will pay for the programs, not the services themselves, and will be evaluated to determine their impact on the health of program participants and the health care services utilization of those participants in light of the program’s central objectives of testing whether addressing the targeted needs will improve participants’ health and reduce their health care utilization.
For further information about the Accountable Health Community project, see this Kaiser Health News report; this CMS news release; this CMS fact sheet; and “Accountable Health Communities — Addressing Social Needs through Medicare and Medicaid,” a New England Journal of Medicine article that describes the program, its goals, and its underlying rationale.

PA Safety Net Admin2016-01-07T06:00:43+00:00January 7th, 2016|Uncategorized|Comments Off

Push From Volume to Value Continues

As the end of 2015 nears, CMS has used its blog to reflect on its continued efforts to move the U.S. health care system from one that pays for the volume of care provided to one that pays for the value of that care.
The blog notes the replacement of the sustainable growth rate (SGR formula) with a new payment system that better supports patient-centered care; the creation of the Home Health Value-Based Purchasing model; and the introduction of Medicare reimbursement for advance care planning.
The blog also describes the many programs launched by the Affordable Care Act-created Center for Medicare and Medicaid Innovation, including the Pioneer ACO Model, the Medicare Shared Savings Program, the Comprehensive Care for Joint Replacement program, the Comprehensive Primary Care Initiative, the Independence at Home demonstration, the Bundled Payment for Care Improvement Initiative, and the State Innovation Models initiative.
Together, CMS hopes these and other programs will help achieve its stated goal of paying for 30 percent of Medicare services through alternative payment models and making 85 percent of payments based on quality or value by the end of 2016.
For a better sense of how CMS sees these efforts pushing toward its policy objectives, see the commentary “Continuing the shift from volume to results in American healthcare” here, on the CMS blog.

PA Safety Net Admin2015-11-30T06:00:46+00:00November 30th, 2015|Affordable Care Act, Health care reform, Medicare|Comments Off

CMS Requires States to Monitor Medicaid Access

A new federal regulation requires states to monitor access to Medicaid-covered services.
According to a new regulation issued by the Centers for Medicare & Medicaid Services (CMS), states must submit to CMS plans for monitoring Medicaid beneficiary access to care in five service areas: primary care, physician specialists, behavioral care; pre- and post-natal care; and home health services.
State monitoring plans must address the extent to which Medicaid is meeting beneficiaries’ needs; the availability of care; changes in service utilization; and comparisons between Medicaid rates and rates paid by other public and private payers.
Interested parties have 60 days to submit comments to CMS about the new regulation.
For a closer look at the regulation, see this CMS fact sheet and the regulation itself here, in the Federal Register.

PA Safety Net Admin2015-11-12T12:09:56+00:00November 12th, 2015|Uncategorized|Comments Off

CMS Proposal Would Mandate Hospital Discharge Planning

Hospitals that participate in Medicare and Medicaid would be required to develop discharge plans for all inpatients and many outpatients under a new regulation proposed by the Centers for Medicare & Medicaid Services (CMS).
According to a CMS news release,

…hospitals, including inpatient rehabilitation facilities and long-term care hospitals, critical access hospitals, and home health agencies would be required to develop a discharge plan based on the goals, preferences, and needs of each applicable patient . Under the proposed rule, hospitals and critical access hospitals would be required to develop a discharge plan within 24 hours of admission or registration and complete a discharge plan before the patient is discharged home or transferred to another facility. This would apply to all inpatients and certain types of outpatients, including patients receiving observation services, patients who are undergoing surgery or other same-day procedures where anesthesia or moderate sedation is used, and emergency department patients who have been identified by a practitioner as needing a discharge plan. In addition, hospitals, critical access hospitals, and home health agencies would have to —

Provide discharge instructions to patients who are discharged home (proposed for hospitals and critical access hospitals only);
Have a medication reconciliation process with the goal of improving patient safety by enhancing medication management (proposed for hospitals and critical access hospitals only);
For patients who are transferred to another facility, send specific medical information to the receiving facility; and
Establish a post-discharge follow-up process (proposed for hospitals and critical access hospitals only).

The proposed regulation stresses the preferences and goals of patients in the development of their discharge plans, including the selection of post-acute-care providers to which they may be discharged or the home health providers that may serve them when they return home.
Significantly, from the perspective of Pennsylvania’s safety-net hospitals, the proposed regulation calls for hospitals to consider the socio-economic status of the patients for whom they are planning – although no requirements are associated with that status.
Interested parties have until January 3 to submit comments to CMS on the proposed regulation.
To learn more about what CMS is proposing and what it hopes to accomplish, see this CMS news release. Find the proposed regulation itself here.

PA Safety Net Admin2015-11-02T06:00:15+00:00November 2nd, 2015|Medicare|Comments Off

CMS Proposes New Medicaid Substance Abuse Initiatives

The Centers for Medicare & Medicaid Services (CMS) has announced a new initiative designed to improve how states identify and serve Medicaid beneficiaries with substances use disorders (SUD).
According to a recent notice sent by CMS to state Medicaid directors, the agency is proposing

… an opportunity to allow states embarking on broad and deep system transformations in the area of SUD to pursue 1115 demonstrations to improve the care and outcomes for individuals with SUD. This new initiative would be available to states that are developing comprehensive strategies to ensure a full continuum of services, focusing greater attention to integration efforts with primary care and mental health treatment, and working to deliver services that are considered promising practices or have fidelity to evidence-based models consistent with industry standards. In addition, we seek to support states that are interested in developing new payment mechanisms and performance quality initiatives…

The aim of this initiative is to enable states that are pursuing significant delivery system transformation efforts in the area of SUD to better identify individuals with an SUD in the Medicaid population, increase access to care for these individuals, increase provider capacity, to deliver effective treatments for SUD, and use quality metrics to evaluate the success of these interventions.

The notice outlines the specific goals of the initiative, the reforms CMS seeks, examples of the kinds of changes it envisions, the results it expects to see, and the process for pursuing section 1115 waivers to launch such initiatives.
For a more detailed look at what CMS is attempting to achieve and how it envisions states working to achieve it, see the letter “New Service Delivery Opportunities for Individuals with a Substance Use Disorder” sent by CMS to the nation’s Medicaid directors.

PA Safety Net Admin2015-07-30T06:00:07+00:00July 30th, 2015|Uncategorized|Comments Off

Feds Propose New Medicaid Managed Care Regs

The Centers for Medicare & Medicaid Services (CMS) has proposed its first major changes in regulations governing Medicaid managed care in more than a decade.
In a 653-page draft regulation published on Monday, CMS proposes imposing a medical-loss ratio on Medicaid managed care plans; establishing new standards for adequate provider networks; partially lifting the ban on payments to institutions for mental diseases; pursuing greater transparency in rate-setting; and new quality initiatives that mirror those of Medicare and the federal marketplace.
In addition, the proposed regulation calls for new marketing guidelines for Medicaid managed care plans, improved access to information for Medicaid beneficiaries, and new program integrity measures. It also proposes better aligning the governance of CHIP with Medicaid, new requirements for managed long-term services and supports, and new tools for fostering delivery system reform at the state level.
With virtually all Medicaid recipients in Pennsylvania now enrolled in managed care plans, this regulation will be significant for the state’s safety-net hospitals.
Interested parties have until July 27 to submit comments to CMS about the proposals.
To learn more about this major regulatory proposal, see this Kaiser Health News article; find the regulation here; and see this CMS fact sheet on the draft regulation.

PA Safety Net Admin2015-05-28T06:00:35+00:00May 28th, 2015|Pennsylvania Medicaid laws and regulations, Pennsylvania Medicaid policy, Pennsylvania safety-net hospitals|Comments Off

Feds Provide More Info on Short Stay Settlement Offer

The Centers for Medicare & Medicaid Services (CMS) has posted more information about its offer to settle hospital appeals of Medicare denials of payments for short hospital stays.
The offer, made last week, seeks to help CMS with an 18-month backlog of hundreds of thousands of appeals from acute-care and critical access hospitals. Hospitals willing to drop their appeals are eligible to receive 68 cents on the dollar for the value of the cases in dispute. The offer is available only for cases in which Medicare’s auditors rejected hospital claims for inpatient reimbursement for short hospital stays and then categorized the cases in question as outpatient care. Hospitals that wish to take advantage of the CMS offer must drop their claims for all such cases; they cannot selectively choose to drop some appeals and continue to pursue others.
Now, CMS has outlined how the process of filing for settlement of the cases will work, including the information hospitals must provide and the format in which they must provide it, the forms they must use, and descriptions of the processes it will employ to address discrepancies and reconcile claims.
CMS also has posted an FAQ, a recording of a teleconference on the subject, and the email address for questions.
Learn more about CMS’s offer and this process and find the materials cited above and additional documents available for download in this announcement on the CMS web site.

PA Safety Net Admin2014-09-12T06:00:11+00:00September 12th, 2014|Uncategorized|Comments Off

GAO Questions State Medicaid Financing

States are now financing more than a quarter of their share of Medicaid expenditures with money from sources other than state general funds, according to a new study by the Government Accountability Office (GAO).
According to the GAO, 26 percent of state share of Medicaid funding comes from taxes on health care providers, transfers from local governments and local government providers, and other sources. Such funding, the GAO noted, shifts additional Medicaid costs to the federal government.
Pennsylvania uses such funding mechanisms, including its gross receipts tax on Medicaid managed care organizations and state-wide and Philadelphia hospital assessments.
Exacerbating this problem, the GAO reports, is that the Centers for Medicare & Medicaid Services (CMS), which oversees Medicaid, does not assure that it receives complete and accurate data on funding sources from the states, leaving CMS without a complete understanding of how states are financing their Medicaid expenditures. In the report, the GAO recommends a stronger CMS effort to gather such data – a recommendation that CMS did not accept.
Learn more about the GAO study “States Increased Reliance on Funds From Health Care Providers and Local Governments Warrants Improved CMS Data Collection” by finding the complete report and a summary here, on the GAO web site.

PA Safety Net Admin2014-07-31T06:00:42+00:00July 31st, 2014|Pennsylvania Medicaid policy|Comments Off

CMS Seeks to Jump-Start Medicaid Innovation

A new federal program seeks to encourage states to work faster to find ways to improve care and improve the health of their Medicaid patients and to reduce health care costs through payment and service delivery reforms.
The Center for Medicare & Medicaid Services’ (CMS) new Medicaid Innovation Accelerator Program is a collaboration between the Center for Medicaid and CHIP Services, the Center for Medicare and Medicaid Innovation, the Medicare-Medicaid Coordination Office, and other federal agencies and centers. According to a CMS fact sheet, the program

…aims to jumpstart innovation in key areas while supporting states in their efforts to improve health, improve health care, and lower costs. In consultation with states and stakeholders, the IAP will develop strategically targeted functions aimed at advancing delivery system and associated payment reforms, aligned with transformation efforts underway in Medicare and the commercial market.

The program will develop resources to support innovation through four key functions: identifying and advancing new models of care delivery and payment; data analytics; improving quality measurement; and state-to-state learning, rapid-cycle improvement, and federal evaluation.
Learn more about the launch of the Medicaid Innovation Accelerator Program from this CMS fact sheet and go here for a more detailed description of the program and a summary of the resources surrounding it.

PA Safety Net Admin2014-07-17T14:49:18+00:00July 17th, 2014|Uncategorized|Comments Off

CMS to Examine How States Set Medicaid Managed Care Rates

The Centers for Medicare & Medicaid Services (CMS) is launching an initiative to explore how states set the rates they pay managed care organizations to serve Medicaid patients.
The initiative consists of two parts: first, CMS is examining the adequacy of the process states employ to set their rates – a process that affects the adequacy of the rates themselves; and second, it is drafting updated Medicaid managed care regulations.
Because Pennsylvania safety-net hospitals serve so many Medicaid patients, this effort could have a future impact on the payments they receive for serving these patients.
Learn more about this new undertaking in this Kaiser Health News report.

PA Safety Net Admin2014-05-29T06:00:25+00:00May 29th, 2014|Pennsylvania Medicaid policy|Comments Off

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